Iowa Law Establishes Health Plan Step-Therapy Override; Medicaid Exempted

On May 11, 2017, Iowa enacted HF 233: a law to reform health insurer fail-first policies for medication step-therapy to require that the insurers provide override exceptions upon request from physicians and consumers. The law goes into effect for health benefit plans that are delivered, issued for delivery, continued, or renewed in Iowa on or after January 1, 2018. The new provisions do not apply to the state’s Medicaid managed care organizations (MCOs).

Currently, insurers in Iowa can limit access to more costly medications by requiring step-therapy, in which their members demonstrate, via fail-first trials . . .