Accident and sickness insurance; step therapy protocols, disclosure of information. (HB362)

Introduced By

Del. Glenn Davis (R-Virginia Beach)

Description

Step therapy protocols; disclosures. Requires health insurers that limit coverage for prescription drugs through the use of a step therapy protocol to have in place a process for a prescribing provider to request an override of the protocol for a patient. A step therapy protocol is a protocol or program that establishes the specific sequence in which prescription drugs for a specified medical condition are medically appropriate for a particular patient and are covered by a health benefit plan or that conditions coverage of a prescription medication on a patient first trying an alternative medication without success. The measure requires the granting of a step therapy protocol override in certain circumstances. Finally, the measure requires an insurer that offers a health benefit plan that uses a step therapy protocol to provide (i) written notice of a determination that the protocol requires denial of coverage of a provider's selected prescription drug, (ii) an explanation of the basis for such determination, and (iii) notice of the procedures for submitting a request for an override of the restrictions of the step therapy protocol. Read the Bill »

Status

01/19/2016: Awaiting a Vote in the Commerce and Labor Committee

History