SB 765

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.