SB 83 — Relating to: utilization management controls for antipsychotic prescription drugs under the Medical Assistance program. (FE)

- 2026 LEGISLATURE LRBs0124/1LRB-0646/1 JPC:emw SENATE SUBSTITUTEBILL AMENDMENT83 2,February TO26, SENATE2025 BILL- 83Introduced Octoberby 3,Senators 2025J -AMES, OfferedC ABRAL-G UEVARA and W ANGGAARD , cosponsored by SenatorRepresentatives AMESNOVAK ., G UNDRUM , B.

JACOBSON , MURSAU , SORTWELL , TEFFEN and TITTL.

Referred to Committee on Mental Health, Substance Abuse Prevention, Children and Families.

priorutilization authorizationmanagement controls for antipsychotic prescription drugs under the Medical Assistance program.

Analysis by the Legislative Reference Bureau This bill prohibits the Department of Health Services from requiringimposing priorany authorizationutilization formanagement acontrols coveredfor antipsychoticprescription drugdrugs forunder athe Medical Assistance recipientprogram whothat isare atapproved leastby 18 years of age under certain circumstances, including 1) if the antipsychoticfederal drugFood wasand previouslyDrug approvedAdministration forand theare recipientclassified atas aantipsychotic. different dosage;

2)Utilization ifmanagement initialcontrols priorare authorizationformal fortechniques theused antipsychoticby druga expireshealth forcarrier theor recipient,prescription anddrug atutilization themanagement timeentity ofthat expiration,are thedesigned recipientto hasevaluate takenprescription the antipsychotic drug continuouslymedical fornecessity, atappropriateness, leastefficacy, 60or days;efficiency.

and 3) if the recipient was recently discharged from an inpatient hospital, and as an inpatient, the recipient was stabilized on the antipsychotic drug.

For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

- 2026 Legislature - 2 - LRB-0646/1 JPC:emw SENATE BILL 83 SECTION 1 S ECTION 1.

- 2026 Legislature - 2 - LRBs0124/1 JPC:emw SECTION 1 49.45 (9o) PU RIORTILIZATION AUTHORIZATIONMANAGEMENT CONTROLS FOR ANTIPSYCHOTIC DRUGSPRESCRIPTION .DRUGS.

(a) In this subsection,subsection: Xantipsychotic drugY means a covered prescription drug that is approved by the federal food and drug administration and that is classified as an antipsychotic.

(b) The department may not require prior authorization for an antipsychotic drug under any of the following circumstances for a Medical Assistance recipient who is at least 18 years of age:

The“Prescription antipsychoticdrug” drughas was previously approved for the recipientmeaning atgiven ain differents. dosage.

450.01 (20).

The“Utilization recipientmanagement wascontrols” newlymeans enrolleda inset theof Medicalformal Assistancetechniques programused withinby thea pasthealth 30carrier days,or andprescription thedrug recipientutilization wasmanagement takingentity thethat antipsychoticare designed to evaluate prescription drug continuouslymedical fornecessity, atappropriateness, leastefficacy, 30or daysefficiency, atincluding theprior timeauthorization ofand enrollment.step therapy protocols.

3.(b) The department may not impose utilization management controls for any prescription drug that is approved by the federal food and drug administration and is classified as an antipsychotic.

Initial(END) prior authorization for the antipsychotic drug expires for the recipient, and at the time of expiration, the recipient has taken the antipsychotic drug continuously for at least 60 days.

4.

The recipient was recently discharged from an inpatient hospital, and as an inpatient, the recipient was stabilized on the antipsychotic drug.

(c) 1.

Nothing in this subsection otherwise restricts the department[s authority to require prior authorization as provided under federal law.

2.

Nothing in this subsection may be interpreted to conflict with 42 USC 1396a (oo).

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