This bill aims to amend the Code of West Virginia by narrowing the scope of prior authorization mandates specifically for FDA-approved antipsychotics. A significant insertion in the bill states that, except for certain conditions outlined in subsection (b), prior authorization mandates and utilization management controls cannot be imposed on these medications under both fee-for-service and managed care medical assistance programs. This change is intended to facilitate timely treatment for individuals with serious mental illnesses, thereby reducing barriers to accessing necessary medications.

Additionally, the bill outlines various procedural requirements for the Bureau for Medical Services regarding prior authorization requests, including the establishment of an electronic portal for submissions, timelines for responses, and protocols for appeals. It also introduces a civil penalty for violations of the new provisions, emphasizing the importance of compliance in the management of prior authorizations. Overall, the bill seeks to streamline the process while ensuring that patients have better access to essential antipsychotic medications.

Statutes affected:
Introduced Version: 9-5-32