Prior Authorization in Delaware
Delaware enacted HB 219 (2019) providing step therapy override rights. The law requires insurers to grant exceptions when the required step is contraindicated, was previously tried, or is expected to be ineffective. Delaware also mandates timely PA decisions and external review for denials.
Key Facts About PA in Delaware
- ✓ Step therapy override law covers contraindications, prior trials, and expected ineffectiveness
- ✓ External review available through the Delaware Department of Insurance
- ✓ PA decisions must be communicated within a reasonable timeframe
- ✓ Highmark BCBS Delaware is the dominant commercial carrier
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Delaware
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Delaware carriers:
Highmark BCBS DelawareAetnaUnitedHealthcareCigna