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Prohibit Carrier From Requiring Alternative Drug

Concerning the prohibition against a carrier requiring a covered person to undergo step therapy, and, in connection therewith, requiring coverage for a prescribed medication that is part of the carrier's medication formulary.
2017 Regular Session
Health Care & Health Insurance
Bill Summary

The bill prohibits a carrier from requiring a covered person to undergo step therapy:

  • When being treated for a terminal condition; or
  • If the covered person has tried a step-therapy-required drug under a health benefit plan and the drug was discontinued by the manufacturer.

A carrier that requires step therapy must have an override process for health care providers.

'Step therapy' is defined as a protocol that requires a covered person to use a prescription drug or sequence of prescription drugs, other than the drug that the covered person's health care provider recommends for the covered person's treatment, before the carrier provides coverage for the recommended drug.

(Note: This summary applies to this bill as introduced.)


Became Law


Bill Text

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The effective date for bills enacted without a safety clause is August 7, 2024, if the General Assembly adjourns sine die on May 8, 2024, unless otherwise specified. Details