Bill > H5320

This bill prohibits the Rhode Island medical assistance program and its managed care organizations from requiring prior authorization or step therapy protocols for nonpreferred anticonvulsant or antipsychotic medications. Specifically, the bill defines "step therapy protocol" as a specific sequence of prescription medications for a medical condition that must be tried before covering another medication. The bill allows for clinical prior authorization edits and maintains the program's ability to deny medications removed from the market due to FDA safety concerns. If federal agency authorization is needed to implement the provisions, the executive office of health and human services can seek a state plan amendment and may delay implementation until authorization is granted. The bill will take effect immediately upon passage and will apply to healthcare policies, contracts, plans, and certificates executed or renewed in Rhode Island on or after January 1, 2026. The primary goal appears to be reducing barriers to accessing specific anticonvulsant and antipsychotic medications by preventing additional administrative hurdles like prior authorization and mandatory sequential medication trials.

Budget and Finance

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