14133.24.
(a) (1) For purposes of this section, “serious mental illness” means a mental disorder, as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, that meets all of the following:(A) Is severe in degree and persistent in duration.
(B) Presents a major risk to the person’s health and well-being.
(C) Causes behavioral functioning that interferes substantially with the primary activities of daily living and that results in an inability to maintain stable adjustment and independent functioning without treatment, support, and rehabilitation for a long or
indefinite period of time.
(2) Serious mental illness may include, but is not limited to, schizophrenia, bipolar disorder, post-traumatic stress disorder, a major affective disorder, and any other severely disabling mental disorder.
(b) Prior authorization shall not be required for a drug prescribed for the treatment of a serious mental illness for a period of 365 days after the initial prescription has been dispensed for a person over 18 years of age who is not under the transition jurisdiction of the juvenile court as described in Section 450.
(c) The department shall automatically approve a prescription for a drug for the treatment of a serious mental illness if the department verifies a record of a paid claim that documents a diagnosis of a serious mental illness within 365 days before the date of that
prescription for a person over 18 years of age and who is not under the transition jurisdiction of the juvenile court as described in Section 450.
(d) The department shall authorize a pharmacist to dispense a 90-day supply of a drug prescribed for the treatment of a serious mental illness if that prescription drug is included in the Medi-Cal list of contract drugs and the prescription otherwise conforms to applicable formulary requirements pursuant to all of the following:
(1) The patient is over 18 years of age.
(2) All required utilization controls have been met.
(3) The patient has filled at least a 30-day supply for the same prescription in the previous 90 days.
(e) The department
shall authorize a pharmacist to dispense an early refill of a drug prescribed for the treatment of a serious mental illness if that prescription drug is included in the Medi-Cal list of contract drugs and the prescription otherwise conforms to applicable formulary requirements pursuant to all of the following:
(1) For a 30-day supply, the dispensing takes place at least 23 days after, but not more than 30 days after, either of the following:
(A) The original date that the prescription was distributed to the beneficiary.
(B) The date of the most recent refill was distributed to the beneficiary.
(2) The number of early refills shall not exceed three in a calendar year.