Bill Text: MS HB1032 | 2011 | Regular Session | Engrossed
Bill Title: Prescription drugs; health coverage plans must allow physician to override plan restrictions on under certain circumstances.
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Failed) 2011-03-28 - Died In Conference [HB1032 Detail]
Download: Mississippi-2011-HB1032-Engrossed.html
MISSISSIPPI LEGISLATURE
2011 Regular Session
To: Public Health and Human Services
By: Representatives Holland, Bondurant, Howell
House Bill 1032
(As Passed the House)
AN ACT TO PROVIDE THAT HEALTH COVERAGE PLANS THAT ARE ISSUED OR RENEWED ON OR AFTER JANUARY 1, 2012, SHALL PROVIDE COVERAGE FOR STEP THERAPY OR FAIL FIRST PROTOCOLS UNDER THE CIRCUMSTANCES SPECIFIED IN THIS ACT; TO PROVIDE THAT WHEN MEDICATIONS FOR THE TREATMENT OF ANY MEDICAL CONDITION ARE RESTRICTED FOR USE BY AN INSURER BY A STEP THERAPY OR FAIL FIRST PROTOCOL, THE PRESCRIBING PHYSICIAN MAY REQUEST AN OVERRIDE OF THAT RESTRICTION FROM THE INSURER, AND THE INSURER SHALL EXPEDITIOUSLY GRANT AN OVERRIDE OF THAT RESTRICTION IF THE PHYSICIAN CAN DEMONSTRATE BY CLINICAL EVIDENCE OR MEDICAL AND SCIENTIFIC EVIDENCE THAT THE PROTOCOL IS OR IS LIKELY TO BE INEFFECTIVE FOR TREATMENT; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. (1) Any health coverage plan that is issued for delivery, delivered, renewed, or otherwise contracted for in this state on or after January 1, 2012, shall provide coverage for step therapy or fail first protocols as provided in this section.
(2) When medications for the treatment of any medical condition are restricted for use by an insurer by a step therapy or fail first protocol, the prescribing physician shall have access to a clear and convenient process to expeditiously request an override of that restriction from the insurer. An override of that restriction shall be expeditiously granted by the insurer under the following circumstances:
(a) The prescribing physician can demonstrate, based on sound clinical evidence, that the preferred treatment required under step therapy or fail first protocol has been ineffective in the treatment of the insured's disease or medical condition; or
(b) Based on sound clinical evidence or medical and scientific evidence:
(i) The prescribing physician can demonstrate that the preferred treatment required under the step therapy or fail first protocol is expected or likely to be ineffective based on the known relevant physical or mental characteristics of the insured and known characteristics of the drug regimen; or
(ii) The prescribing physician can demonstrate that the preferred treatment required under the step therapy or fail first protocol will cause or will likely cause an adverse reaction or other physical harm to the insured.
(3) The duration of any step therapy or fail first protocol shall not be longer than a period of thirty (30) days when the treatment is deemed clinically ineffective by the prescribing physician. When the prescribing physician can demonstrate, through sound clinical evidence, that the originally prescribed medication is likely to require more than two (2) weeks to provide any relief or an amelioration to the insured, the step therapy or fail first protocol may be extended for up to seven (7) additional days.
(4) As used in this section, "health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract or agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan.
SECTION 2. This act shall take effect and be in force from and after July 1, 2011.
