BULLETIN NO. 4-2023
|All Health Insurance Companies, HMOS, and Other Interested Parties
|New Legislative Requirements for Step Therapy Protocol and Biomarker Testing (HB 1736, HB 2748, and SB 513)
|Glen Mulready, Insurance Commissioner
|July 14, 2023
House Bills 1736 and 2748
Effective November 1, 2023, House Bills 1736 and HB 2748 mandate all health benefit plans to implement new requirements related to step therapy protocols. Although located in Title 63, these new requirements apply to health benefit plans as regulated by the Insurance Commissioner under Title 36.
House Bill 1736 adds a new section of law that applies to all health benefit plans that provide coverage for invasive or noninvasive mechanical ventilation to treat chronic respiratory failure consequent to chronic obstructive pulmonary disease (CRF-COPD). Health benefit plans requiring step therapy protocol for treatment of CRF-COPD must provide a clear and transparent process by which insureds can request an exception to step therapy protocols. The process must be readily available on the insurance issuer’s website. The new law also sets forth circumstances requiring an exception to step therapy protocols. Please review House Bill 1736 for additional details.
House Bill 2748 adds a new section of law that applies to all health benefit plans providing coverage for advanced metastatic cancer and associated conditions. It prohibits step therapy requirements for certain prescription drugs to treat advanced metastatic cancer and associated conditions. Please review House Bill 2748 for additional details.
Senate Bill 513
Effective January 1, 2024, Senate Bill 513 adds a new section of law in Title 36 requiring all health benefit plans to provide coverage for biomarker testing for certain purposes when the biomarker test provides clinical utility as demonstrated by medical and scientific evidence. Senate Bill 513 also amends Title 56 with respect to the State Medicaid Program (SoonerCare). Please review Senate Bill 513 for additional details.