The bill amends Chapter 27-38.2 of the General Laws, which is entitled "Insurance Coverage for Mental Illness and Substance Abuse," by adding new definitions and provisions. It introduces the term "step therapy protocol," which refers to a specific sequence in which prescription drugs are deemed medically necessary for a particular enrollee and are covered under a pharmacy or medical benefit by a carrier. The bill also prohibits group health plans, individual or group health insurance plans, the Rhode Island medical assistance program, and contracts with managed care organizations from requiring prior authorization or a step therapy protocol for the prescription of nonpreferred medications used to assess or treat certain mental health conditions. These conditions include bipolar disorder, schizophrenia or schizotypal disorder, major depressive disorder, or post-traumatic stress disorder as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition.

The bill specifies that this prohibition does not affect clinical prior authorization edits for preferred and nonpreferred prescriptions of medications to treat serious mental illness. It also states that if federal authorization is necessary for implementation, the executive office of health and human services is authorized to seek such an amendment and may delay implementing the provisions until authorization is granted. The Rhode Island medical assistance program is required to ensure that managed care organizations meet the provisions of this section through amending current and future contracts. The bill clarifies that health plans can still deny an exception for a drug removed from the market due to safety concerns by the FDA. The act will take effect upon passage and applies to all policies, contracts, and certificates in Rhode Island on or after January 1, 2024.

Statutes affected:
6218: 27-38.2-2