House Bill 721 amends the Florida Statutes to establish new protocols for step-therapy in the Medicaid program, specifically for recipients diagnosed with serious mental illnesses. The bill defines "serious mental illness" according to the American Psychiatric Association's standards and mandates the Agency for Health Care Administration (AHCA) to approve certain drug products without requiring step-therapy prior authorization under specified conditions. It also introduces a "step-edit" protocol for prior authorization, allowing for an automatic electronic review of medications and enabling age-related prior authorizations. The bill emphasizes the need for prescribers to provide supporting medical evidence for prior authorization and outlines criteria for bypassing step-therapy requirements for specific drugs.

In addition to these changes, the bill establishes a Medicaid prescribed-drug spending-control program, which includes a preferred drug list and management of drug therapies to ensure cost-effective purchasing while maintaining quality care. It mandates the implementation of a return and reuse program for unused Medicaid prescription drugs, which includes a $5 restocking fee, aimed at reducing waste. The bill also updates definitions and responsibilities for health insurance entities regarding payment claims and requires the AHCA to consider the financial impact of these changes on future Medicaid rates. The act is set to take effect on October 1, 2025, with some provisions effective immediately upon passage.

Statutes affected:
H 721 Filed: 409.912, 409.910