This bill proposes to amend the Arizona Revised Statutes by adding a new section, 36-2907.17, which specifically addresses the coverage of prescription antipsychotic drugs for members aged eighteen and older with a serious mental illness. Under the new provisions, the administration and its contractors would be prohibited from imposing prior authorization requirements or other processes that could delay or deny access to these medications, except for a step therapy protocol that requires members to demonstrate a lack of response to no more than two distinct antipsychotic drugs. Additionally, members or their healthcare providers would have the option to bypass this step therapy if they can provide evidence of previous treatment failures.

The bill also outlines specific requirements for any step therapy protocols, including the need for real-time electronic adjudication and criteria for considering a member to have tried two distinct drugs based on paid claims. It clarifies that the new regulations apply only to prescription antipsychotic drugs supported by peer-reviewed literature and that they do not restrict the administration's ability to contract with managed care organizations or perform necessary drug utilization reviews. Definitions for key terms such as "failure to successfully respond," "health benefit plan," and "health care provider" are also included to ensure clarity in the implementation of these provisions. The act is set to take effect on December 31, 2026.

Statutes affected:
Introduced Version: 36-2907.17