On January 16, 2024, the Division of Insurance issued Bulletin 2024-03 regarding the state’s new step therapy protocol requirements of Chapter 254 of the Acts of 2022.
Massachusetts law defines a “step therapy protocol” as “a utilization management policy or program that establishes the specific sequence in which a prescription drug for a specified medical condition is covered by a carrier.” Chapter 254 applies to carriers that provide coverage of a prescription drug pursuant to a policy that meets the definition of a step therapy protocol, regardless of whether the policy is described as a step therapy protocol.
The bulletin details the process for covered individuals to request an exception to a carrier’s step therapy protocol, including updates to the standard forms for prior authorization requests. The bulletin also includes instructions for carriers regarding the exceptions process and the maintenance of continuity of coverage for covered individuals during that process.
Although the bulletin is primarily directed at carriers, employers that sponsor insured plans may want to be aware of this guidance.
Bulletin 2024-03 »
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