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Bill

Bill

HB 1638

creating a bypass mechanism for health insurer step therapy protocols when medically necessary.

2026 Regular Session Introduced by Kevin Avard and 5 co-sponsors

Creates process for patients to bypass insurer step therapy requirements in medically urgent situations, prioritizing clinical need over cost-reduction treatment sequencing.

Refer for Interim Study: MA VV 03/11/2026 HJ 7 P. 13
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Bill Summary · HB 1638

Legislative bill overview

HB 1638 establishes a bypass mechanism allowing patients to circumvent health insurer "step therapy" protocols when medically necessary. Step therapy requires patients to try lower-cost treatments before insurers will cover more expensive alternatives, even if a doctor recommends a specific medication or treatment. This bill creates a process for urgent medical situations where the standard step therapy sequence could harm patient outcomes.

Why is this important

Step therapy protocols affect millions of insured patients annually and can delay access to clinically appropriate treatments. For conditions requiring immediate intervention (acute infections, certain cancers, psychiatric crises), mandatory step therapy can create dangerous delays. This bill directly impacts patient safety, physician autonomy, and healthcare access in New Hampshire by allowing doctors and patients to bypass insurance restrictions in medically urgent situations.

Potential points of contention

  • Insurance industry costs: Reducing step therapy use may increase insurer expenses if patients access more expensive treatments sooner, potentially raising premiums
  • Defining "medically necessary": The bill's language around what qualifies for bypass must be precise to prevent abuse while protecting legitimately urgent cases; vague standards could lead to litigation
  • Administrative burden: Creating and processing bypass requests adds operational complexity for insurers and healthcare providers, raising implementation costs and potential delays in approval decisions

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

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