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 medications prescribed for on-label or off-label use in the treatment of autoimmune disorders, cancer, rare diseases, and substance use disorders, provided that these prescriptions are based on a medical necessity determination. The only exceptions to this exemption are when 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 necessary medications for patients with serious health conditions, reducing barriers to treatment while still allowing for oversight in cases where alternative medications are available.

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