NC H680

Prohibits insurers from requiring prior authorization or step therapy for prescription drugs prescribed by health care providers to enrollees age 18 and older for prevention or treatment of serious mental illness, effective October 1, 2023.

Defines serious mental illness to include bipolar disorders, major depressive disorders, obsessive-compulsive disorder, paranoid personality disorder, schizo-affective disorders, and schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders.

Requires insurers to establish expeditious exception processes allowing enrollees or providers to request coverage for nonformulary drugs determined medically necessary, with 72-hour response times for non-urgent requests and 24-hour response times for urgent requests.

Mandates pharmacy and therapeutics committees meet conflict of interest standards set by the Centers for Medicare and Medicaid Services or accreditation standards of the National Committee for Quality Assurance.

Amends Medicaid provisions to prohibit step therapy requirements for Medicaid beneficiaries prescribed medications for serious mental illness if they previously failed treatment with a preferred drug or obtained prior authorization for the specific medication during the preceding calendar year.