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| 5 | 5 | | 2025 -- H 5320 |
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| 6 | 6 | | ======== |
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| 7 | 7 | | LC000814 |
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| 8 | 8 | | ======== |
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| 9 | 9 | | S T A T E O F R H O D E I S L A N D |
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| 10 | 10 | | IN GENERAL ASSEMBLY |
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| 11 | 11 | | JANUARY SESSION, A.D. 2025 |
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| 12 | 12 | | ____________ |
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| 13 | 13 | | |
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| 14 | 14 | | A N A C T |
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| 15 | 15 | | RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- PRESCRIPTION |
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| 16 | 16 | | DRUGS |
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| 17 | 17 | | Introduced By: Representatives Casey, Potter, Donovan, Speakman, McGaw, Kazarian, |
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| 18 | 18 | | Dawson, Chippendale, Serpa, and Cortvriend |
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| 19 | 19 | | Date Introduced: February 05, 2025 |
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| 20 | 20 | | Referred To: House Finance |
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| 21 | 21 | | |
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| 22 | 22 | | |
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| 23 | 23 | | It is enacted by the General Assembly as follows: |
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| 24 | 24 | | SECTION 1. Chapter 40-21 of the General Laws entitled "Medical Assistance — 1 |
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| 25 | 25 | | Prescription Drugs" is hereby amended by adding thereto the following section: 2 |
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| 26 | 26 | | 40-21-4. Prohibition of prior authorization or step therapy protocol. 3 |
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| 27 | 27 | | (a) The Rhode Island medical assistance program, as defined by this chapter, and any 4 |
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| 28 | 28 | | contract between the Rhode Island medical assistance program, as defined under chapter 8 of title 5 |
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| 29 | 29 | | 40, and a managed care organization shall not require prior authorization or a step therapy protocol 6 |
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| 30 | 30 | | for the prescription of a nonpreferred medication classified as an anticonvulsant or antipsychotic 7 |
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| 31 | 31 | | on their drug formulary. 8 |
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| 32 | 32 | | (b) If the secretary of health and human services determines that authorization from a 9 |
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| 33 | 33 | | federal agency is necessary for the implementation of this section, the executive office of health 10 |
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| 34 | 34 | | and human services is authorized to seek such state plan amendment and may delay implementing 11 |
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| 35 | 35 | | the provisions until the authorization is granted. 12 |
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| 36 | 36 | | (c) The Rhode Island medical assistance program, as defined under chapter 8 of title 40, 13 |
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| 37 | 37 | | shall require, through amending current and future medical assistance managed care contracts, that 14 |
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| 38 | 38 | | the managed care organizations meet the provisions of this section. 15 |
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| 39 | 39 | | (d) The provisions of subsection (a) of this section do not affect clinical prior authorization 16 |
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| 40 | 40 | | edits to prescriptions of medications classified as an anticonvulsant or antipsychotic. 17 |
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| 41 | 41 | | (e) This section does not prevent the Rhode Island medical assistance program, as defined 18 |
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| 42 | 42 | | |
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| 43 | 43 | | |
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| 44 | 44 | | LC000814 - Page 2 of 3 |
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| 45 | 45 | | under chapter 8 of title 40, and any contract between the Rhode Island medical assistance program 1 |
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| 46 | 46 | | and a managed care organization from denying an exception for a medication that has been removed 2 |
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| 47 | 47 | | from the market due to safety concerns from the federal Food and Drug Administration. 3 |
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| 48 | 48 | | (f) For the purposes of this section, "step therapy protocol" means a protocol that 4 |
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| 49 | 49 | | establishes a specific sequence in which prescription medications for a specified medical condition 5 |
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| 50 | 50 | | are medically necessary for a particular enrollee and are covered under a pharmacy or medical 6 |
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| 51 | 51 | | benefit by a carrier, including self-administered and physician-administered drugs. 7 |
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| 52 | 52 | | SECTION 2. This act shall take effect upon passage and applies to all healthcare policies, 8 |
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| 53 | 53 | | contracts, plans, and certificates executed, delivered, issued for delivery, continued or renewed in 9 |
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| 54 | 54 | | this state on or after January 1, 2026. 10 |
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| 55 | 55 | | ======== |
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| 56 | 56 | | LC000814 |
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| 57 | 57 | | ======== |
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| 58 | 58 | | |
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| 59 | 59 | | |
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| 60 | 60 | | LC000814 - Page 3 of 3 |
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| 61 | 61 | | EXPLANATION |
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| 62 | 62 | | BY THE LEGISLATIVE COUNCIL |
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| 63 | 63 | | OF |
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| 64 | 64 | | A N A C T |
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| 65 | 65 | | RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- PRESCRIPTION |
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| 66 | 66 | | DRUGS |
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| 67 | 67 | | *** |
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| 68 | 68 | | This act would define step therapy protocol and prohibit the Rhode Island medical 1 |
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| 69 | 69 | | assistance program, and any contract between the Rhode Island medical assistance program and a 2 |
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| 70 | 70 | | managed care organization from requiring prior authorization or a step therapy protocol for the 3 |
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| 71 | 71 | | prescription of a nonpreferred medication classified as an anticonvulsant or antipsychotic. 4 |
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| 72 | 72 | | This act would take effect upon passage and would apply to all policies, contracts, and 5 |
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| 73 | 73 | | plans executed, delivered, issued for delivery, continued or renewed in this state on or after January 6 |
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| 74 | 74 | | 1, 2026. 7 |
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| 75 | 75 | | ======== |
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| 76 | 76 | | LC000814 |
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