KMA has achieved a number of legislative successes in the last several years, thanks to the advocacy efforts of Kentucky physicians. Members can now access two comprehensive resources detailing KMA-priority legislation that recently became law related to step therapy protocols and biomarker testing coverage.
Step Therapy Protocols (SB140, 2022):
Kentucky was a pioneer in patient protections when it enacted step therapy reforms a decade ago. Now, more than half of states have stronger laws in place. In 2022, in the wake of evolving clinical practices and insurance policies, Sen. Max Wise introduced Senate Bill 140 to update and clarify existing statutes that address step therapy protocols mandated by insurers and pharmacy benefit managers. The legislation was unanimously approved by both chambers and signed by the governor, taking effect on Jan. 1, 2023.
The new law requires step therapy protocols to be based on widely accepted medical and clinical guidelines and will update the clinically justified circumstances for a patient and health care provider to override a step therapy protocol.
Biomarker Testing Coverage (HB180, 2023):
Biomarker testing allows physicians to analyze a patient’s tissues or blood to find specific markers indicating normal biological processes, diseases, or responses to medications in order to help determine the best treatment. In 2023, the Kentucky General Assembly passed House Bill 180, which requires health insurance plans to cover biomarker testing when ordered by a qualified healthcare provider, following certain medical and scientific evidence criteria. The new law took effect Jan. 1, 2024.
These materials provide insight into the policy changes and their impact on medical practices. KMA members are encouraged to continue to lend their voices to KMA’s legislative priorities to ensure future successes. Be sure to look for KMA’s 2024 Legislative Alerts, which are distributed each Tuesday during the legislative session, and find more updates at kyma.org/advocacy.
