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House Bill 2822 |
House Author: Hull et al. |
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Effective: 9-1-21 |
Senate Sponsor: Buckingham et al. |
House Bill 2822 amends the Government Code to prohibit the executive commissioner of the Health and Human Services Commission (HHSC), in the rules and standards governing the Medicaid vendor drug program, from requiring prior authorization for a nonpreferred antipsychotic drug that is included on the vendor drug formulary prescribed to an adult patient under certain conditions related to the patient having previously been prescribed, treated with, or obtained prior authorization for such a drug. The bill requires a contract between HHSC and a Medicaid managed care organization (MCO) to contain a requirement that the MCO develop, implement, and maintain an outpatient pharmacy benefit plan for its enrolled recipients that does not require prior authorization for a nonpreferred antipsychotic drug prescribed to an adult recipient if the conditions of the prohibition are met. The bill provides for the automation of clinical prior authorization for each drug in the antipsychotic drug class to the maximum extent possible based on a pharmacy benefit manager's claim system.