Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.

Plain-English Summary

What is step therapy? Many health insurance plans use a practice called "step therapy" — sometimes called "fail first" — which requires patients to try less expensive or more common drugs before the insurer will cover a different medication. For example, a doctor might prescribe a specific medication for a condition, but the insurance company requires the patient to first try one or two other drugs and show those don't work before they'll cover the one the doctor originally recommended.

What this bill would do: This Rhode Island bill would place limits on how insurers can use step therapy requirements. Most importantly, it would allow doctors and other medical providers to formally request an exception to the step therapy process on behalf of their patients. This means if a doctor believes a patient should not have to go through the standard drug sequence — perhaps because a required first-step drug is unsafe for that patient, or because the patient has already tried it — the provider could request that the insurer skip or bypass that requirement.

Who does this affect? This bill would affect Rhode Island residents who have health insurance that uses step therapy protocols, along with their doctors and other healthcare providers. It would also affect health insurance companies operating in Rhode Island, who would need to have a process in place to review and respond to these exception requests.

Where does the bill stand? The bill has been introduced in the Rhode Island House and referred to the House Health & Human Services Committee. The committee has recommended holding it for further study, meaning it has not yet moved forward toward a vote.