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S 2385Pharmaceuticals

Human Services - Medical Assistance - Prescription Drugs

This bill eliminates approval hurdles for Medicaid patients needing seizure or antipsychotic medications until the end of 2029.

Introduced36 Yea0 Nay2 Not voting
Population
Affected
15
Email Legislator
Introduced Jan 30, 2026Committee Senate Health & Human Services

Plain-English Summary

This legislation changes how the Rhode Island Medical Assistance Program (Medicaid) covers certain medications. It prohibits the program and its managed care contractors from requiring "prior authorization" or "step therapy" (a process requiring patients to try cheaper drugs first) for anticonvulsant and antipsychotic prescriptions. The bill allows for standard clinical safety checks and requires federal approval if necessary. Additionally, it mandates that state agencies collect and report detailed data regarding the costs and usage of these drugs, as well as the costs incurred by emergency services for mental health emergencies, between 2021 and 2029.

For younger readers

Sometimes, when people need medicine for seizures or serious mental health problems, insurance rules make them ask for special permission or try other medicines first. This bill stops those rules for people who get health insurance from the state. It allows doctors to give patients the exact medicine they need right away without waiting or filling out extra forms. The state will also collect information to see how much this costs and how often police or ambulances are used for mental health emergencies. This new rule starts in 2027 and ends in 2029.

Who & Where It Applies

Impacted groups
Medicaid recipientsManaged care organizationsDoctors and psychiatristsPharmacistsPatients with epilepsy or mental health conditions
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
Amount unknown
Estimated revenue
None

Bill Analysis

Both viewpoints
For Progressives
  • Ensures immediate access to critical mental health and seizure medications for low-income residents on Medicaid, removing bureaucratic barriers that often delay treatment.
  • Mandates comprehensive data collection on the use of police and emergency services for mental health crises, which can help identify systemic failures and support arguments for non-carceral crisis intervention.
  • Protects vulnerable patients from "fail-first" protocols that can cause physical harm or mental instability, prioritizing patient well-being over insurance cost-cutting measures.
  • Likely increases the cost of the Medicaid program significantly, which could divert limited funds away from other essential social services or public health initiatives.
  • Removes negotiating leverage against pharmaceutical corporations, potentially allowing them to profit more heavily from state funds without price controls.
  • The legislation includes a sunset clause, meaning these protections are temporary and could leave patients facing instability when the law expires in 2029.
For Conservatives
  • Reduces bureaucratic red tape and government interference in the doctor-patient relationship by removing administrative hurdles like prior authorization.
  • Includes a strict sunset clause, ensuring that the program automatically expires and must be re-evaluated rather than becoming a permanent government expansion.
  • mandates rigorous data reporting on government spending and program efficacy, increasing transparency regarding how taxpayer funds are utilized in the Medicaid system.
  • Removes cost-control mechanisms (step therapy) used by insurers, which will almost certainly result in higher government spending and increased burdens on taxpayers.
  • Interferes with the free market operations of managed care organizations by dictating contract terms and prohibiting standard insurance practices.
  • Expands government entitlement benefits without identifying a funding source, potentially leading to future budget deficits.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 64 additions

SECTION 1. Chapter 40-21 of the General Laws entitled "Medical Assistance — Prescription Drugs" is hereby amended by adding thereto the following section: 40-21-4. Prohibition of prior authorization or step therapy protocol.

(a) The Rhode Island medical assistance program, as defined under chapter 8 of this title, and any contract between the Rhode Island medical assistance program and a managed care organization shall not require prior authorization or a step therapy protocol for the coverage of a medication classified as an anticonvulsant or antipsychotic on their drug formulary.

(b) If the secretary of the executive office of health and human services determines that authorization from a federal agency is necessary for the implementation of this section, the secretary is authorized to seek such state plan amendment and may delay implementing the provisions until the authorization is granted.

(c) The Rhode Island medical assistance program shall require, through amending current and future medical assistance managed care contracts, that the managed care organizations meet the provisions of this section.

(d) The provisions of subsection (a) of this section do not affect clinical prior authorization edits to prescriptions of medications classified as an anticonvulsant or antipsychotic.

(e) This section does not prevent the Rhode Island medical assistance program and any contract between the Rhode Island medical assistance program and a managed care organization from denying a medication that has been removed from the market due to safety concerns from the federal Food and Drug Administration.

(f) For the purposes of this section, "step therapy protocol" means a protocol that establishes a specific sequence in which prescription medications for a specified medical condition are medically necessary for a particular enrollee and are covered under a pharmacy or medical benefit by the Rhode Island medical assistance program or a managed care organization, including self-administered and physician-administered drugs.

(g) On or before July 1, 2029, the Rhode Island medical assistance program and any managed care organization that has a contract with the Rhode Island medical assistance program shall collect and provide to the executive office of health and human services, in a form and frequency acceptable to the secretary, a report that includes the following data for the years 2021- 2029:

(1) For anticonvulsants and antipsychotics;

(i) The annual gross amount spent;

(ii) The annual net amount spent after rebates;

(iv) The average annual cost by class for generic and non-generic anticonvulsant and antipsychotic medications;

(v) The total number of anticonvulsant and antipsychotic medication claims;

(vi) The percentage of adherence to the preferred drug list ("PDL") for anticonvulsant and antipsychotic medications;

(vii) The total number of prior authorizations submitted for nonpreferred anticonvulsant and antipsychotic medications;

(viii) The total number of step therapy exceptions requested for nonpreferred anticonvulsant and antipsychotic medications;

(ix) The total number of step edits per nonpreferred anticonvulsant and antipsychotic medication;

(x) The percentages of prior authorization and step therapy approvals and denials; and

(xi) The generic anticonvulsant and generic antipsychotic medication utilization percentages.

(h) On or before July 1, 2029, the director of the department of health shall collect and provide to the executive office of health and human services, in a form and frequency acceptable to the secretary, a report that includes the following data for the years 2021-2029 from the state and from each of the thirty-nine (39) municipalities:

(1) Gross amount, non-aggregated by entity type, spent on services and personnel related to mental health emergencies performed by the following entities:

(i) Ground ambulance transport;

(ii) Air ambulance transport;

(iii) Hospitals, including inpatient and emergency departments;

(iv) Police departments; and

(v) Fire departments.

(i) On or before October 1, 2029, the executive office of health and human services shall produce and provide the information collected pursuant to subsections (g) and (h) of this section to the speaker of the house of representatives, the president of the senate, the house of representatives committee on finance, and the senate committee on health and human services.

(j) The provisions of this section shall sunset and be repealed effective December 31, 2029.

(k) This section applies to all policies, contracts, and plans executed, delivered, issued for delivery, continued or renewed in this state on or after January 1, 2027. This section shall sunset and be repealed on December 31, 2029.

SECTION 2. This act shall take effect on January 1, 2027, and shall sunset and be repealed on December 31, 2029.