HUMAN SERVICES -- MEDICAL ASSISTANCE -- PRESCRIPTION DRUGS, the official text

H7587 2026 -- H 7587 ======== LC004281 ======== STATE OF RHODE ISLAND IN GENERAL ASSEMBLY JANUARY SESSION, A.D. 2026 ____________ A N A C T RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- PRESCRIPTION DRUGS Introduced By: Representatives Casey, Potter, Chippendale, Hopkins, Paplauskas, Santucci, Speakman, Serpa, and McGaw Date Introduced: February 06, 2026 Referred To: House Finance It is enacted by the General Assembly as follows: 1 SECTION 1. Chapter 40-21 of the General Laws entitled Medical Assistance — 2 Prescription Drugs is hereby amended by adding thereto the following section: 3 40-21-4. Prohibition of prior authorization or step therapy protocol. 4 (a) The Rhode Island medical assistance program, as defined under chapter 8 of this title, 5 and any contract between the Rhode Island medical assistance program and a managed care 6 organization shall not require prior authorization or a step therapy protocol for the coverage of a 7 medication classified as an anticonvulsant or antipsychotic on their drug formulary. 8 (b) If the secretary of the executive office of health and human services determines that 9 authorization from a federal agency is necessary for the implementation of this section, the 10 secretary is authorized to seek such state plan amendment and may delay implementing the 11 provisions until the authorization is granted. 12 (c) The Rhode Island medical assistance program shall require, through amending current 13 and future medical assistance managed care contracts, that the managed care organizations meet 14 the provisions of this section. 15 (d) The provisions of subsection (a) of this section do not affect clinical prior authorization 16 edits to prescriptions of medications classified as an anticonvulsant or antipsychotic. 17 (e) This section does not prevent the Rhode Island medical assistance program and any 18 contract between the Rhode Island medical assistance program and a managed care organization 1 from denying a medication that has been removed from the market due to safety concerns from the 2 federal Food and Drug Administration. 3 (f) For the purposes of this section, step therapy protocol means a protocol that 4 establishes a specific sequence in which prescription medications for a specified medical condition 5 are medically necessary for a particular enrollee and are covered under a pharmacy or medical 6 benefit by the Rhode Island medical assistance program or a managed care organization, including 7 self-administered and physician-administered drugs. 8 (g) On or before July 1, 2029, the Rhode Island medical assistance program and any 9 managed care organization that has a contract with the Rhode Island medical assistance program 10 shall collect and provide to the executive office of health and human services, in a form and 11 frequency acceptable to the secretary, a report that includes the following data for the years 2021- 12 2029: 13 (1) For anticonvulsants and antipsychotics; 14 (i) The annual gross amount spent; 15 (ii) The annual net amount spent after rebates; 16 (iv) The average annual cost by class for generic and non-generic anticonvulsant and 17 antipsychotic medications; 18 (v) The total number of anticonvulsant and antipsychotic medication claims; 19 (vi) The percentage of adherence to the preferred drug list ( PDL ) for anticonvulsant and 20 antipsychotic medications; 21 (vii) The total number of prior authorizations submitted for nonpreferred anticonvulsant 22 and antipsychotic medications; 23 (viii) The total number of step therapy exceptions requested for nonpreferred 24 anticonvulsant and antipsychotic medications; 25 (ix) The total number of step edits per nonpreferred anticonvulsant and antipsychotic 26 medication; 27 (x) The percentages of prior authorization and step therapy approvals and denials; and 28 (xi) The generic anticonvulsant and generic antipsychotic medication utilization 29 percentages. 30 (h) On or before July 1, 2029, the director of the department of health shall collect and 31 provide to the executive office of health and human services, in a form and frequency acceptable 32 to the secretary, a report that includes the following data for the years 2021-2029 from the state and 33 from each of the thirty-nine (39) municipalities: 34 (1) Gross amount, non-aggregated by entity type, spent on services and personnel related LC004281 - Page 2 of 4 1 to mental health emergencies performed by the following entities: 2 (i) Ground ambulance transport; 3 (ii) Air ambulance transport; 4 (iii) Hospitals, including inpatient and emergency departments; 5 (iv) Police departments; and 6 (v) Fire departments. 7 (i) On or before October 1, 2029, the executive office of health and human services shall 8 produce and provide the information collected pursuant to subsections (g) and (h) of this section to 9 the speaker of the house of representatives, the president of the senate, the house of representatives 10 committee on finance, and the senate committee on health and human services. 11 (j) The provisions of this section shall sunset and be repealed effective December 31, 2029. 12 (k) This section applies to all policies, contracts, and plans executed, delivered, issued for 13 delivery, continued or renewed in this state on or after January 1, 2027. This section shall sunset 14 and be repealed on December 31, 2029. 15 SECTION 2. This act shall take effect on January 1, 2027, and shall sunset and be repealed 16 on December 31, 2029. ======== LC004281 ======== LC004281 - Page 3 of 4 EXPLANATION BY THE LEGISLATIVE COUNCIL OF A N A C T RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- PRESCRIPTION DRUGS *** 1 This act would prohibit the Rhode Island medical assistance program, and any contract 2 between the Rhode Island medical assistance program and a managed care organization, from 3 requiring prior authorization or a step therapy protocol for the coverage of a medication classified 4 as an anticonvulsant or antipsychotic. 5 This act would take effect on January 1, 2027, and would sunset and be repealed on 6 December 31, 2029. ======== LC004281 ======== LC004281 - Page 4 of 4