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 these protocols should be based on clinical practice guidelines developed by independent experts and should consider the individual needs of patients. It mandates that patients be exempt from step therapy protocols when they are deemed inappropriate or not in the patient's best interest, and it ensures that patients have access to a transparent process for requesting exceptions to these protocols.

Additionally, the bill outlines the criteria under which a step therapy exception can be granted, including situations where the required drug is contraindicated, ineffective, or not in the patient's best interest. It requires carriers to provide a clear and accessible process for requesting exceptions and to respond to these requests within specified timeframes. Furthermore, the bill mandates annual reporting to the Commissioner of Banking and Insurance on the nature and outcomes of step therapy exception requests, ensuring accountability and oversight in the application of these protocols.