On July 14, 2023, Commissioner Mulready issued Bulletin No. 4-2023, advising issuers of new requirements imposed by new statutes that are effective on November 1, 2023, (HB 1736 and HB 2748) and on January 1, 2024, (SB 513). These requirements apply to all health plans regulated by the state.
HB 1736 requires health benefit plans that require step therapy protocol for treatment of CRF-COPD to provide a clear and transparent process (readily available on the insurer’s website) by which insureds can request an exception to step therapy protocols. HB 2748 prohibits step therapy requirements for certain prescription drugs that treat advanced metastatic cancer and associated conditions.
SB 513 requires all health benefit plans to provide coverage for biomarker testing for certain purposes when the biomarker test provides clinical utility as demonstrated by medical and scientific evidence.
Employers with plans regulated by the state should be aware of these requirements.
HB 1736 » HB 2748 » SB 513 » Bulletin No. 4-2023 »
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