HF4402 Summary

• Expands mental health carve out from prior authorization requirements to include any FDA-approved medicine indicated for treatment of mental disorders or conditions that result in serious functional impairment, not just atypical antipsychotic drugs.

• Adds "other utilization management controls" (including step therapy protocols) to the prohibition on prior authorization requirements for covered mental health medications.

• Requires automatic 60-day prior authorization approval for brand-name mental health drugs within 60 days of when a generic equivalent becomes available, provided the brand drug was part of the recipient's treatment at that time.

• Requires the Formulary Committee to hold a public forum and accept public comment for an additional 15 days before the commissioner can require prior authorization for any drug.

• Maintains existing provisions for liquid methadone and oral liquid forms of drugs, including 24-hour automatic approval for patients using enteral tubes for feeding or medication administration.