Limitation on step therapy — Definitions.
Ark. Code Ann. § 23-99-1114
in effect(a) An insurance policy shall not limit or exclude coverage under the health benefit plan for a drug approved by the United States Food and Drug Administration that is on the prescription drug formulary of the insurance policy by mandating that a covered person undergo step therapy if the insurance policy provides coverage for the treatment of:
(1) Psychosis and serious mental illness through antipsychotic prescription drugs; and
(2) Metastatic cancer unless the preferred drug is consistent with best practices that:
(A) Are used for the treatment of metastatic cancer or associated conditions under:
(i) United States Food and Drug Administration-approved indication; or
(ii) The National Comprehensive Cancer Network Drugs and Biologics Compendium indication; or
(B) Use evidence-based, peer-reviewed, recognized medical literature.
(b) As used in this section:
(1) "Metastatic cancer” means cancer that has spread from a primary or original site of the cancer to surrounding or nearby tissues, lymph nodes, or other parts of the body;
(2)(A) "Psychosis" means a condition that affects the mind and affects the way the brain processes information.
(B) "Psychosis" includes delusions and hallucinations; and
(3) "Serious mental illness" means a mental, behavioral, or emotional disorder resulting in serious functional impairment, that substantially interferes with or limits one (1) or more major life activities.
(c) For psychosis and serious mental illness, if there is a generic drug equivalent approved by the United States Food and Drug Administration under the same chemical or generic name of a name brand drug that is available, it is not considered step therapy to allow access to and coverage for both the generic drug and the name brand drug.
(c) If a request for prior authorization is denied due to a step therapy requirement under this section, then the utilization review entity shall authorize the preferred treatment required under the step therapy if a prior authorization for the preferred treatment is required without requiring the healthcare provider to submit a new or revised request.
Source: Arkansas General Assembly, Acts of 2021-2026 (arkleg.state.ar.us)URL: https://arkleg.state.ar.us/Acts/FTPDocument?path=%2FACTS%2F2023R%2FPublic%2F&file=577.pdf&ddBienniumSession=2023%2F2023RFetched: 11/8/2026