85(R) - 2017
Relating to step therapy protocols required by a health benefit
plan in connection with prescription drug coverage.
From the LBB: no significant fiscal implication to the state is anticipated.
HB 1464 would amend the Insurance Code to add that a health benefit plan issuer that requires a step therapy protocol before providing coverage for a prescription drug must establish and implement the step therapy protocol in accordance with clinical review criteria. A patient or a prescription provider would be able submit a request for exemption from the protocol to the patient’s health plan provider. If the request is denied and appealed, an independent review from a utilization review agent would take place.
Vote Recommendation Notes
While this bill does increase regulation on health benefit plan issuers that require a step therapy protocol before issuing a prescription drug, it allows a patient or a prescription provider to get exceptions from step therapy protocols that could be harmful to patients. We remain neutral on HB 1464.
American Cancer Society Cancer Action Network
Coalition of Texans with Disabilities
National Alliance on Mental Illness (NAMI) Texas
National Association of Social Workers
Texans Care for Children
Texas Academy of Family Physicians
Texas Federation of Drug Stores
Texas Pharmacy Association