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  • Summary date: Mar 26 2019 - View Summary

    Includes whereas clauses.

    Enacts new GS 58-3-295, which allows a health benefit plan that covers abuse-deterrent opioid analgesic drug products (defined as a analgesic drug product approved by the USFDA with an abuse-deterrence labeling claim that indicates that the drug product is expected to deter abuse) to impose a prior authorization requirement for the product only if the plan imposes the same requirement for each opioid analgesic drug product without an abuse-deterrence labeling claim. Prohibits a health benefit plan covering the abuse-deterrent opioid analgesic drug product from requiring the use of an opioid analgesic drug product without an abuse-deterrence labeling claim before authorizing the use of an abuse-deterrent opioid analgesic drug product. 

    Enacts new Part 8, Administration of Step Therapy Protocols, in Article 50 of GS Chapter 58. Requires clinical review criteria used to establish step therapy protocols to be based on clinical practice guidelines that meet the five specified requirements. Defines step therapy protocol as a protocol or program that establishes the specific sequence in which prescription drugs for a specified medical condition are medically appropriate for a particular patient and are covered by an insurer or health plan. Requires that the patient and prescribing practitioner have access to a clear and convenient process for requesting a step therapy override determination when coverage for a prescription drug is restricted for use by a health benefit plan or utilization review organization through the use of a step therapy protocol. Sets out conditions under which a step therapy override determination request must be expeditiously granted. Requires that when an override determination is granted, the health plan or utilization review organization authorize coverage for the prescribed drug if it is a covered prescription. Sets out the timeline within which the health benefit plan or utilization review organization must respond to a step therapy exception request or an appeal of a request denial; if the deadline is not met, then the exception request or the appeal is deemed granted. Specifies that nothing in the Part impacts an insurer's ability to substitute a generic drug for a name brand drug. Effective October 1, 2019, and applies to health benefit contracts issued, renewed, or amended on or after that date.