Section 23-99-1114 - Limitation on step therapy - Definitions(a) An insurance policy shall not limit or exclude coverage under the health benefit plan for a drug approved by the United States Food and Drug Administration that is on the prescription drug formulary of the insurance policy by mandating that a covered person undergo step therapy if the insurance policy provides coverage for the treatment of:(1) Psychosis and serious mental illness through antipsychotic prescription drugs; and(2) Metastatic cancer unless the preferred drug is consistent with best practices that: (A) Are used for the treatment of metastatic cancer or associated conditions under:(i) United States Food and Drug Administration-approved indication; or(ii) The National Comprehensive Cancer Network Drugs and Biologics Compendium indication; or(B) Use evidence-based, peer-reviewed, recognized medical literature.(b) As used in this section: (1) "Metastatic cancer" means cancer that has spread from a primary or original site of the cancer to surrounding or nearby tissues, lymph nodes, or other parts of the body;(2)(A) "Psychosis" means a condition that affects the mind and affects the way the brain processes information.(B) "Psychosis" includes delusions and hallucinations; and(3) "Serious mental illness" means a mental, behavioral, or emotional disorder resulting in serious functional impairment, that substantially interferes with or limits one (1) or more major life activities.(c) For psychosis and serious mental illness, if there is a generic drug equivalent approved by the United States Food and Drug Administration under the same chemical or generic name of a name brand drug that is available, it is not considered step therapy to allow access to and coverage for both the generic drug and the name brand drug.(d) If a request for prior authorization is denied due to a step therapy requirement under this section, then the utilization review entity shall authorize the preferred treatment required under the step therapy if a prior authorization for the preferred treatment is required without requiring the healthcare provider to submit a new or revised request.Amended by Act 2023, No. 577,§ 1, eff. 8/1/2023.Amended by Act 2023, No. 501,§ 4, eff. 8/1/2023.Amended by Act 2021, No. 97,§ 5, eff. 7/28/2021.Amended by Act 2019, No. 699,§ 5, eff. 7/24/2019.Amended by Act 2019, No. 699,§ 4, eff. 7/24/2019.Amended by Act 2017, No. 815,§ 11, eff. 8/1/2017.Added by Act 2015, No. 1106,§ 2, eff. 7/22/2015.