Arkansas § 23-99-1114 Limitation on step therapy - Definitions

Arkansas Statutes

§ 23-99-1114 — Limitation on step therapy - Definitions

Arkansas § 23-99-1114

Title23

This text of Arkansas § 23-99-1114 (Limitation on step therapy - Definitions) is published on Counsel Stack Legal Research, covering Arkansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ark. Code Ann. § 23-99-1114 (2026).

Text

(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-r

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(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.

Legislative History

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.