Legislators hear bill to curb retroactive denials, speed approval of biologics for children

Representative Ed Buttrey opened the hearing on House Bill 544, which has two central components: prohibiting retroactive denials of approved services except for fraud, misrepresentation, nonpayment of premium or exhaustion of benefits; and requiring insurers to approve prior authorization requests for certain biologic therapies for minors when the off‑label use is supported by peer‑reviewed medical literature.

Medical providers and parents described the human impact of delays and denials. Julie Campbell, Montana’s only pediatric rheumatologist, said many rare pediatric autoimmune conditions lack FDA‑approved drug trials and that clinicians often rely on peer‑reviewed evidence when treating children. “There could be an entire capital full of people that want you to hear these stories,” Campbell said, describing cases in which months of appeals delayed sight‑saving or life‑saving treatment.

Parents and patient advocates described long denials and the use of nonprofit crowdfunding to pay for initial doses while appeals proceed. Rachel Markovich and others said they founded VEO Guardians to pay for urgently needed biologics until insurers approved coverage; they argued that charity is not a sustainable substitute for timely coverage.

Representatives of the insurance commissioner’s office and national mental‑health advocates supported the bill after negotiations; Blue Cross and Blue Shield of Montana said it was neutral and available to answer questions. The insurance regulator noted the bill’s schedule language and recommended an implementation effective date of Jan. 1, 2026 to align with plan years; regulators also said they can investigate current retroactive‑denial complaints for fully insured plans immediately.

Committee members asked how the bill’s prohibitions apply to self‑funded plans, and the sponsor said section 3 extends requirements to certain self‑funded plans such as the state and university group benefits plans. The sponsor also noted a fiscal note tied to the state university system and said chairs should expect materials on costs in later hearings.

The committee did not vote at the hearing. Sponsor and supporters asked for a do‑pass; the hearing record closed after testimony concluded.

Why it matters: proponents said the bill stops insurer practices that can leave seriously ill children waiting for approved therapies; insurers and regulators stressed the need to align implementation timing with plan years and to preserve fraud and misrepresentation exceptions.