Delaware insurers can require biological alternatives before covering brand-name medicines

Insurers, health plans, and organizations that review medicine coverage may require patients to try specified biological alternatives before covering the matching brand-name medicine. The permission appears in both amended Delaware insurance sections on step therapy exceptions. Step therapy means trying one medicine before insurance covers another. An interchangeable biological medicine may be required before coverage of its equivalent brand-name drug. A biosimilar—a similar version of a biological medicine—may be required before coverage of its brand-name reference medicine. These alternatives must meet the federal definitions cited in the law. The law permits these requirements; it does not order health plans to use them.