The bill amends Chapter 40-21 of the General Laws regarding "Medical Assistance Prescription Drugs" by introducing a new section, 40-21-4, which prohibits the Rhode Island medical assistance program and any contracts with managed care organizations from requiring prior authorization or a step therapy protocol for the prescription of nonpreferred medications classified as anticonvulsants or antipsychotics on their drug formulary.

The bill also states that if the secretary of health and human services determines that federal authorization is necessary for the implementation of this section, the executive office of health and human services is authorized to seek such state plan amendment and may delay implementation until the authorization is granted.

Furthermore, the Rhode Island medical assistance program is required to ensure that managed care organizations meet the provisions of this section through amendments to current and future medical assistance managed care contracts. The provisions of this section do not affect clinical prior authorization edits to prescriptions of medications classified as anticonvulsants or antipsychotics. Additionally, the bill allows for the denial of exceptions for medications that have been removed from the market due to safety concerns from the federal Food and Drug Administration.

The bill defines "step therapy protocol" as a protocol that establishes a specific sequence in which prescription medications for a specified medical condition are deemed medically necessary for a particular enrollee and are covered under a pharmacy or medical benefit by a carrier, including self-administered and physician-administered drugs.

This act is set to take effect upon passage and will apply to all policies, contracts, and plans executed, delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2026.