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 such as bipolar disorder, major depressive disorder, obsessive-compulsive disorder, and schizophrenia. The bill mandates that the Agency for Health Care Administration (AHCA) approve drug products for treating serious mental illnesses without requiring step-therapy prior authorization under specific circumstances, thereby facilitating access to essential medications. Additionally, it includes provisions for the AHCA to implement a Medicaid prescribed-drug spending-control program, which will involve creating a preferred drug list and managing drug therapies for recipients using significant numbers of prescribed drugs.

Moreover, the bill modifies the prior authorization process for Medicaid medications, requiring the agency to post prior authorization criteria and updates on its website within 21 days of approval. It allows for age-related prior authorizations and establishes a step-therapy prior authorization process for medications not on the preferred drug list, developed in accordance with the Pharmaceutical and Therapeutics Committee. The bill also introduces a return and reuse program for drugs dispensed to institutional recipients, which includes a $5 restocking fee and mandates electronic execution for efficiency. The agency is tasked with evaluating the program's effectiveness in reducing the destruction of Medicaid prescription drugs and considering the rate impact of these changes in future Medicaid program rates, effective October 1, 2026.

Statutes affected:
S 70 Filed: 409.912, 409.910