SB 1036 Summary

• Prohibits the Department of Health and Human Services from requiring prior authorization for central nervous system prescription drugs classified as anticonvulsants, antidepressants, antipsychotics, or noncontrolled antianxiety drugs under Medicaid.

• Exempts prescription drugs cross-indicated for exempted CNS drugs and those recognized as effective for conditions in the Diagnostic and Statistical Manual of Mental Disorders, including substance use disorder, from prior authorization requirements.

• Adds exemption from prior authorization for prescription drugs recognized to prevent or treat human immunodeficiency virus infection, complications of HIV, or acquired immunodeficiency syndrome.

• Maintains exemptions for drugs prescribed to treat cancer, organ replacement therapy, and epilepsy or seizure disorder.

• Excludes health maintenance organization contracts from these prior authorization restrictions and takes effect 90 days after enactment.