On March 24, 2026, the Delaware Department of Insurance issued Domestic and Foreign Insurers Bulletin No. 165, signed by Commissioner Trinidad Navarro and directed at all insurers, health service corporations, and managed care organizations that deliver or issue individual and group insurance policies or plans subject to regulation under Title 18 of the Delaware Code. The Department said it had reviewed carrier practices and found that clarification was needed to ensure uniform and accurate implementation of the state’s step therapy provisions.