This bill amends the Social Welfare Act to establish specific provisions regarding prior authorization for prescription drugs under the medical assistance program. It stipulates that if the Department of Health and Human Services develops a prior authorization process, it cannot require prior authorization for certain categories of prescription drugs, including central nervous system medications (such as anticonvulsants and antidepressants), drugs for treating conditions recognized in the latest diagnostic manual, and medications for managing symptoms of menopause and perimenopause. The bill also clarifies that the department may not deny prior authorization requests for controlled substances unless they are inconsistent with licensed indications or accepted medical practices.

Additionally, the bill introduces a new section (Sec. 109t) that mandates coverage for medically necessary care or treatment related to menopause and perimenopause, including hormone replacement therapy. It prohibits the use of step therapy or fail-first protocols for these treatments, ensuring that patients can access necessary medications without unnecessary barriers. Definitions for "menopause" and "perimenopause" are also provided to clarify the terms used in the legislation.

Statutes affected:
House Introduced Bill: 400.109