House Bill 721 amends several sections of the Florida Statutes to improve the step-therapy protocols for treating serious mental illnesses under Medicaid. It introduces a definition for "serious mental illness," encompassing various psychiatric disorders recognized by the American Psychiatric Association. The bill mandates that the Agency for Health Care Administration (AHCA) approve drug products for Medicaid recipients with serious mental illnesses without requiring prior authorization for step-therapy under specific circumstances. This change is intended to enhance access to essential medications for individuals facing serious mental health challenges.

The bill also implements a "step-edit" protocol for prior authorization of certain medications, allowing for an automatic electronic review process. It enables the AHCA, in collaboration with the Pharmaceutical and Therapeutics Committee, to establish age-related prior authorizations and a step-therapy approval process for medications not on the preferred drug list. Additionally, it introduces a return and reuse program for unused medications dispensed to institutional recipients, which includes a $5 restocking fee for pharmacies. The AHCA is tasked with assessing the effectiveness of this program in reducing drug waste and considering the financial implications of these changes on Medicaid rates, effective October 1, 2025.

Statutes affected:
H 721 Filed: 409.912, 409.910