Bulletin 2024-03: https://www.mass.gov/doc/bulletin-2024-03-step-therapy-protocols-pursuant-to-chapter-254-of-the-acts-of-2022-chapter-254-issued-january-16-2024/download

Step therapy is defined as a “utilization management policy or program that establishes the specific sequence in which a prescription drug for a specified medical condition is covered by a carrier.”  This bulletin applies to fully insured Massachusetts licensed carriers that provide coverage for prescription drugs and outlines the process to request an exception to step therapy protocols. Exceptions may be requested when the drug required under the step therapy protocol is contraindicated, expected to be ineffective, has previously been tried and was ineffective and thus discontinued, or the patient is stable on a prescription drug prescribed by their provider and switching drugs will likely cause an adverse reaction. The exception request must be acted on not more than 3 business days following the receipt of all information or within 24 hours for urgent situations.  Carriers are expected to forward implementation plans to the DOI by February 15th.