The bill amends Chapter 40-21 of the General Laws entitled "Medical Assistance Prescription Drugs" by adding a new section that prohibits the Rhode Island medical assistance program and any managed care organization contracts from requiring prior authorization or a step therapy protocol for the prescription of nonpreferred medications used to treat certain mental health conditions and epilepsy or seizure disorders. The conditions specified include bipolar disorder, schizophrenia, schizotypal disorder, major depressive disorder, post-traumatic stress disorder as defined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and epilepsy or seizure disorders. This prohibition applies under certain conditions, such as if the enrollee has previously been prescribed the nonpreferred medication, if preferred medications have failed to produce desired health outcomes or caused unacceptable side effects, if the enrollee has been stabilized on a nonpreferred medication, or if the enrollee is stable on a nonpreferred medication that was ordered in an inpatient setting.

The bill also outlines that if federal authorization is necessary for implementation, the executive office of health and human services is authorized to seek such an amendment. It requires the Rhode Island medical assistance program to amend current and future contracts to meet the provisions of this section. The bill clarifies that this section does not prevent the program from denying an exception for a medication removed from the market due to safety concerns by the FDA. Additionally, it defines "step therapy protocol" as a protocol that establishes a specific sequence in which prescription medications for a specified medical condition are covered under a pharmacy or medical benefit. The act is set to take effect upon passage and applies to all healthcare policies, contracts, plans, and certificates in the state on or after January 1, 2025.