Bill Text: MO HB2203 | 2010 | Regular Session | Introduced
Bill Title: Requires the establishment of a web site that includes the step therapy and prior authorization protocols of every health carrier and benefit plan to facilitate the continuance of certain medications
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2010-05-14 - Referred: Health Care Policy (H) [HB2203 Detail]
Download: Missouri-2010-HB2203-Introduced.html
SECOND REGULAR SESSION
95TH GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVES STEVENSON (Sponsor), SCHAD AND FLANIGAN (Co-sponsors).
5088L.01I D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To amend chapter 376, RSMo, by adding thereto one new section relating to a step therapy and prior authorization protocols website.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 376, RSMo, is amended by adding thereto one new section, to be known as section 376.1600, to read as follows:
376.1600. 1. The department of insurance, financial institutions and professional registration shall manage or contract for private management of a website to include the step therapy and prior authorization protocols for every health carrier and health benefit plan providing pharmaceutical benefits, including but not limited to through utilization of a pharmacy benefit manager, in this state.
2. The website shall provide a single source for step therapy and prior authorization protocols which will allow health care providers and patients to obtain disease-specific step therapy and prior authorization requirements for each health carrier, health benefit plan, and pharmacy benefit manager in this state.
3. The step therapy and prior authorization protocols website shall provide information:
(1) To allow for the approval of medications for those patients who have tried and failed on medications that are required as a part of step therapy or prior authorization protocols under a health benefit plan or for those health care providers who believe based on patient history that use of a specific medication will have a negative side effect for the patient;
(2) To ensure that patients who have tried and failed previously on medications will have access to the medication that will not have a negative side effect on them;
(3) To ensure that patients have access to medications that will not have a negative side effect by eliminating any switching of prescribed medications for other medications on the health benefit plan's step therapy or prior authorization protocols in those limited situations where patients have tried and failed on medications required as part of a step therapy or prior authorization protocols;
(4) To ensure that patients will be permitted to remain on medications which do not have negative side effects while the patient's health care provider establishes that the patient has tried and failed on other medications in the health benefit plan's step therapy or prior authorization protocols; and
(5) To facilitate the inclusion of relevant patient history, including physical conditions or diseases, by the health care provider when assessing possible negative side effects for the patient.
4. (1) Each health carrier and health benefit plan in this state shall provide the department with the information required under this section for inclusion on the step therapy and prior authorization website.
(2) In addition, each health carrier and health benefit plan shall include simple standardized forms that health care providers can use to verify that a patient has tried and failed on a medication that the health carrier or health benefit plan requires under step therapy and prior authorization protocols, or that based on the health care provider's clinical determination, the patient is likely to have a negative side effect with a medication.
(3) Upon completion of the form in subdivision (2) of this subsection, the patient shall have immediate access to the medication that does not result in a negative side effect for the patient without any further requirements under the health benefit plan.
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