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 that clinical review criteria for these protocols must be based on established clinical practice guidelines developed by a multidisciplinary panel of experts, ensuring that they are free from conflicts of interest and are continually updated based on new evidence. The bill also mandates that patients be exempt from step therapy protocols when they are deemed inappropriate and provides a clear process for requesting exceptions to these protocols.

Additionally, the bill outlines the conditions under which a step therapy exception must be granted, such as when a required drug is contraindicated or ineffective for the patient. It requires carriers to respond to exception requests within specified timeframes and allows for appeals if an exception is denied. Furthermore, health insurance carriers are required to report data on step therapy exceptions to the Commissioner of Banking and Insurance, ensuring transparency and accountability in the process. Overall, the bill aims to protect patient rights and ensure that treatment decisions are made in the best interest of patients.