This bill establishes guidelines for health insurance carriers regarding the implementation and review of step therapy protocols, which require patients to try specific prescription drugs before coverage is granted for a drug recommended by their healthcare provider. The legislation emphasizes the importance of basing these protocols on clinical practice guidelines developed by independent experts, ensuring that patients are exempt from protocols deemed inappropriate for their individual needs. It mandates that carriers provide a clear and accessible process for patients and healthcare providers to request exceptions to step therapy protocols, with specific criteria outlined for when such exceptions should be granted.

Additionally, the bill requires carriers to respond to exception requests within specified timeframes, including a 72-hour response for standard requests and a 24-hour response for urgent cases. If a carrier fails to respond within these time limits, the exception is automatically granted. The bill also includes provisions for annual reporting to the Commissioner of Banking and Insurance on the number and reasons for step therapy exception requests, approvals, and denials, thereby promoting transparency and accountability in the use of step therapy protocols.