The bill seeks to amend existing laws regarding health insurance policies by adding provisions that restrict the use of prior authorization and step therapy protocols for nonpreferred anticonvulsant or antipsychotic medications under specific circumstances. These circumstances include cases where the patient has previously been prescribed the medication, has not achieved the desired outcome with a preferred medication, has suffered unacceptable side effects from a preferred medication, has been stabilized on a nonpreferred medication, or is stable on a nonpreferred medication after inpatient care. The bill also specifies that these prohibitions do not interfere with clinical prior authorization edits or the denial of exceptions for medications that have been removed from the market by the FDA due to safety concerns. Additionally, the bill defines "step therapy protocol" and aims to simplify the process for patients to receive medically appropriate nonpreferred medications without the need for prior authorization or step therapy.

The proposed legislation affects individual or group health insurance contracts, hospital or medical expense insurance policies, plans, or group policies delivered, issued for delivery, or renewed in Rhode Island, as well as the Rhode Island medical assistance program and managed care organization contracts. The bill mandates that these entities comply with the new provisions and authorizes the executive office of health and human services to seek federal authorization if necessary for implementation. The act would become effective upon passage and apply to all relevant policies, contracts, and certificates in the state on or after January 1, 2025.