Medicaid Prior Authorization Prohibition

The act prohibits the department of health care policy and financing (department) from requiring an adult to be prescribed an antipsychotic prescription drug that is included on the preferred drug list and used to treat a mental health disorder or mental health condition if:

• During the preceding year, the adult was prescribed and unsuccessfully treated with an antipsychotic prescription drug that is included on the preferred drug list and used to treat a mental health disorder or mental health condition and for which a single claim is paid; or
• The adult is stable on an antipsychotic drug used to treat a mental health disorder or mental health condition that is not included on the preferred drug list.

The act appropriates $1,092,134 to the department. This appropriation consists of $888,555 from the general fund and $203,579 from the healthcare affordability and sustainability fee cash fund. The department may use this appropriation for medical and long-term care services for medicaid-eligible individuals. It is anticipated that the department will receive an additional $2,295,189 in federal funds for the implementation of this act.

APPROVED by Governor June 3, 2024

EFFECTIVE June 3, 2024
(Note: This summary applies to this bill as enacted.)