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REFERENCE TITLE: AHCCCS; antipsychotic drugs; authorization |
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State of Arizona Senate Fifty-seventh Legislature Second Regular Session 2026
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SB 1672 |
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Introduced by Senator Kavanagh
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AN ACT
Amending title 36, chapter 29, ARticle 1, Arizona Revised Statutes, by adding section 36-2907.17; relating to the Arizona health care cost containment system.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 36, chapter 29, article 1, Arizona Revised Statutes, is amended by adding section 36-2907.17, to read:
36-2907.17. Prescription antipsychotic drugs; coverage; definitions
A. Before providing coverage of a prescription antipsychotic drug that is prescribed to a member who is at least eighteen years of age and who has a serious mental illness determination for which the prescription antipsychotic drug is approved by the United States food and drug administration as described on the prescription antipsychotic drug's approved labeling, the administration and its contractors:
1. Except for the process described in paragraph 2 of this subsection, may not impose a prior authorization requirement or other process that conditions, delays or denies the delivery of the prescription antipsychotic drug to the member by applying predetermined criteria by the administration or its contractor for covered prescription drugs.
2. May impose a process, including a step therapy protocol, requiring that the member show a failure to successfully respond to not more than two distinct prescription antipsychotic drugs.
B. The administration and its contractors shall grant a member or the member's health care provider the ability to bypass a step therapy protocol by providing a history of the member's failure to successfully respond to two distinct prescription antipsychotic drugs on the member's current or previous health benefit plan.
C. Any step therapy protocol or other process administered in accordance with subsection A, paragraph 2 of this section must both:
1. Be adjudicated electronically and in real time.
2. Consider a member to have tried two prescription antipsychotic drugs if the member has two paid claims for two distinct preferred antipsychotic drugs.
D. This section applies only to a prescription antipsychotic drug whose use is supported by peer-reviewed, evidence-based literature.
E. This section applies to prescription drug coverage that is paid either on a fee-for-service basis or through a prepaid capitated health services contract under the system.
F. This section does not:
1. Prohibit the administration from contracting with a managed care organization for pharmaceutical services offered under the system pursuant to section 36-2904 if the contract complies with this section.
2. Prohibit or discourage the use of a generic drug.
3. Prevent the administration from performing a drug utilization review that is necessary for patient safety or to ensure that the prescribed use is for a medically accepted indication, as required by section 1927 of the social security act.
G. For the purposes of this section:
1. "Failure to successfully respond" means a determination, based on clinically appropriate guidelines, that a patient has failed on a medication, including a lack of efficacy during a six-week medication trial, an allergic reaction, intolerable side effects, significant drug-to-drug interactions or a known interacting genetic polymorphism that prevents safe preferred medication dosing as attested to by the patient's health care provider.
2. "Health benefit plan" means a policy, contract, certificate or agreement entered into, offered by or issued by an insurer or by the administration to provide, deliver, arrange for, pay for or reimburse any costs of health care services.
3. "Health care provider" means a health care provider who is licensed pursuant to title 32 and who has prescription AUTHORITY pursuant to title 32.
4. "Insurer" means any person that is engaged in making any hospital, health or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract or agreement with a health maintenance organization or a preferred provider organization or health and accident insurance policy or any other insurance contract of this type, including a group insurance plan.
5. "Prescription drug" means any prescription medication as defined in section 32-1901.
Sec. 2. Effective date
This act is effective from and after December 31, 2026.