The bill amends the Prior Authorization Act to expand the categories of drugs that are exempt from prior authorization and step therapy protocols. Specifically, it adds coverage for medications approved by the federal Food and Drug Administration (FDA) that are prescribed for on-label or off-label use in the treatment of autoimmune disorders, cancer, rare diseases, or substance use disorders, provided that a medical necessity determination is made. This exemption applies unless a biosimilar, interchangeable biologic, or generic version of the medication is available.

Additionally, the bill defines "rare disease" as a condition that affects fewer than two hundred thousand people in the United States. This legislative change aims to streamline access to essential medications for patients with serious health conditions, reducing barriers to timely treatment.

Statutes affected:
introduced version: 59A-22B-8