This bill amends the Florida Statutes to enhance protocols for step-therapy concerning Medicaid recipients diagnosed with serious mental illnesses. It introduces a definition for "serious mental illness" in section 409.901, aligning with the American Psychiatric Association's classifications. The legislation mandates that the Agency for Health Care Administration (AHCA) approve drug products for treating serious mental illnesses without requiring step-therapy prior authorization under specific conditions, thereby facilitating quicker access to essential medications. Additionally, amendments to section 409.912 emphasize the implementation of a Medicaid prescribed-drug spending-control program and the management of drug therapies for recipients on multiple prescriptions, ensuring timely access to medications, especially in emergencies.

The bill also modifies existing Medicaid prior authorization processes, including a return and reuse program for prescription drugs, which aims to minimize waste and improve efficiency in drug management. It requires the agency to post prior authorization criteria on its website within 21 days of approval and introduces a step-therapy prior authorization process for non-preferred medications, necessitating prescriber justification for alternatives. Notably, the language shifts from "shall" to "must," indicating a stronger obligation for the agency. The return and reuse program includes a $5 restocking fee for pharmacies and mandates the agency to evaluate its effectiveness. The provisions of this act are set to take effect on October 1, 2025, with some sections becoming effective immediately upon passage.

Statutes affected:
S 264 Filed: 409.912, 409.910