This bill amends the Florida Statutes to enhance the step-therapy protocols for Medicaid recipients diagnosed with serious mental illnesses. It introduces a definition for "serious mental illness" in section 409.901, encompassing conditions such as bipolar disorder, major depressive disorder, and schizophrenia. The bill mandates that the Agency for Health Care Administration (AHCA) must approve necessary drug products for these recipients without requiring step-therapy prior authorization under specific circumstances, thereby facilitating quicker 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 prescriptions.

Moreover, the bill outlines new requirements for the Medicaid prescription drug authorization process, including the obligation for the agency to post prior authorization and step-edit criteria on its website within 21 days of approval. It introduces a more stringent language change from "shall" to "must" regarding the development of the step-therapy approval process and allows for age-related prior authorizations. The bill also establishes a return and reuse program for drugs dispensed to institutional recipients, aiming to minimize waste, and amends the responsibilities of health insurance entities concerning claims records. The act is set to take effect on October 1, 2026, with certain provisions becoming effective immediately upon passage.

Statutes affected:
S 70 Filed: 409.912, 409.910