2025 -- S 0786 SUBSTITUTE A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE PRESCRIPTION DRUGS

     Introduced By: Senators Bissaillon, Lawson, Murray, DiMario, and Appollonio

     Date Introduced: March 14, 2025

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 40-21 of the General Laws entitled "Medical Assistance —

Prescription Drugs" is hereby amended by adding thereto the following section:

     40-21-4. Prohibition of prior authorization or step therapy protocol.

     (a) The Rhode Island medical assistance program, as defined under chapter 8 of this title,

and any contract between the Rhode Island medical assistance program and a managed care

organization shall not require prior authorization or a step therapy protocol for the coverage of a

nonpreferred medication classified as an anticonvulsant or antipsychotic on their drug formulary.

     (b) If the secretary of the executive office of health and human services determines that

authorization from a federal agency is necessary for the implementation of this section, the

secretary is authorized to seek such state plan amendment and may delay implementing the

provisions until the authorization is granted.

     (c) The Rhode Island medical assistance program shall require, through amending current

and future medical assistance managed care contracts, that the managed care organizations meet

the provisions of this section.

     (d) The provisions of subsection (a) of this section does not affect clinical prior

authorization edits to prescriptions of medications classified as an anticonvulsant or antipsychotic.

     (e) This section does not prevent the Rhode Island medical assistance program and any

contract between the Rhode Island medical assistance program and a managed care organization

from denying a medication that has been removed from the market due to safety concerns from the

federal Food and Drug Administration.

     (f) For the purposes of this section, "step therapy protocol" means a protocol that

establishes a specific sequence in which prescription medications for a specified medical condition

are medically necessary for a particular enrollee and are covered under a pharmacy or medical

benefit by the Rhode Island medical assistance program or a managed care organization, including

self-administered and physician-administered drugs.

     (g) On or before July 1, 2027, the Rhode Island medical assistance program and any

managed care organization who has a contract with the Rhode Island medical assistance program

shall collect and provide to the executive office of health and human services, in a form and

frequency acceptable to the secretary, a report that includes the following data for the years 2020-

2027:

     (1) For anticonvulsants and antipsychotics;

     (i) The annual gross amount spent;

     (ii) The annual net amount spent after rebates;

     (iv) The average annual cost by class for generic and non-generic anticonvulsant and

antipsychotic medications;

     (v) The total number of anticonvulsant and antipsychotic medication claims;

     (vi) The percentage of adherence to the preferred drug list ("PDL") for anticonvulsant and

antipsychotic medications;

     (vii) The total number of prior authorizations submitted for nonpreferred anticonvulsant

and antipsychotic medications;

     (viii) the total number of step therapy exceptions requested for nonpreferred anticonvulsant

and antipsychotic medications;

     (ix) the total number of step edits per nonpreferred anticonvulsant and antipsychotic

medication;

     (x) The percentages of prior authorization and step therapy approvals and denials; and

     (xi) The generic anticonvulsant and generic antipsychotic medication utilization

percentages.

     (h) On or before July 1, 2027, the director of the department of health shall collect and

provide to the executive office of health and human services, in a form and frequency acceptable

to the secretary, a report that includes the following data for the years 2020-2027 from the state and

from each of the thirty-nine (39) municipalities:

     (1) Gross amount, non-aggregated by entity type, spent on services and personnel related

to mental health emergencies performed by the following entities:

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     (i) Ground ambulance transport;

     (ii) Air ambulance transport;

     (iii) Hospitals, including inpatient and emergency departments;

     (iv) Police departments; and

     (v) Fire departments.

     (i) On or before October 1, 2027, the executive office of health and human services shall

produce and provide the information collected pursuant subsections (g) and (h) of this section to

the speaker of the house of representatives, the president of the senate, the house of representatives

committee on finance, and the senate committee on health and human services.

     (j) The provisions of this section shall sunset and be repealed effective December 31, 2028.

     SECTION 2. This act will take effect upon passage and would apply to all policies,

contracts, and plans executed, delivered, issued for delivery, continued or renewed in this state on

or after January 1, 2026 and shall sunset and be repealed effective December 31, 2028.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE PRESCRIPTION DRUGS

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     This act would define step therapy protocol and prohibit the Rhode Island medical

assistance program, and any contract between the Rhode Island medical assistance program and a

managed care organization from requiring prior authorization or a step therapy protocol for the

coverage of a nonpreferred medication classified as an anticonvulsant or antipsychotic.

     This act would take effect upon passage and would apply to all policies, contracts, and

plans executed, delivered, issued for delivery, continued or renewed in this state on or after January

1, 2026 and shall sunset and be repealed effective December 31, 2028.

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