SB 716

This bill prohibits an insurer, pharmacy benefit manager, or utilization review

organization from requiring a step therapy protocol for a drug that is prescribed for

metastatic cancer or a cancer-associated condition and the use of the drug is

approved by the federal Food and Drug Administration, consistent with best

practices for the treatment of metastatic cancer or the cancer-associated condition,

and supported by peer-reviewed publications that are based on evidence-based

research. A step therapy protocol, as defined in current law, establishes a specific

sequence in which medically appropriate prescription drugs are covered by a policy

or plan. Current law requires insurers, pharmacy benefit managers, and utilization

review organizations to use clinical review criteria for establishing a step therapy

protocol that are based on clinical practice guidelines that meet certain specific

criteria and to provide access to a process to request an exception to the step therapy

protocol.