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

Step therapy (sometimes called "fail first") is a practice used by insurance companies that requires patients to try less expensive or more common drugs before the insurer will cover a different medication. For example, if a doctor prescribes a specific drug for a condition, the insurance company might require the patient to first try one or two cheaper alternatives — and show they don't work — before agreeing to pay for the originally prescribed medication. This bill places limits on when and how Rhode Island insurers can use this practice.

The key change this bill would make is allowing a patient's doctor or other medical provider to formally request an exception to the step therapy requirement. This means that if a provider believes a patient has a good medical reason to skip the required sequence and go directly to a specific drug — such as a history of bad reactions to the required drugs, or a condition that makes the standard approach inappropriate — they would have a formal process to request that exception from the insurer.

This bill would directly affect Rhode Island patients who have insurance coverage and need prescription medications, as well as doctors and healthcare providers who prescribe those medications. Patients who might benefit most are those with complex or serious health conditions where following the insurer's required drug sequence could delay effective treatment or cause harm. Insurers operating in Rhode Island would also be affected, as they would need to establish and honor a process for reviewing these exception requests.

The bill has been introduced and referred to the Senate Health and Human Services Committee, meaning it is still in the early stages of the legislative process and has not yet become law.