On May 11, 2021, Commissioner Mulready issued Bulletin No. LH 2021-01 addressing complaints that insurers are violating a state statute that requires timely responses for requests for exceptions to determinations made in accordance with step therapy protocols mandated by the law.
Under the law, any health insurance plan that utilizes a step therapy protocol must establish guidelines governing the use of the step therapy protocol using clinical practice guidelines. When a health insurance plan restricts prescription drug coverage pursuant to a step therapy protocol, the insurance provider must provide a process for a step therapy exception. A request for an exception must be addressed by the plan within 72 hours. According to the bulletin, some insurers are failing to address these requests.
The commissioner reminds insurers of their responsibilities under the law, as well as their responsibility to grant exceptions when requests are made with supporting documentation sufficient to meet the requirements under the law.
Employers with plans regulated by the state should be aware of this reminder.
Bulletin No. LH 2021-01 »
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