§346-59.9 Psychotropic medication. (a) This section shall apply only to the medicaid managed care and fee-for-service programs administered by the department when the department or the department's contracted health plan is the primary insurer. When the department is the secondary insurer, the department and its contracted health plans shall be responsible only for the secondary insurer's share of any psychotropic medication covered by the primary insurer.
(b) The department and its contracted health plans shall not impose any restriction or limitation on the coverage for, or a recipient's access to, antipsychotic medication.
(c) The department and its contracted health plans shall not impose any restriction or limitation on the coverage for, or a recipient's access to, antidepressant medication other than:
For purposes of this subsection, a "failed attempt" means that the prescribed generic antidepressant medication up to the maximum FDA-approved dosage is not effective in treating the individual, or the individual's compliance is compromised due to the side effects caused by the medication.
(d) The department and its contracted health plans shall not impose any restriction or limitation on the coverage for, or a recipient's access to, anti-anxiety medication other than:
For purposes of this subsection, a "failed attempt" means that the prescribed generic anti-anxiety medication up to the maximum FDA-approved dosage is not effective in treating the individual, or the individual's compliance is compromised due to the side effects caused by the medication.
(e) The department and its contracted health plans shall not require any individual stable on a brand-name antidepressant medication on or before July 1, 2010, to transfer to a different antidepressant medication, generic or brand-name, unless the individual's condition becomes unstable and requires the medication to be replaced.
(f) The department and its contracted health plans shall not require any individual stable on a brand-name anti-anxiety medication on or before July 1, 2010, to transfer to a different anti-anxiety medication, generic or brand-name, unless the individual's condition becomes unstable and requires the medication to be replaced.
(g) The department and its medicaid managed care contracted health plans shall have the authority to investigate fraud, abuse, or misconduct.
(h) All psychotropic medications covered by this section shall be prescribed by a psychiatrist, a physician, or an advanced practice registered nurse with prescriptive authority under chapter 457 and duly licensed in the State.
(i) As used in this section:
"Anti-anxiety medication" means those medications included in the United States Pharmacopeia's anxiolytic therapeutic category.
"Antidepressant medication" means those medications included in the United States Pharmacopeia's antidepressant therapeutic category.
"Antipsychotic medication" means those medications included in the United States Pharmacopeia's antipsychotic therapeutic category.
"Psychotropic medication" means only antipsychotic, antidepressant, or anti-anxiety medications approved by the United States Food and Drug Administration for the treatment of mental or emotional disorders. [L 2005, c 239, pt of §2, §5; am L 2006, c 311, pt of §2, §3; am L 2007, c 39, §§1, 2; am L 2010, c 205, §§2, 9; am L 2012, c 120, §2; am L 2015, c 20, §§6, 7; am L 2022, c 126, §2]