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 step therapy 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 these protocols when they are deemed inappropriate and ensures that there is a transparent process for requesting exceptions to the protocols.

Additionally, the bill outlines the criteria under which a step therapy exception can be granted, such as when a required drug is contraindicated or ineffective for the patient. It requires carriers to provide a clear and accessible process for patients and healthcare providers to request these exceptions, with specific timelines for responses. The bill also mandates annual reporting to the Commissioner of Banking and Insurance on the nature of step therapy exception requests, including the number of requests received, approved, and denied. Overall, the legislation aims to protect patient rights and ensure that treatment decisions are made in the best interest of patients.