California - AB374

Establishes Step Therapy Override Process

Introduced

February 17, 2015

Description

AB 374 allows a prescribing provider, based on his/her professional judgment, to request a step therapy override determination from a health plan or insurer, on behalf of a patient.

A step therapy override determination request shall be expeditiously granted by the health plan/insurer, if the prescription drug required by the plan:

  1. Is contraindicated or will likely cause an adverse reaction to the patient.
  2. Is expected to be ineffective based on the known relevant physical or mental characteristics of the patient and the known characteristics of the prescription drug.
  3. Is not in the best interest of the patient, based on medical appropriateness.
  4. Will interrupt the patient’s stability on a prescription drug selected by their health care provider.
  5. Has not been approved by the federal Food and Drug Administration for the patient’s condition.

“Step therapy override determination” means a determination as to whether a step therapy protocol should apply in a particular patient’s situation, or whether the step therapy protocol should be overridden in favor of immediate coverage of the selected prescription drug.

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Our Position

Support

Commentary

The California Rheumatology Alliance is a proud cosponsor of this patient-focused legislation. Visit the CRA Step Therapy issue page for more information.

Original Sponsor 1

Co-Sponsors 0

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