No. SB 70
Filed under Healthcare.
Step-therapy Protocols; Requiring the Agency for Health Care Administration to approve drug products for Medicaid recipients for the treatment of serious mental illness without step-therapy prior authorization under certain circumstances; directing the agency to include rate impacts resulting from the act in certain rates that become effective on a specified date, etc.
Plain English Summary
AI-GENERATEDCreates a new legal definition of 'serious mental illness' covering bipolar disorder, major depression, obsessive-compulsive disorder, paranoid personality or other psychotic disorders, schizoaffective disorders, and schizophrenia for Florida's Medicaid statutes.
Expands the diagnoses that let a Medicaid drug bypass step-therapy prior authorization from only schizophrenia-spectrum disorders to the full, broader list of serious mental illnesses defined by this bill.
For drugs treating a serious mental illness, the agency must approve the bypass once a physician documents medical necessity, rather than simply having discretion to approve it as with other drugs.
Directs the state Medicaid agency to fold the cost of this change into managed care capitation rates that take effect October 1, 2026, when the rest of the act also takes effect.
AICreates a new statutory definition of serious mental illness listing specific psychiatric disorders, including bipolar disorders, major depressive disorders, obsessive-compulsive disorders, paranoid personality or other psychotic disorders, schizoaffective disorders, and schizophrenia.
AIFor a drug product treating a serious mental illness, the agency must approve the drug without the usual step-therapy prior authorization once the documentation criteria are met, instead of merely having discretion to approve it.
AIThe step-therapy exception for a patient already stabilized on a specific drug used to apply only to schizophrenia, schizotypal, or delusional disorders. It now applies to any diagnosis covered by the broader serious mental illness definition.
AIThe Agency for Health Care Administration must build the rate impact of this act into the Medicaid managed medical assistance program and long-term care managed care program rates effective October 1, 2026.