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  • Summary date: Apr 18 2023 - View Summary

    Amends GS 58-3-221(Access to nonformulary and restricted access prescription drugs) to prohibit insurers from requiring prior authorization or the use of other drugs not prescribed by the provider when a patient age 18 or older is prescribed a drug by a health care provider for the prevention or treatment of a serious mental illness, as defined. Also applies the requirements of the statute to a pharmacy benefits manager under contract with an insurer. Makes clarifying changes to the definitions for the section and to language used throughout the section. Effective and applicable to insurance contracts issued, renewed, or amended on or after October 1, 2023. 

    Amends GS 108A-68.1 (Certain prescription drugs exempt from prior authorization requirements) to ensure a Medicaid beneficiary does not have to try a different prescription medication prior to the approval of the prescribed drug for the treatment of severe mental illness, if certain conditions are met. Requires that the medication be prescribed to the beneficiary by a licensed health care provider for the treatment of specific severe mental illnesses, as identified. Also requires that, during the preceding calendar year, even if not receiving Medicaid benefits, either the beneficiary was prescribed and unsuccessfully treated with a preferred prescription drug from a Medicaid drug formulary, or the beneficiary was prescribed and had prior authorization for the specific medication prescribed. Provides that beneficiaries will not be required to try a different prescription medication prior to the approval of coverage for injectable antipsychotic drugs for the treatment of schizophrenia.