Prior Authorization For Step-therapy Exception

The act requires the department of health care policy and financing (state department) review and determine if an exception to step therapy is granted if the prescribing provider submits a prior authorization request with justification and supporting clinical documentation for treatment of a serious or complex medical condition. The act requires the state department to provide a response to a prior authorization request for a step-therapy exception within 24 hours after receipt of the request.

If a prior authorization request for a step-therapy exception is incomplete or if additional clinically relevant information is required, the act requires the state department to notify the prescribing provider within 24 hours after the submission of the request. If the state department does not receive a response within 72 hours after the state department's request for additional information, the prior authorization is denied. If the prior authorization request is denied, the act requires the state department to inform the recipient in writing that the recipient has a right to appeal the determination.

The act requires the state department to authorize coverage for the prescription drug prescribed by the recipient's prescribing provider if the prior authorization request for a step-therapy exception request is granted.

The act requires the state department to make the prior authorization requirements for coverage of prescription drugs and a description of the step-therapy exemption process available on the state department's website.

The act appropriates $56,250 to the state department from the general fund.

APPROVED by Governor May 1, 2023

EFFECTIVE May 1, 2023
(Note: This summary applies to this bill as enacted.)