Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
Search Saved

Delaware program

How quickly the plan must answer (Delaware approval deadlines)

Delaware sets response times for certain treatment and drug requests to state-regulated health plans.

What it is

Delaware sets response times for certain treatment and drug requests to state-regulated health plans.

The type of request and how it was sent set the response clock. Different rules cover a request to skip a required first medicine. The prescriber and Department of Insurance can help identify the applicable deadline.

Eligibility rules
  • These clocks apply to plans an insurer runs under Delaware law; Medicaid has its own rules. If the employer pays the claims itself, federal rules apply instead.
What you get
  • A drug-request response within two business days under the current rules.
  • A service response within five business days electronically or eight business days on paper.
  • A step-therapy exception response within two business days, or 24 hours in an emergency.
What the help includes
  • Step therapy means the plan normally requires trying one medicine before another. The prescriber states the exception ground and whether circumstances are an emergency.
  • For policies covered by the new law’s transaction trigger after December 31, 2026, ordinary service approvals generally remain valid at least 90 days rather than the prior 60. Drug approvals generally remain valid for one year. The plan can confirm the rule for the particular approval.
If you decide to apply
  1. Ask the prescribing team when the request was sent and whether it was electronic.
  2. Have the request reference and the prescriber’s reason for any medicine exception ready.
  3. Ask Department of Insurance Consumer Services about a missed deadline.

Delaware Department of Insurance Consumer Services · 302-674-7310 · Official page ↗

What happens next
  • The plan sends an approval or denial. A denial can move into the plan’s appeal process and, where eligible, outside review.
Good to know

A missed step-therapy exception deadline counts as approval. The other request types have their own rules.

Other details
  • The deadline depends on a complete request, the request type and how it was sent. Your plan can confirm its policy’s applicable law and whether another rule gives a shorter deadline.
  • The new service deadlines apply to policies issued, renewed, modified, altered, amended or reissued after December 31, 2026—not automatically to every policy on January 1. They are three business days for electronic service requests and five for other service requests, with urgent-service or transfer decisions within 24 hours electronically or 48 hours otherwise. Drug requests remain at two business days. These are authorization rules for qualifying state-regulated coverage, not Medicaid appeal deadlines.
Official sources
Ask your social worker

“Which deadline applies to this treatment request? What could challenging a delay achieve, what are the limits, and could you help us use the right process?”

Why I’m asking: I want to know whether treatment is waiting on a response that is already overdue.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Note the date the request went in, and chase the day the deadline passes.

Your social worker

The prescriber sends the request and states the exception ground.

The care team

The oncologist states which step-therapy exception ground applies and whether the circumstances are an emergency.

Who decides
The plan’s utilisation review.
Ask your social worker
“When did the authorisation go in, and was it sent electronically? Delaware gives the plan a deadline, and a missed step-therapy deadline counts as approval.”

How to apply

First step: Ask the prescriber to send the request electronically and to write down the date and time it went in.

  1. Ask the prescriber to send the request electronically and to note the date and time.
  2. On a step-therapy exception, ask for written confirmation of the deadline and say the request is deemed granted if it is missed.
  3. If the deadline passes, call the Department of Insurance Consumer Services.

Official application / program page ↗

Where it starts: The prescriber files; you hold the plan to the clock and complain to the Department of Insurance when it slips.

What to gather

  • The date and time the request went in
  • Whether it went electronically
  • The exception ground the prescriber gave

How long: Two business days for a drug; eight on paper or five electronically for a service.

What a yes looks like

An authorisation, or a step-therapy exception granted.

What a no looks like, and the next move

A denial can go to the plan’s appeal and then to outside review. A missed deadline is worth a call to the Department of Insurance.

Watch out

  • A missed step-therapy deadline counts as approval. Ask for that in writing.
  • New, shorter clocks start only when the policy is next issued, renewed or amended after December 2026. Ask the plan which set it is on.
  • A general urgent-service deadline for 2026 was not found. Do not quote one you cannot cite.

If they say no, quote this: 18 Del. C. §3381: on a step-therapy exception, "A request shall be deemed granted if the required response is not received by the requesting or appealing party within the times set forth in this subsection."

Dates that change this

2027-01-01: For policies issued, renewed or amended after December 31, 2026 the standard clocks become five business days for a paper request and three for an electronic one, with 48 hours and 24 hours for urgent ones. The new clocks do not apply before the policy event, so ask the plan which set it is on.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Two business days for a drug, eight on paper or five electronically for a service, and two business days or 24 emergency hours on a step-therapy exception.

  • $2 — Deadline for a drug prior authorisation, in force now
  • $8 — Deadline for a service request sent on paper, in force now
  • $5 — Deadline for a service request sent electronically, in force now
  • $2 — Deadline for a step-therapy exception
  • $24 — Deadline for a step-therapy exception in emergency circumstances

Legal protection: A step-therapy exception is treated as granted if the plan does not answer inside the deadline · Step-therapy exceptions cover harm or contraindication, expected ineffectiveness, a drug already tried and stopped, medical necessity, and being stable on the current drug

What it costs the family: None.

The eligibility facts, as published

Plan type
a plan subject to Delaware insurance regulation; the older subchapter excludes policies designed for people eligible under Medicare, Medicaid or similar government plans
Note
a general urgent-service clock for 2026 and a gold-card exemption were not found

The trap: For a step-therapy exception the plan has two business days, or 24 hours in an emergency, and if it misses the deadline the request is treated as granted. Ask for that in writing.

Where I read this

← Back to your options