This bill amends the Florida Statutes to establish 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 as defined by the American Psychiatric Association. The bill mandates that the Agency for Health Care Administration (AHCA) approve drug products for treating serious mental illness without requiring step-therapy prior authorization under certain conditions, thereby facilitating access to essential medications. Additionally, it modifies section 409.912 to emphasize the implementation of a Medicaid prescribed-drug spending-control program and to manage drug therapies for recipients on multiple prescribed drugs, while also considering rate impacts from these changes in future adjustments.

Moreover, the bill introduces modifications to the Medicaid prior authorization processes, including a requirement for the agency to post prior authorization criteria on its website within 21 days of approval. It allows for age-related prior authorizations and establishes a step-therapy prior authorization process for non-preferred medications, necessitating prescribers to justify alternative medication use. The bill also creates a return and reuse program for prescription drugs dispensed to institutional recipients, which includes a $5 restocking fee to minimize drug waste. It clarifies the responsibilities of health insurance entities regarding payment claims and directs the AHCA to consider the financial implications of these changes on Medicaid rates, effective October 1, 2025, with certain provisions taking effect immediately upon enactment.

Statutes affected:
S 264 Filed: 409.912, 409.910