The proposed bill, if enacted, would amend current statutes related to the Arizona Health Care Cost Containment System (AHCCCS) by introducing new provisions regarding the coverage of prescription antipsychotic drugs. Specifically, it would prohibit AHCCCS and its contractors from requiring prior authorization for these medications for members aged 18 and older with a serious mental illness, except in cases where a step therapy protocol is applied, which would be limited to requiring a member to demonstrate a failure to respond to no more than two distinct antipsychotic drugs. Additionally, the bill mandates that any step therapy protocols be processed electronically and in real-time, and it establishes criteria for determining a member's prior use of antipsychotic drugs based on paid claims within the last five years.

Furthermore, the bill clarifies that the new coverage requirements would only apply to antipsychotic drugs supported by peer-reviewed literature and would not restrict AHCCCS from contracting with managed care organizations or from conducting necessary drug utilization reviews. It also allows for the collection of federal rebates and the establishment of supplemental rebate agreements with drug manufacturers. The definitions of key terms such as "failure to successfully respond" and "health benefit plan" are also included to provide clarity on the bill's provisions. The act is set to take effect on January 1, 2027.

Statutes affected:
Introduced Version: 36-2907.17
Senate Engrossed Version: 36-2907.17