Last Action | 03/17/22: signed by Governor (Acts Ch. 19) |
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Title | AN ACT relating to step therapy protocols. |
Bill Documents |
Acts Chapter 19
Current/Final Introduced |
Bill Request Number | 1471 |
Sponsors | M. Wise, D. Carroll |
Summary of Original Version | Amend KRS 304.17A-163 to define terms; establish requirements for clinical review criteria and clinical practice guidelines used to establish step therapy protocols; require certain notices and disclosures relating to step therapy protocols; establish requirements for exception requests, internal appeals, and external reviews of step therapy protocols; create a new section of Subtitle 17A of KRS Chapter 304 to require the commissioner of insurance to promulgate administrative regulations; require insurers, health plans, pharmacy benefit managers, or private review agents to submit an annual report relating to step therapy exception requests; amend KRS 304.17A-168, 304.17A-535, 304.17A-600, 304.17A-607, 304.17A-617, and 304.17A-623 to conform; amend KRS 205.522, 205.6485, 164.2871, and 18A.225 to require Medicaid, the Kentucky Children's Health Insurance Program, self-insured employer group health plans provided by the governing board of a state postsecondary education institution, and the state employee health plan to comply with the step therapy protocol requirements; apply to health plans delivered, issued for delivery, or renewed on or after the effective date of Sections 1 to 12 of the Act; require the Cabinet for Health and Family Services to seek a federal waiver of authorization if necessary; EFFECTIVE, in part, January 1, 2023. |
Index Headings of Original Version |
Drugs and Medicines - Coverage, step therapy protocols, requirements Education, Higher - Self-insured employer group health plan, step therapy protocol, requirements Effective Dates, Delayed - Coverage for prescription drugs, step therapy protocols, requirements, January 1, 2023 Insurance, Health - Coverage for prescription drugs, step therapy protocol, requirements State Agencies - Cabinet for Health and Family Services, step therapy protocols, waiver application State Agencies - Department of Insurance, prescription drug coverage, step therapy protocol, requirements State Employees - Health plan, prescription drug coverage, step therapy protocols, requirements Medicaid - Prescription drugs, step therapy protocols, requirements Administrative Regulations and Proceedings - Commissioner of Insurance, step therapy protocols, enforcement Children and Minors - Kentucky Children's Health Insurance Program, prescription drugs, step therapy protocol Reports Mandated - Health plan, prescription drugs, step therapy exceptions Reports Mandated - Insurer, prescription drugs, step therapy exceptions Reports Mandated - Pharmacy benefit manager, prescription drugs, step therapy exceptions Reports Mandated - Private review agent, prescription drugs, step therapy exceptions |
Jump to Proposed Amendments | Senate Committee Substitute 1 |
Votes | Vote History |
02/03/22 |
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02/07/22 |
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02/15/22 |
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02/16/22 |
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02/17/22 |
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02/24/22 |
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03/02/22 |
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03/03/22 |
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03/09/22 |
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03/10/22 |
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03/11/22 |
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03/17/22 |
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Amendment | Senate Committee Substitute 1 |
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Summary | Retain original provisions except reword provision requiring clinical review criteria to be based on clinical practice guidelines; replace provision requiring a step therapy exception request to be granted based on the best interest of the insured; effective January 1, 2023. |
Index Headings |
Drugs and Medicines - Coverage, step therapy protocol, requirements Education, Higher - Self-insured employer group health plan, step therapy protocol, requirements Effective Dates, Delayed - Coverage for prescription drugs, step therapy protocols, requirements, January 1, 2023 Insurance, Health - Coverage for prescription drugs, step therapy protocols, requirements State Agencies - Cabinet for Health and Family Services, step therapy protocols, waiver application State Agencies - Department of Insurance, prescription drug coverage, step therapy protocol, requirements State Employees - Health plan, prescription drug coverage, step therapy protocol, requirements Medicaid - Prescription drugs, step therapy protocols, requirements Administrative Regulations and Proceedings - Commissioner, Department of Insurance, step therapy protocols, enforcement Children and Minors - Kentucky Children's Health Insurance Program, prescription drugs, step therapy protocols Reports Mandated - Health plan/insurer, prescription drugs, step therapy exceptions Reports Mandated - Pharmacy benefit manager, step therapy exceptions Reports Mandated - Private review agent, prescription drugs, step therapy exceptions |
Last updated: 2/8/2023 2:57 PM (EST)