Easier Access to Medications: Ending Step Therapy Barriers
New regulations require health plans and insurers to establish a clear and prompt process for appealing 'step therapy' protocols. This means if your doctor believes you need a specific medication, but your insurer requires you to try other, potentially less effective options first, you will have the right to request an exception, potentially speeding up access to appropriate treatment.
Key points
Insurers must provide a quick appeal process for step therapy requirements, allowing access to prescribed medications if deemed necessary by a doctor.
Exceptions can be granted if prior treatments were ineffective, delaying treatment would cause severe harm, the drug is contraindicated, or it impairs daily functioning.
Decisions on exceptions must be made within 72 hours, or within 24 hours in urgent cases threatening life or health.
Once granted, an exception ensures coverage for the requested drug for at least one year, providing treatment stability.
Introduced
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