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Senate Bill 680 |
Senate Author: Hancock et al. |
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Effective: 9-1-17 |
House Sponsor: Bonnen, Greg et al. |
Senate Bill 680 amends the Insurance Code to require a health benefit plan issuer that requires a step therapy protocol before providing coverage for a prescription drug to establish, implement, and administer the step therapy protocol in accordance with clinical review criteria readily available to the health care industry. The bill sets out requirements regarding the establishment of the clinical review criteria. The bill authorizes a prescribing provider on behalf of a patient to submit to the patient's health benefit plan issuer a written request for an exception to a step therapy protocol required by the patient's health benefit plan, requires a health benefit plan issuer to establish a process through which an exception request may be submitted, and requires a health benefit plan issuer to grant an exception request under certain circumstances. The bill provides for an expedited appeal of the denial of an exception request and requires the standards for independent review organizations to require each such organization to make its determination for a review of an exception request within a certain timeframe.