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FL H0721

FL H0721
Step-therapy Protocols


summary

Introduced
02/19/2025
In Committee
02/26/2025
Crossed Over
Passed
Dead
06/16/2025

Introduced Session

2025 Regular Session

Bill Summary

An act relating to step-therapy protocols; amending s. 409.901, F.S.; defining the term "serious mental illness"; amending s. 409.912, F.S.; requiring the Agency for Health Care Administration to approve drug products for Medicaid recipients for the treatment of serious mental illness without step-therapy prior authorization under certain circumstances; amending s. 409.910, F.S.; conforming a cross-reference; directing the agency to include rate impacts resulting from the act in certain rates that become effective on a specified date; providing effective dates.

AI Summary

This bill modifies Florida's Medicaid prescription drug policies, primarily focusing on step-therapy protocols for mental health medications. The bill defines "serious mental illness" by listing seven specific psychiatric disorders from the Diagnostic and Statistical Manual of Mental Disorders, including conditions like bipolar disorders, major depressive disorders, schizophrenia, and obsessive-compulsive disorders. It requires the Agency for Health Care Administration (AHCA) to approve drug products for treating serious mental illnesses without requiring step-therapy prior authorization, which means patients can more quickly access medications recommended by their physicians. The bill also directs AHCA to include the financial impact of these changes in Medicaid managed care program rates effective October 1, 2025. Additionally, the bill makes some technical changes to existing statutes, such as renumbering subsections and adjusting language related to third-party record-keeping requirements. The overall goal appears to be improving access to mental health medications for Medicaid recipients by reducing bureaucratic barriers to prescription approvals.

Committee Categories

Health and Social Services

Sponsors (1)

Last Action

Died in Health Care Facilities & Systems Subcommittee (on 06/16/2025)

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