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Is Your State Fighting Back Against Step Therapy?

Healthcare insurance coverage on medications keeps changing as the political climate changes. This page will keep you up to date on the most recent changes and the State's that need immediate action from you as an advocate. If you see your State listed or have experienced a step therapy issue follow the links below for help. 

Is Your State Fighting Back Against Step Therapy?


Step therapy describes insurance company practices that require the least expensive drug in any class to be prescribed to a patient first, even if a patient’s physician believes a different therapy is a better treatment option. We believe that you and your doctor should get to decide together on the best medication for you — not your health insurance company.

 

State laws regarding step therapy keep changing as the policy enters the national spotlight, amid a recent announcement that the Centers for Medicare and Medicaid Services (CMS) will allow Medicare Advantage plans to use step therapy in Part B drugs in 2019.

Currently there are 19 States that have some sort of Step Therapy bill. Here is information about those who have. If you live in a State that still doesn't have a Step Therapy bill join our 50-State Network to be part of the change!

State Time Limit Insurer has to respond: If Insurer doesn’t respond within allotted time it is: Link to appeal if denied:
Alabama NA NA, sign up to change this
Alaska NA NA, sign up to change this
Arizona NA NA, sign up to change this
Arkansas All cases – 72 hours  If no answer it is: Approved
California Normal case- 72 hours

Emergency case- 24 hours

If no answer it is: Approved
Colorado “Expeditiously” (No time limit) If no answer it is:

Not approved, sign up to change this

Connecticut “Expeditiously” (No time limit) If no answer it is:

Not approved, sign up to change this

Delaware NA NA, sign up to change this
District of Columbia NA NA, sign up to change this
Florida NA NA, sign up to change this
Georgia NA NA, sign up to change this
Hawaii NA NA, sign up to change this
Idaho NA NA, sign up to change this
Illinois Normal case – 72 hours

Emergency case- 24 hours

If no answer it is: Approved

After approval, granted for 12 months or until renewal

Indiana Normal case- 72 hours

Emergency case- 24 hours

If no answer is is: Approved
Iowa Normal case – 5 days

Emergency case- 24 hours

If no answer it is: Approved
Kansas* Normal case – 72 hours 

Emergency case- 24 hours

*Step Therapy also applies to Medicaid

If no answer it is: Approved
Kentucky “Expeditiously” (No time limit) If no answer it is:

Not approved, sign up to change this

Louisiana “Expeditiously” (No time limit) If no answer it is:

Not approved, sign up to change this


Maine NA NA, sign up to change this
Maryland “Expeditiously” (No time limit) If no answer it is:

Not approved, sign up to change this

Massachusetts NA NA, sign up to change this
Michigan NA NA, sign up to change this
Minnesota Normal case – 5 days

Emergency case – 72 hours

If no answer it is: Approved
Mississippi  “Expeditiously” (No time limit) If no answer it is:

Not approved, sign up to change this

Missouri “Expeditiously” (No time limit) If no answer it is:

Not approved, sign up to change this

Montana NA NA, sign up to change this
Nebraska NA NA, sign up to change this
Nevada NA NA, sign up to change this
New Hampshire NA NA, sign up to change this
New Jersey NA NA, sign up to change this
New Mexico Normal case – 72 hours

Emergency case- 24 hours

If no answer it is: Approved
New York Normal case – 72 hours

Emergency case – 24 hours

If no answer it is: Approved
North Carolina NA NA, sign up to change this
North Dakota NA NA, sign up to change this
Ohio NA NA, sign up to change this
Oklahoma NA NA, sign up to change this
Oregon “Expeditiously” (No time limit) If no answer it is:

Not approved, sign up to change this

Pennsylvania NA NA, sign up to change this
Puerto Rico No Deadline NA, sign up to change this
Rhode Island NA NA, sign up to change this
South Carolina NA NA, sign up to change this
South Dakota NA NA, sign up to change this
Tennessee NA NA, sign up to change this
Texas  Normal case – 72 hours

Emergency case – 24 hours

If no answer it is: Approved
Utah NA NA, sign up to change this
Vermont NA NA, sign up to change this
Virginia NA NA, sign up to change this
Washington NA NA, sign up to change this
West Virginia “Expeditiously” (No time limit) If no answer it is:

Not approved, sign up to change this

Wisconsin NA NA, sign up to change this
Wyoming NA NA, sign up to change this

 

 
 

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