Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Step Therapy Exceptions Pilot topic
No spam. Unsubscribe anytime.
Bill would require faster insurer review of step‑therapy exceptions and a one‑biennium pilot under PERS (SB 2249)
Summary
Senate Bill 2249 would require insurers to provide a published, expedited process for step‑therapy exceptions, set insurer response timelines and run a two‑year pilot in the PERS plan to evaluate impacts.
Senate Bill 2249 would require insurers to adopt and publish processes for patients and providers to request step‑therapy exceptions and set time limits for insurer responses. The sponsor, Senator Jeff Barta, described the bill as a transparency and process reform rather than a prohibition on step therapy.
Key timelines in the bill’s draft require insurers to respond to a standard exception request within five calendar days (with shorter deadlines for urgent or emergency care). The measure also directs a two‑year pilot under the Public Employees Retirement System (PERS) to report results to the Legislature and, if specified thresholds are met, would trigger an application for the private market in the following session.
Supporters’ case: Clinicians and patient groups testified that step‑therapy protocols create delays, administrative burdens, and emotional stress for patients who must ‘‘fail first’’ on certain therapies before receiving the medication a provider prescribed. Senator Barta and witnesses argued that streamlined exception timelines will reduce delays in effective clinical care and lessen non‑clinical burdens on patients and clinicians.
Opposition and fiscal concerns: The Greater North Dakota Chamber warned the proposal could increase employer‑sponsored health‑insurance costs, particularly in the small‑group market; the chamber also said many North Dakota employers are self‑insured under ERISA and therefore outside state mandate reach. PERS provided neutral testimony and said its actuary estimated no fiscal impact to the PERS plan in current form because the carrier already covers many exception situations; PERS proposed an amendment to exempt Medicare Part D from the pilot because federal rules govern Part D plans.
Next steps: Committee testimony closed with no recorded committee vote. Senators asked follow up questions about whether data from a PERS pilot could answer questions about clinical outcomes and the indirect administrative costs borne by providers.
