This bill amends the Social Welfare Act by modifying section 109h and adding section 109t. The amendments to section 109h establish that if the Department of Health and Human Services creates a prior authorization process for prescription drugs under the medical assistance program, it cannot require prior authorization for certain categories of drugs. These include specific central nervous system prescription drugs, drugs recognized for treating conditions in the latest diagnostic manual, and medications for HIV treatment, cancer, organ replacement therapy, epilepsy, opioid withdrawal, and menopause symptoms. Additionally, the bill specifies that prior authorization cannot be denied for controlled substances unless they do not align with licensed indications or accepted medical practices.

Section 109t mandates that the department provide coverage for medically necessary care related to menopause and perimenopause, including hormone replacement therapy. It prohibits the use of step therapy or fail-first protocols for these treatments. The bill also defines "menopause" and "perimenopause" to clarify the conditions under which the coverage applies. Overall, the bill aims to enhance access to necessary medications and treatments for individuals experiencing menopause and related health issues.

Statutes affected:
House Introduced Bill: 400.109