The bill amends Chapter 40-21 of the General Laws regarding "Medical Assistance Prescription Drugs" by introducing a new section that 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 coverage of nonpreferred medications classified as anticonvulsants or antipsychotics. The secretary of the executive office of health and human services is authorized to seek federal authorization if necessary for the implementation of this section and may delay implementation until such authorization is granted. Managed care organizations are required to comply with these provisions through amendments to current and future medical assistance managed care contracts.

The bill clarifies that clinical prior authorization edits for prescriptions of medications classified as anticonvulsants or antipsychotics remain permissible, and it does not prevent the Rhode Island medical assistance program from denying coverage for medications that have been removed from the market due to safety concerns by the federal Food and Drug Administration.

Additionally, the Rhode Island medical assistance program and managed care organizations must collect and report specific data related to anticonvulsant and antipsychotic medications, including annual spending, claims, adherence to preferred drug lists, and prior authorization requests, by July 1, 2027. The director of the department of health is also required to report on expenditures related to mental health emergencies from various entities by the same date.

The provisions of this section will sunset and be repealed effective December 31, 2028. The act will take effect upon passage and will apply to all relevant policies, contracts, and plans executed, delivered, issued for delivery, continued, or renewed in the state on or after January 1, 2026.