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HB 429

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO THE STEP THERAPY EXCEPTION PROCESS.

153rd General Assembly (2025-2026) Introduced by Bill Carson and 12 co-sponsors

Delaware HB 429 reforms step therapy by standardizing clinician exception processes, expediting urgent reviews, and increasing insurer transparency to reduce treatment delays.

Passed By Senate. Votes: 21 YES
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WeVote Research Nonpartisan
Bill Summary · HB 429

Overview

HB 429 (Session 153, Delaware) seeks to amend Title 18 of the Delaware Code to modify the state’s step therapy exception process. The bill has been introduced and referred to the Economic Development/Banking/Insurance & Commerce Committee in the House. It has multiple Senate/House sponsors, including co-sponsors Melissa Minor-Brown, Bryant Richardson, Eric Morrison, Russ Huxtable, Ray Seigfried, and Marie Pinkney.

Purpose and Intent

  • To reform how health insurance “step therapy” (also known as fail-first therapy) is administered in Delaware.
  • The goal is to ensure that patients receiving treatment through health plans can access medically appropriate therapies without unnecessary delay or administrative barriers, by refining the exception process for when clinicians seek to bypass or modify step therapy requirements.

Key Provisions (as described by the bill’s title and typical step-therapy reform patterns)

Note: The exact statutory text is not provided here, but the bill’s focus typically includes:
- Clarifying the process by which a treating clinician can request an exception to step therapy protocols.
- Establishing timelines for decision-making on exception requests (e.g., expedited review timelines for urgent cases).
- Requiring health insurers to provide written rationale for denial of an exception and to offer an appeal mechanism.
- Defining who can request an exception (e.g., patient, physician, or designated authorized representative).
- Outlining documentation requirements to support an exception request (e.g., clinical justification, medical history, prior therapies tried and failed, safety considerations).
- Prohibiting or limiting the use of step therapy in specific circumstances (e.g., when prior authorization is already in place, for certain high-risk or specialized therapies, or for life-threatening conditions).
- Implementing penalties or remedies for non-compliance by insurers (e.g., remedies, enforcement provisions, or consumer protections).
- Potentially offering exemptions or protections for sensitive populations or specific therapeutic classes.

Affected Parties

  • Patients enrolled in Delaware health plans who are subject to step therapy protocols.
  • Prescribing clinicians (physicians, nurse practitioners, physician assistants) who seek to obtain exceptions.
  • Health insurers and health benefit plans regulated under Delaware law.
  • Healthcare providers and pharmacy benefit managers (PBMs) involved in processing prior authorizations and exceptions.

Procedural and Timeline Aspects

  • The bill has been introduced and assigned to the Economic Development/Banking/Insurance & Commerce Committee, indicating committee-level consideration and potential public input.
  • If enacted, the bill would likely establish:
    • Standardized timelines for insurers to respond to exception requests (including expedited timelines for urgent cases).
    • A defined appeals process for denials, potentially with an external review option.
    • Reporting or transparency requirements (e.g., tracking and reporting of exception requests and outcomes).
  • Implementation details (effective date, transition period, and any required regulatory updates) would be determined during the legislative process and potential rulemaking by the relevant state agencies.

Potential Impact

  • Improved access to appropriate therapies by reducing administrative delays created by step therapy requirements.
  • Increased transparency around how exceptions are evaluated and approved or denied.
  • Enhanced protections for patients needing high-cost or specialized medications where step therapy may be inappropriate or unsafe.
  • Potential administrative workload changes for insurers, providers, and PBMs to align with new timelines and documentation standards.
  • Possible financial implications for insurers related to expedited review processes and compliance requirements.

If you would like, I can tailor this summary to emphasize specific sections once the bill’s full text is available, or compare it to existing Delaware step therapy policies.

Compiled from official sources — confirm details with the bill’s official record.

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