1 STATE OF OKLAHOMA
2 1st Session of the 59th Legislature (2023)
3 HOUSE BILL 1736 By: Townley
4
5
6 AS INTRODUCED
7 An Act relating to step therapy protocol; providing
for exceptions to step therapy protocol; providing
8 for codification; and providing for an effective
date.
9
10
11
12 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
13 SECTION 1. NEW LAW A new section of law to be codified
14 in the Oklahoma Statutes as Section 7330 of Title 63, unless there
15 is created a duplication in numbering, reads as follows:
16 No health benefit plan, health maintenance organization,
17 preferred provider organization, or other provider network
18 authorized to administer health care coverage in this state shall
19 require treatment following step therapy protocol when any of the
20 following exceptions are present:
21 1. Any treatments otherwise required under the protocol have
22 not been shown to be as effective as other available options in the
23 treatment of the disease or condition of the participant or
24
Req. No. 5330 Page 1
1 beneficiary, when prescribed consistent with clinical directions,
2 clinical guidelines, or other peer-reviewed evidence;
3 2. Delay of proven effective treatment would lead to severe or
4 irreversible consequences, and the treatment initially required
5 under the protocol is reasonably expected to be less effective
6 based upon the documented physical or mental characteristics of the
7 participant or beneficiary and the known characteristics of such
8 treatment;
9 3. Any treatments otherwise required under the protocol are
10 contraindicated for the participant or beneficiary or have caused,
11 or are likely to cause, based on clinical, peer-reviewed evidence,
12 an adverse reaction or other physical harm to the participant or
13 beneficiary;
14 4. Any treatment otherwise required under the protocol has
15 prevented, will prevent, or is likely to prevent a participant or
16 beneficiary from achieving or maintaining reasonable and safe
17 functional ability in performing occupational responsibilities or
18 activities of daily living as defined in 42 CFR, Section 441.505, or
19 successor regulations;
20 5. The participant or beneficiary is stable for his or her
21 disease or condition on the prescription drug or drugs selected by
22 the prescribing health care provider and has previously received
23 approval for coverage of the relevant drug or drugs for the disease
24 or condition; or
Req. No. 5330 Page 2
1 6. The patient and devices require frequent and substantial
2 services.
3 SECTION 2. This act shall become effective November 1, 2023.
4
5 59-1-5330 TJ 01/14/23
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Req. No. 5330 Page 3