An Act To Provide Protections for Maine Patients Facing Step Therapy
Maine Legislature, Session 129, LD 1009
Committee Amendment CA_A_H432 (House)

COMMITTEE AMENDMENT "A-" to H.P. 751, L.D. 1009, Bill, "An Act To 
Provide Protections for Maine Patients Facing Step Therapy" 
Amend the bill in section 1 in the first line (page 1, line 2 in L.D.) by striking out the 
following: 
11§4320-L" and inserting the following: '§4320-M' 
Amend the bill in section 1 in §4320-L in the first line (page 1, line 3 in L.D.) by 
striking out the following: "§4320-L" and inserting the following: '§4320-M' 
Amend the bill in section 1 in §4320-L in subsection 1 by inserting after paragraph D 
the following: 
'E. "Stable on a prescription drug" means, with respect to an enrollee, receiving a 
positive therapeutic outcome on a prescription drug selected by the enrollee's health 
care provider for the enrollee's medical condition.' 
Amend the bill in section 1 in §4320-L in subsection 1 by relettering the paragraphs 
to read alphabetically. 
Amend the bill in section 1 in §4320-L in subsection 6 by striking out all of 
paragraph D (page 3, lines 15 to 21 in L.D.) and inserting the following: 
'D. A carrier or utilization review organization shall grant or deny a request for a step 
therapy override exception determination or an appeal of a determination within 72 
hours, or 2 business days, whichever is less, after receipt of the request. If exigent 
circumstances, as described in section 4311, subsection 1-A, paragraph B, exist, a 
carrier or utilization review organization shall grant or deny the request within 24 
hours after receipt of the request. The canier shall provide coverage for the 
prescription drug prescribed by the prescriber during the pendency of the request for 
a step therapy override exception determination or an appeal of a determination. If a 
carrier or utilization review organization does not grant or deny the request within the 
time required under this paragraph, the exception or appeal is granted.' 
Amend the bill in section 1 in §4320-L in subsection 6 by striking out all of 
paragraph F (page 3, lines 23 to 28 inL.D.) and inserting the following: 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT"~" to H.P. 751, L.D. 1009 
'F. This section does not prevent: 
(1) A carrier or utilization review organization from requiring an enrollee to try a 
generic drug, as defined in Title 32, section 13702-A, subsection 14, or an 
interchangeable biological product, as defined in Title 32, section 13702-A, 
subsection 14-A, prior to providing coverage for the equivalent brand-name 
prescription drug; or 
(2) 
A health care provider from prescribing a prescription drug that is 
determined to be medically necessary.' 
Amend the bill in section 1 in §4320-L by striking out all of subsection 7 (page 3, 
lines 29 to 33 in L.D.) and inserting the following: 
'7. Rules. The superintendent may adopt rules to implement this section. Rules 
adopted pursuant to this subsection are routine technical rules as defined in Title 5, 
chapter 375. subchapter 2-A.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment conforms the timeline for responding to a request for a step therapy 
override exception determination with the existing timeline for prior authorization 
requests. The amendment clarifies the meaning of exigent circumstances and makes clear 
that a carrier is required to continue to provide access to the prescription drug subject to 
step therapy protocol during the consideration of a request for a step therapy override 
exception determination. 
The amendment also adds a definition of "stable on a 
prescription drug" and clarifies that the provisions do not prevent a carrier from requiring 
an enrollee to try an interchangeable biological product. The amendment also changes 
the allocation of a new section of the statutory provision to avoid a numbering problem. 
FISCAL NOTE REQUIRED 
(See attaehed) 
COMMITTEE AMENDMENT 
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Approved: 05/26/19 :.Wac 
LD 1009 
LR 1137(02) 
An Act To Provide Protections for Maine Patients Facing Step Therapy 
Fiscal Note for Bill as Amended by Committee Amendment J1. {fl· '/ 3~ 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Maine State Employee Health Plan not affected 
Fiscal Detail and Notes 
Drug step therapy is the practice of beginning drug therapy for a medical condition with the most cost-effective and 
safest drug and progressing to other more costly or risky therapies only if necessary, with the goal of controlling costs 
and minimizing risks. This bill adds an exception process that must be clear, readily accessible and convenient to the 
patient and presc1iber. The Maine State Employee Health Plan does not pem1it step therapy and will not be affected 
by this bill. 
LRl 137(02) - Fiscal Note - Page 1 of 1