This bill amends the Social Welfare Act to establish guidelines for the prior authorization process for prescription drugs under the medical assistance program. It specifies that the Department of Health and Human Services cannot require prior authorization for certain categories of prescription drugs, including specific central nervous system medications, drugs for treating conditions recognized in the latest diagnostic manual, and medications for HIV treatment. Additionally, the bill introduces a new provision that mandates coverage for medically necessary care related to menopause and perimenopause, including hormone replacement therapy, and prohibits the use of step therapy or fail-first protocols for these treatments.

Furthermore, the bill defines key terms related to menopause and perimenopause, ensuring clarity in the implementation of these provisions. The inclusion of these definitions and the stipulations regarding prior authorization aim to enhance access to necessary medications and treatments for individuals under the medical assistance program, particularly for those experiencing menopause and related health issues.

Statutes affected:
Senate Introduced Bill: 400.109