Easier Access to Medications: Removing Barriers in Treatment
New rules make it easier for patients to get the medications they need, even if their health plan previously required trying other, cheaper options. The act introduces clear guidelines on when an insurer must approve a medication change, which will speed up treatment and improve the quality of life for many.
Key points
Health insurers must create a simple appeal process if a patient or doctor wants to change medication under a 'step therapy' protocol.
Appeals must be processed quickly: within 72 hours for regular cases and within 24 hours for urgent situations where life or health is at risk.
Patients can get approval for a different medication if previous treatment was ineffective, poses serious consequences, causes side effects, hinders daily functioning, or if the patient was already stable on that medication.
Information about the appeal process must be easily accessible on insurers' websites.
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