An Act To Prohibit Prior Authorization Requirements and Step Therapy Protocols for Medications Addressing Serious Mental Illness for MaineCare Recipients
Maine Legislature, Session 130, LD 1877
Committee: Health and Human Services
Sponsors: MADIGAN, STEWART, CONNOR, COREY, FECTEAU, PERRY, TEPLER, BREEN, CLAXTON, JACKSON
Amends: 22 MRSA §3174-I

Legislative Document
No. 1877
H.P. 1387
House of Representatives, January 5, 2022
An Act To Prohibit Prior Authorization Requirements and Step 
Therapy Protocols for Medications Addressing Serious Mental 
Illness for MaineCare Recipients
(EMERGENCY)
Approved for introduction by a majority of the Legislative Council pursuant to Joint Rule 
203.
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative MADIGAN of Waterville.
Cosponsored by Senator STEWART of Aroostook and
Representatives: CONNOR of Lewiston, COREY of Windham, Speaker FECTEAU of 
Biddeford, PERRY of Calais, TEPLER of Topsham, Senators: BREEN of Cumberland, 
CLAXTON of Androscoggin, President JACKSON of Aroostook.
Emergency preamble.  Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and
Whereas, for residents of the State living with mental illness, life can be a complex 
and difficult journey, riddled with significant barriers and obstacles, and for those with 
serious mental illness, the right medications enable them to maintain stable, safe and full 
lives; and
Whereas, the State benefits when neighbors and community members living with 
serious mental illness are able to access appropriate medical treatment; and
Whereas, when access to medication is disrupted, individuals living with serious 
mental illness may face costly and devastating life consequences, including loss of homes, 
jobs and access to children, involuntary commitment, incarceration or loss of life due to 
suicide; and
Whereas, this legislation is needed to immediately remove the requirements for prior 
authorization and step therapy for medications used to treat serious mental illness that 
create unnecessary and potentially devastating interruptions in patient care and burdensome 
bureaucracy for health care providers and that have the unintentional effect of more costly 
and catastrophic outcomes; and
Whereas, in the judgment of the Legislature, these facts create an emergency within 
the meaning of the Constitution of Maine and require the following legislation as 
immediately necessary for the preservation of the public peace, health and safety; now, 
therefore,
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §3174-III is enacted to read:
§3174-III.  Treatment of serious mental illness
1. Definitions.  For purposes of this section, unless the context otherwise indicates, the 
following terms have the following meanings.  
A. "Serious mental illness" means a mental disorder listed in the edition of the 
Diagnostic and Statistical Manual of Mental Disorders published by the American 
Psychiatric Association that took effect October 1, 2021 that results in serious 
functional impairment that substantially interferes with or limits one or more major life 
activities.  
B.  "Step therapy protocol" means a protocol that establishes a specific sequence in 
which prescription drugs for a specified medical condition are medically necessary for 
a particular enrollee and are covered under a pharmacy or medical benefit by a carrier, 
including self-administered and physician-administered drugs.   
2.  Prior authorization or step therapy protocol.  The department may not require 
under the MaineCare program prior authorization or a step therapy protocol for prescription 
drugs used for the assessment or treatment of serious mental illness.
3.  Rules. The department may adopt rules to implement this section. Rules adopted 
pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, 
subchapter 2-A.
Emergency clause.  In view of the emergency cited in the preamble, this legislation 
takes effect when approved.
SUMMARY
This bill prohibits prior authorization requirements and step therapy protocols under 
the MaineCare program for prescription drugs used to assess or treat serious mental illness.