§ 108A-68.1B. Coverage of medication to treat severe mental illness.

288 words·~1 min read·/nc/chapter-108a/108a-68-1b

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(a)The Department shall provide immediate coverage under the Medicaid program of a new prescription medication approved by the Food and Drug Administration that becomes available to the public if

(i)the manufacturer of that medication is enrolled in the federal Medicaid Drug Rebate Program and

(ii)the medication is approved for the treatment of any of the following conditions, as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders:

(1)Bipolar disorders, hypomanic, manic, depressive, and mixed.

(2)Childhood and adolescent depression.

(3)Major depressive disorders, single episode or recurrent.

(4)Obsessive-compulsive disorders.

(5)Paranoid personality disorder and other psychotic disorders.

(6)Schizo-affective disorders, bipolar or depressive.

(7)Schizophrenia.

(b)If the new prescription medication required to be covered under the Medicaid program under subsection

(a)of this section is within a class of medications eligible for inclusion on the Department's Preferred Drug List, then, no later than the end of the next calendar quarter following the date the new prescription medication became available to the public, the Department shall, in consultation with the Physician's Advisory Group, review and submit a proposed policy to the Preferred Drug List Policy Review Panel regarding the inclusion of the new prescription medication as either a preferred or nonpreferred drug on the Department's Preferred Drug List.

(c)Within 30 days of the receipt of a proposed policy under subsection

(b)of this section, the Preferred Drug List Policy Review Panel shall, in accordance with G.S. 108A-68.1A, hold an open meeting to review the recommended policy and submit policy recommendations about the proposed policy to the Department upon the conclusion of that meeting. (2023-134, s. 9E.17(b).)