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. It outlines that if the secretary of the executive office of health and human services determines that federal authorization is necessary for implementation, the secretary is authorized to seek such state plan amendment and may delay implementation until authorization is granted. The bill mandates that managed care organizations comply with these provisions through amendments to current and future contracts.

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

The bill requires the Rhode Island medical assistance program and managed care organizations to collect and report specific data related to the spending and utilization of anticonvulsant and antipsychotic medications from 2020 to 2027. This includes metrics such as annual gross and net spending, average annual costs, adherence to the preferred drug list, prior authorization requests, and step therapy exceptions. The collected data must be submitted to the executive office of health and human services, which will provide a comprehensive report to key legislative leaders by October 1, 2027.

The provisions of this bill will take effect upon passage, apply to policies executed, delivered, issued for delivery, continued, or renewed in the state on or after January 1, 2026, and will sunset on December 31, 2028.