AN ACT RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- PRESCRIPTION DRUGS (Prohibits the Rhode Island medical assistance program from requiring prior authorization or a step therapy protocol for the coverage of a medication classified as an anticonvulsant or antipsychotic.)

S2385

2026 -- S 2385
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LC004629
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
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A N A C T
RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- PRESCRIPTION
DRUGS

Introduced By:
Senators Bissaillon, Murray, LaMountain, and DiMario

Date Introduced:
January 30, 2026

Referred To:
Senate Health & Human Services
It is enacted by the General Assembly as follows:
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SECTION 1. Chapter 40-21 of the General Laws entitled "Medical Assistance —
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Prescription Drugs" is hereby amended by adding thereto the following section:
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40-21-4. Prohibition of prior authorization or step therapy protocol.

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(a) The Rhode Island medical assistance program, as defined under chapter 8 of this title,
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and any contract between the Rhode Island medical assistance program and a managed care
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organization shall not require prior authorization or a step therapy protocol for the coverage of a
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medication classified as an anticonvulsant or antipsychotic on their drug formulary.
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(b) If the secretary of the executive office of health and human services determines that
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authorization from a federal agency is necessary for the implementation of this section, the
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secretary is authorized to seek such state plan amendment and may delay implementing the
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provisions until the authorization is granted.
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(c) The Rhode Island medical assistance program shall require, through amending current
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and future medical assistance managed care contracts, that the managed care organizations meet
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the provisions of this section.
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(d) The provisions of subsection (a) of this section do not affect clinical prior authorization
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edits to prescriptions of medications classified as an anticonvulsant or antipsychotic.
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(e) This section does not prevent the Rhode Island medical assistance program and any
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contract between the Rhode Island medical assistance program and a managed care organization

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from denying a medication that has been removed from the market due to safety concerns from the
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federal Food and Drug Administration.
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(f) For the purposes of this section, "step therapy protocol" means a protocol that
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establishes a specific sequence in which prescription medications for a specified medical condition
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are medically necessary for a particular enrollee and are covered under a pharmacy or medical
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benefit by the Rhode Island medical assistance program or a managed care organization, including
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self-administered and physician-administered drugs.
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(g) On or before July 1, 2029, the Rhode Island medical assistance program and any
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managed care organization that has a contract with the Rhode Island medical assistance program
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shall collect and provide to the executive office of health and human services, in a form and
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frequency acceptable to the secretary, a report that includes the following data for the years 2021-
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2029:
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(1) For anticonvulsants and antipsychotics;
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(i) The annual gross amount spent;
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(ii) The annual net amount spent after rebates;
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(iv) The average annual cost by class for generic and non-generic anticonvulsant and
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antipsychotic medications;
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(v) The total number of anticonvulsant and antipsychotic medication claims;
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(vi) The percentage of adherence to the preferred drug list ("PDL") for anticonvulsant and
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antipsychotic medications;
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(vii) The total number of prior authorizations submitted for nonpreferred anticonvulsant
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and antipsychotic medications;
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(viii) The total number of step therapy exceptions requested for nonpreferred
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anticonvulsant and antipsychotic medications;
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(ix) The total number of step edits per nonpreferred anticonvulsant and antipsychotic
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medication;
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(x) The percentages of prior authorization and step therapy approvals and denials; and
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(xi) The generic anticonvulsant and generic antipsychotic medication utilization
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percentages.
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(h) On or before July 1, 2029, the director of the department of health shall collect and
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provide to the executive office of health and human services, in a form and frequency acceptable
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to the secretary, a report that includes the following data for the years 2021-2029 from the state and
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from each of the thirty-nine (39) municipalities:
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(1) Gross amount, non-aggregated by entity type, spent on services and personnel related

LC004629 - Page 2 of 4
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to mental health emergencies performed by the following entities:
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(i) Ground ambulance transport;
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(ii) Air ambulance transport;
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(iii) Hospitals, including inpatient and emergency departments;
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(iv) Police departments; and
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(v) Fire departments.
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(i) On or before October 1, 2029, the executive office of health and human services shall
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produce and provide the information collected pursuant to subsections (g) and (h) of this section to
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the speaker of the house of representatives, the president of the senate, the house of representatives
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committee on finance, and the senate committee on health and human services.
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(j) The provisions of this section shall sunset and be repealed effective December 31, 2029.
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(k) This section applies to all policies, contracts, and plans executed, delivered, issued for
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delivery, continued or renewed in this state on or after January 1, 2027. This section shall sunset
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and be repealed on December 31, 2029.
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SECTION 2. This act shall take effect on January 1, 2027, and shall sunset and be repealed
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on December 31, 2029.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- PRESCRIPTION
DRUGS
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This act would prohibit the Rhode Island medical assistance program, and any contract
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between the Rhode Island medical assistance program and a managed care organization, from
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requiring prior authorization or a step therapy protocol for the coverage of a medication classified
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as an anticonvulsant or antipsychotic.
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This act would take effect on January 1, 2027, and would sunset and be repealed on
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December 31, 2029.
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