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The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress, and was published on Apr 6, 2017.
Restoring the Patient's Voice Act of 2017
This bill amends the Employee Retirement Income Security Act of 1974 (ERISA) to require a group health plan to establish an exception to medication step-therapy protocol in specified cases. A medication step-therapy protocol establishes a specific sequence in which prescription drugs are covered by a group health plan or a health insurance issuer.
To warrant an exception to the protocol, at least one of the following circumstances must be met: (1) the treatment is contraindicated, (2) the treatment is expected to be ineffective, (3) the treatment will cause or is likely to cause an adverse reaction to the individual, (4) the treatment is expected to decrease the individual's ability either to perform daily activities or occupational responsibilities or adhere to the treatment plan, or (5) the individual is stable based on the prescription drugs already selected.
The bill requires a group health plan to implement a clear process for an individual to request an exception to the protocol. The process shall be readily available on the website of the group health plan and must list the requirements for a request and any necessary forms and contact information.
Requests shall be granted no later than three days after receipt of the request. In certain cases where the life, health, and ability of the individual are jeopardized by the protocol, the request shall be granted no later than 24 hours after receipt of the request.