This bill amends the Florida Statutes to implement new protocols for step-therapy concerning Medicaid recipients diagnosed with serious mental illnesses. It introduces a definition for "serious mental illness" in section 409.901, encompassing various psychiatric disorders recognized by the American Psychiatric Association. The bill requires the Agency for Health Care Administration (AHCA) to approve drug products for treating serious mental illnesses without the need for step-therapy prior authorization under certain conditions, thereby facilitating quicker access to essential medications. Additionally, it modifies existing language regarding the agency's authority to manage drug therapies and outlines its responsibilities in overseeing Medicaid drug spending and ensuring cost-effective healthcare services.

Moreover, the bill mandates that the AHCA post prior authorization criteria and updates on its website within 21 days of approval and allows for age-related prior authorizations. It establishes a step-therapy prior authorization process for medications not on the preferred drug list and emphasizes a stronger obligation by changing "shall" to "must" in the context of developing the step-therapy approval process. The bill also introduces a return and reuse program for drugs dispensed to institutional recipients, along with a $5 restocking fee, and modifies the responsibilities of health insurance entities regarding Medicaid claims. Overall, the legislation aims to improve the efficiency and accessibility of medication management within the Medicaid system while ensuring adherence to necessary protocols.

Statutes affected:
S 264 Filed: 409.912, 409.910