1|ENGROSSED HOUSE | |BILL NO. 2801 By: Marti of the House | 2| | | and | 3| | | Stanley of the Senate | 4| | | | 5| | | | 6| | | | 7| [ antipsychotic drugs - vendor drug program | | | 8| disorders - prior authorization - effective date ] | | | 9| | | | 10| | | | 11|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 12| SECTION 1. AMENDATORY 56 O.S. 2021, Section 204, is | | | 13|amended to read as follows: | | | 14| Section 204. A. Except as otherwise provided, the Oklahoma | | | 15|Health Care Authority shall be authorized and directed to establish | | | 16|a vendor drug program to provide any drugs that have been approved | | | 17|and designated as safe and effective by the federal Food and Drug | | | 18|Administration, and that are prescribed by a licensed medical, | | | 19|dental, podiatric, or osteopathic practitioner for eligible | | | 20|recipients of assistance payments suffering from painful or | | | 21|life-endangering diseases or other persons who are suffering from a | | | 22|catastrophic illness. | | | 23| B. The Authority shall, in accordance with federal law, not be | | | 24|obligated to cover any outpatient drugs of a manufacturer which has | | | arsid16532362 ENGR. H. B. NO. 2801 Page 1 ___________________________________________________________________________
1|not entered into or which does not have in effect a rebate agreement | | | 2|with the Secretary of Health and Human Services on behalf of the | | | 3|state. | | | 4| C. Such program shall, to the fullest extent possible, be | | | 5|established and maintained in conjunction with existing federal | | | 6|programs of prescribed drugs so as to earn the maximum of federal | | | 7|financial participation. Exempt from the provisions of this section | | | 8|are the following drugs or classes of drugs, or their medical uses: | | | 9| 1. Agents when used for anorexia or weight gain; | | | 10| 2. Agents when used to promote fertility; | | | 11| 3. Agents when used for cosmetic purposes or hair growth; | | | 12| 4. Agents when used for the symptomatic relief of coughs and | | | 13|colds; | | | 14| 5. Agents when used to promote smoking cessation; | | | 15| 6. Prescription vitamins and mineral products, except prenatal | | | 16|vitamins and fluoride preparations; | | | 17| 7. Nonprescription drugs; | | | 18| 8. Covered outpatient drugs when the manufacturer seeks to | | | 19|require as a condition of sale that associated tests or monitoring | | | 20|services be purchased exclusively from the manufacturer or its | | | 21|designee; | | | 22| 9. Drugs described in paragraph 3 of subsection c of Section | | | 23|107 of the Drug Amendments of 1962, 21 U.S.C., Section 107(c)(3), | | | 24|and identical, similar or related drugs, within the meaning of | | | arsid16532362 ENGR. H. B. NO. 2801 Page 2 ___________________________________________________________________________
1|paragraph 1 of subsection b of Section 310.6 of Title 21 of the Code | | | 2|of Federal Regulations; | | | 3| 10. Barbiturates; or | | | 4| 11. Benzodiazepines; | | | 5|provided, however, the Authority shall be authorized to include | | | 6|specific drugs within these categories for reimbursement based upon | | | 7|specific medical need. | | | 8| D. The Authority shall be authorized to establish a prospective | | | 9|drug utilization review program for the H2 Antagonists; provided | | | 10|that such limitations are in compliance with federal Food and Drug | | | 11|Administration Agency-approved product labeling. | | | 12| E. The Authority shall approve a prior authorization request | | | 13|for any Food and Drug Administration approved atypical antipsychotic | | | 14|that is not on the preferred drug list for the treatment and | | | 15|prevention of mood disorders with psychotic symptoms including | | | 16|bipolar disorders, schizophrenia, and schizotypal or delusion | | | 17|disorders. Medications included under this section shall be | | | 18|available at parity to other branded medications in the same class. | | | 19|Approval shall be based on patient's claims history or health care | | | 20|provider attestation of one of the following conditions for the | | | 21|Medicaid client: | | | 22| 1. A trial and failure of any preferred atypical antipsychotic | | | 23|in the preceding three hundred sixty-five (365) days; or | | | 24| | | | arsid16532362 ENGR. H. B. NO. 2801 Page 3 ___________________________________________________________________________
1| 2. The patient is stable on an atypical antipsychotic that is | | | 2|not included on the preferred drug list. | | | 3| SECTION 2. This act shall become effective November 1, 2025. | | | 4| Passed the House of Representatives the 10th day of March, 2025. | | | 5| | | | 6| | | Presiding Officer of the House | 7| of Representatives | | | 8| | | Passed the Senate the ___ day of __________, 2025. | 9| | | | 10| | | | 11| Presiding Officer of the Senate | | | 12| | | | 13| | | | 14| | | | 15| | | | 16| | | | 17| | | | 18| | | | 19| | | | 20| | | | 21| | | | 22| | | | 23| | | | 24| | | | arsid16532362 ENGR. H. B. NO. 2801 Page 4