AN ACT relating to step therapy protocols.
SB 307 would revise Kentucky law governing step therapy protocols used by insurers, health plans, pharmacy benefit managers, and private review agents for prescription drug coverage. The bill tightens the standards for how step therapy criteria are developed, requiring them to be grounded in clinical practice guidelines or, if those are unavailable, peer-reviewed publications. It also requires transparency in the development process, including conflict-of-interest disclosures, public comment opportunities, and consideration of patient subgroups and preferences.
The bill creates a more detailed and faster process for step therapy exception requests. Insureds and prescribing providers would have access to a clear request process, with required criteria and documentation posted online, and electronic submission of exception requests integrated into prior authorization systems by January 1, 2027. Requests or appeals meeting specified medical criteria would have to be granted within 48 hours, and if the insurer or PBM does not respond in time, the request is deemed approved. The bill also limits step therapy duration when treatment is documented as ineffective and preserves the ability of providers to prescribe medically appropriate drugs.
SB 307 would amend KRS 304.17A-163 and related provisions to impose new procedural and substantive requirements on step therapy protocols in Kentucky’s commercial insurance market, with parallel application to Medicaid and KCHIP to the extent allowed by federal law. It would require insurers, health plans, PBMs, and private review agents to disclose clinical review criteria, accept electronic exception requests, and honor specific exception grounds such as contraindication, lack of efficacy, adverse events, clinical instability, or risk of harm to adherence or functioning. The bill also clarifies that it does not eliminate generic, interchangeable biological, or biosimilar substitution requirements, and it applies to policies and plans issued or renewed on or after enactment.
The available record shows no committee transcript and no recorded votes, so there is no direct evidence of debate or floor sentiment. Based on the bill text, the measure appears designed to improve patient access and reduce delays in obtaining prescribed medications, suggesting a consumer- and provider-friendly policy approach. The absence of recorded opposition or amendments in the provided materials means sentiment cannot be assessed beyond the bill’s apparent intent.
The main likely point of contention is the balance between patient access and utilization management. Supporters would likely favor the bill’s faster exception timelines, transparency requirements, and deemed-approval provisions, while insurers and pharmacy benefit managers may object to the administrative burden, tighter deadlines, and limits on their ability to enforce step therapy. Another possible issue is the bill’s application to Medicaid and KCHIP only to the extent permitted by federal law, which could raise implementation questions and concerns about federal authorization and compliance. The bill also preserves generic and biosimilar step requirements, which may reduce some opposition but does not eliminate disputes over when exceptions must be granted.