An Act to Clarify the Requirements for Accessing Nonformulary Drugs and Drugs Used to Treat Serious Mental Illness
Sponsored By: Donna Bailey (Democratic)
Signed by Governor
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 2 benefits, 0 costs, 0 mixed.
Coverage for mental health drug shortages
If you have a serious mental illness and a covered drug is out due to a shortage, your insurer must cover an equivalent nonformulary drug. This applies when no equivalent covered drug is available. Coverage lasts while the covered drug is unavailable. Serious mental illness is defined in law using the latest DSM standard.
Faster coverage decisions for noncovered drugs
For plan years starting on or after March 19, 2019, your health plan must accept requests to cover a clinically appropriate drug it normally does not cover. You, your designee, or your prescriber can make the request. The plan must decide within 72 hours or 2 business days, whichever is less. In urgent cases, or if you are already on the drug, it must decide within 24 hours. If approved, the drug counts as an essential health benefit and is covered for the prescription and refills. Expedited approvals last for the length of the urgent situation.
Sponsors & Cosponsors
Sponsor
Donna Bailey
Democratic • Senate
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
Signed by Governor, ACTPUB Chapter 473
7/1/2025On motion by Senator ROTUNDO of Androscoggin taken from the Special Appropriations Table PASSED TO BE ENACTED in concurrence.
6/25/2025SenateOn motion by Senator ROTUNDO of Androscoggin PLACED ON THE SPECIAL APPROPRIATIONS TABLE pending ENACTMENT in concurrence.
6/2/2025SenatePASSED TO BE ENACTED. Sent for concurrence. ORDERED SENT FORTHWITH.
6/2/2025HouseCONSENT CALENDAR - FIRST DAYUnder suspension of the rules CONSENT CALENDAR - SECOND DAY.The Bill was PASSED TO BE ENGROSSED as Amended by Committee Amendment "A" (S-166).In concurrence. ORDERED SENT FORTHWITH.
5/29/2025HouseReport READ and ACCEPTED.READ ONCE.Committee Amendment "A" (S-166) READ and ADOPTED.Under suspension of the Rules, READ A SECOND TIME and PASSED TO BE ENGROSSED AS AMENDED BY Committee Amendment "A" (S-166).Ordered sent down forthwith for concurrence.
5/28/2025SenateCARRIED OVER, in the same posture, to the next special or regular session of the 132nd Legislature, pursuant to Joint Order SP 519.
3/21/2025SenateReceived by the Secretary of the Senate on March 14, 2025 and REFERRED to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES pursuant to Joint Rule 308.2
3/14/2025Senate
Bill Text
Amendment C-A (S-166), adopted by House & Senate
Enacted
Introduced
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