Easier Access to Medications: New Rules for Bypassing Step Therapy Protocols.
This law mandates that health insurers establish a fast and transparent appeals process for 'step therapy protocols' (which require trying cheaper drugs first). This allows patients and their doctors to quickly gain access to the most appropriate medication, especially when treatment delay is dangerous or standard drugs are ineffective. The change aims to improve the safety and effectiveness of pharmacological treatment.
Key points
Insurers must implement a clear process allowing patients or doctors to request an exception to the 'step therapy' rule.
An exception must be granted if standard drugs are ineffective, contraindicated, cause serious harm, or the patient is already stable on the prescribed medication.
Insurers must issue a standard decision within 72 hours, and within 24 hours in urgent cases where delay seriously jeopardizes the patient's life or health.
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