M.H. Dutch Salmon Greater Gila Wild and Scenic River Act
IntroducedApril 10, 2025
Introduced11 months ago
Intro
House
Senate
Pres
Introduced in Senate
Health
Why This Matters
This bill requires employer-sponsored health plans and insurers to offer a clear, prompt process for patients or their doctors to request an exception to step therapy rules for prescription drugs.
Who this affects
Group health plans · Health insurers · Prescribing providers · Patients
What changes is this bill making?
1Plans must set up a transparent process for a patient or their prescriber to request an exception to a medication step therapy protocol.
2The bill lists six conditions that trigger an exception, including past treatment failure, risk of serious harm, contraindications, and patient stability.
3Plans must use a standard form with clear instructions, allow paper or electronic submissions, and limit requests for information to what is strictly necessary.
4Routine exception requests must be decided within 72 hours, and expedited requests in cases of serious risk must be decided within 24 hours.
5Approved exceptions must remain in effect for at least one year.
6Plans and insurers must report annually to the Labor Secretary on exception requests, approvals, denials, appeals, and related data.
7Contracts with third-party administrators or pharmacy benefit managers cannot block plans from getting data needed for these reports.
8The requirements apply to plan years beginning at least six months after enactment, and final regulations are due within six months.
