Questions about MA step therapy protocol exceptions (effective 10/01/2023)

I'm looking at this website (overview of protections by state) as well as this document (MA specific) and just wanting to make sure I understand this all correctly.

My questions:

Are these protections by the state the patient is in? Or the state the insurance is from? For example, my partner lives in MA but has NY insurance. In her case, which laws should I be looking at? A lot of the states have an exception for "patient is stable on the requested drug". What does "stable" mean? Also curious about "the prescription drug required under the step therapy protocol is contraindicated or will likely cause an adverse reaction in or physical or mental harm to the enrollee"… many step therapy drugs have significant side effects and it should be pretty easy to argue that they are not worth the problems they would cause… but that seems to simple. Am I missing something with this part?

Specific situation in mind: my partner currently has a magical unicorn insurance that did not require step therapy before migraine Botox. Because Botox was the most appropriate treatment for her situation and all of the other medications would have likely worsened existing medical issues, her doctor opted to go straight for Botox. She started in September 2023 and it's working amazingly well. She may need to change jobs, though, and we're worried about losing coverage. Do these laws help at all?

submitted by /u/mssunshine636
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