{"data":{"id":"us-ar/ark.-code-ann.-23-99-1114","jurisdiction":"us-ar","citation":"Ark. Code Ann. § 23-99-1114","heading":"Limitation on step therapy - Definitions","body":"(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. (d) 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. Amended by Act 2023, No. 577,§ 1, eff. 8/1/2023. Amended by Act 2023, No. 501,§ 4, eff. 8/1/2023. Amended by Act 2021, No. 97,§ 5, eff. 7/28/2021. Amended by Act 2019, No. 699,§ 5, eff. 7/24/2019. Amended by Act 2019, No. 699,§ 4, eff. 7/24/2019. Amended by Act 2017, No. 815,§ 11, eff. 8/1/2017. Added by Act 2015, No. 1106,§ 2, eff. 7/22/2015.\n\n(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.\n\n(1) Psychosis and serious mental illness through antipsychotic prescription drugs; and\nre 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.\n\n(1) Psychosis and serious mental illness through antipsychotic prescription drugs; and\n\n(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.\n\n(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\n\n(i) United States Food and Drug Administration-approved indication; or\n\n(ii) The National Comprehensive Cancer Network Drugs and Biologics Compendium indication; or\n\n(B) Use evidence-based, peer-reviewed, recognized medical literature.\n\n(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.\n\n(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;\n\n(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\n\n(A) \"Psychosis\" means a condition that affects the mind and affects the way the brain processes information.\n\n(B) \"Psychosis\" includes delusions and hallucinations; and\n\n(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.\n\n(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.\n\n(d) 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.","path":["AR Code","Title 23","Chapter 99","Subchapter 11"],"source_url":"https://oss-data-us.vaquill.ai/v2026.08/us_ar_statutes.parquet","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:41Z","sha256":"9fc6936235585c4c825061411f72020f202616832b25168c03bc741fc59f57c6","source_id":"us-ar","stale":false,"prev":"us-ar/ark.-code-ann.-23-99-1113","next":"us-ar/ark.-code-ann.-23-99-1115"},"notice":"GroundRules: Original legal text. Not legal advice."}