SB 1672

Senate Engrossed
AHCCCS; antipsychotic
  drugs; authorization
State of Arizona
Senate
Fifty-seventh Legislature
Second Regular Session
2026
SENATE BILL 1672
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:
START_STATUTE36-2907.17. 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 that were
prescribed in a nonemergency or outpatient treatment within the previous five
years.
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.
4. Prohibit the administration from
collecting federal statutory rebates from participating drug manufacturers as
part of the medicaid drug rebate program authorized by section 1927 of the
social security act.
5. Prohibit the administration from
entering into a supplemental rebate contract agreement with a drug manufacturer
for preferred placement on the preferred drug list.
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.END_STATUTE
Sec. 2. Effective date
This act is effective from and after
December 31, 2026.