On April 6, 2022, Gov. DeSantis signed HB 459 into law, which restricts step therapy protocols. Step therapy protocol is a medical management process that requires a plan participant to take a certain prescription drug (other than the drug or other course of treatment recommended by his health care provider) or take prescription drugs in a certain order before the plan provides coverage for the recommended treatment.
Under existing Florida law, an insurer may not require a step-therapy protocol for a prescription drug requested by a participant if the participant has previously been approved to receive the prescription drug through the completion of a step therapy protocol under a separate health plan. The other plan must have provided benefits for the prescription drug within the 90 days preceding the participant’s current request and when the participant provides supporting documentation.
The new law, effective July 1, 2022, requires health insurers to publish on their website and provide to participants upon request, the insurers’ procedures to request an exemption to the protocol or appeal a denial. The procedures must include:
Employer plan sponsors should work with their insurer to understand the availability of the step therapy protocol exemption and communicate to participants accordingly.
HB 459 »
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