Kentucky House Bill 220 | Enhancing Access to Medications
Kentucky HB220 was introduced in the 2024 Regular session and formally passed last week (March 14, 2024). The legislation aims to regulate how insurers, health plans, pharmacy benefit managers, and private review agents establish step therapy protocols for prescription drugs. The bill emphasizes the importance of using clinical practice guidelines endorsed by multidisciplinary experts, minimizing biases and conflicts of interest, considering patient preferences, providing clear processes for step therapy exceptions, and ensuring timely responses to requests and appeals. It also encourages access to biosimilar medicines to reduce prescription drug costs.
The Impact on Insurers
This legislation mandates that clinical review criteria for step therapy protocols must align with expert-developed clinical practice guidelines, ensuring treatment decisions are evidence-based and free from conflicts of interest. Additionally, insurers are required to enhance transparency and accessibility by making these step therapy protocols easily accessible on their websites and disclosing all related rules and criteria to prescribing providers upon request. This is to promote a more transparent and informed decision-making process for healthcare providers and patients.
The Impact on Kentucky Patients & Prescribers
For Kentucky prescribers and patients, HB 220 will establish a clear and convenient process for requesting step therapy exceptions, with requests required to be granted within forty-eight hours under certain conditions. Patients will then have the right to appeal exception request denials internally and request external reviews, ensuring decisions the insurer’s decisions can be and can be reconsidered based on additional information or evidence.
It's also important to note that the bill will improve access to cost-saving biosimilar medicines by eliminating barriers to their use, aligning with efforts to reduce prescription drug costs.
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