Bill > S2385

This bill prohibits the Rhode Island medical assistance program, which is a state-funded healthcare program for low-income individuals, and any managed care organizations contracted with it, from requiring prior authorization or a step therapy protocol for anticonvulsant (seizure-preventing) and antipsychotic (mental health) medications. Prior authorization is a process where a healthcare provider must get approval from the insurance plan before a service or drug is provided, and step therapy protocol means patients must try certain less expensive medications first before a more expensive one is covered. This change aims to ensure patients can access these important medications more readily, though it does not prevent the program from denying coverage for medications removed from the market due to safety concerns by the Food and Drug Administration or from applying clinical edits to prescriptions. The bill also mandates the collection and reporting of data on spending and utilization of these medications, as well as data on mental health emergency services, with the provisions set to expire on December 31, 2029, and take effect on January 1, 2027.

Health and Social Services

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