Plain English Breakdown
The official text does not define what constitutes a 'serious mental illness' or 'substance use disorder,' referring only to existing definitions in other laws.
Ban on Step Therapy for Mental Health and Substance Use Drugs
This law stops health plans from requiring patients to try other drugs first before covering medicine for serious mental illness or substance use disorders, starting in January 2027.
What This Bill Does
- Prohibits step therapy requirements for prescription drugs treating serious mental illness or substance use disorder on new or renewed policies after January 1, 2027.
- Allows an exception if the U.S. Food and Drug Administration label says a patient must take other medication before taking the prescribed drug.
- Makes it a crime for health care service plans to willfully break this rule.
Who It Names or Affects
- Health care service plan contracts
- Health insurance policies issued, amended, or renewed on or after January 1, 2027
Terms To Know
- Step therapy
- A rule requiring patients to try other medications before a health plan covers the prescribed drug.
- Serious mental illness or substance use disorder
- Conditions defined by existing law that are protected from step therapy rules under this bill.
Limits and Unknowns
- The exact definition of 'serious mental illness' and 'substance use disorder' comes from other laws not included in this text.
- This rule only applies to policies issued, amended, or renewed on or after January 1, 2027.