The bill, Substitute Senate Bill No. 331, amends the step therapy requirements for prescription drugs covered under the Medicaid program and establishes new notice requirements for HUSKY Health enrollees affected by payment suspensions, denials, or new requirements. Specifically, it allows the Department of Social Services (DSS) to impose step therapy requirements based on evidence-based guidelines from drug manufacturers and the FDA, with a maximum duration of thirty days if no such guidelines exist. If a prescribing practitioner deems the treatment clinically ineffective after this period, the drug they recommend will be dispensed and covered by Medicaid.

Additionally, the bill mandates that DSS or its contracted entities provide timely written notices to HUSKY Health enrollees regarding decisions to deny or suspend payment for prescription drugs or to implement new step therapy or prior authorization requirements. These notices must be individualized and delivered within specified timeframes, including immediate notification at the pharmacy for denials and advance notice for planned suspensions. The notices must also include clear information about the new requirements and the enrollee's rights to due process and appeals under applicable laws.