2003 Session

Budget Amendments - HB1400 (Conference Report)

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Pharmacy Benefit Management Svs. (language only)

Item 325 #8c

Item 325 #8c

Health And Human Resources
Medical Assistance Services, Department of

Page 327, after line 3, insert:
"UUU. In the event that the Department of Medical Assistance Services decides to contract for pharmaceutical benefit management services to administer, develop, manage, or implement Medicaid pharmacy benefits, the Department shall establish the fee paid to any such contractor based on the reasonable cost of services provided.  The Department may not offer or pay directly or indirectly any material inducement, bonus, or other financial incentive to a program contractor based on the denial or administrative delay of medically appropriate prescription drug therapy, or on the decreased use of a particular drug or class of drugs, or a reduction in the proportion of beneficiaries who receive prescription drug therapy under the Medicaid program.  Bonuses cannot be based on the percentage of cost savings generated under the benefit management of services."

(This amendment adds language that would prohibit the Department of Medical Assistance Services from offering or paying incentives to any potential contractor for pharmacy benefit management services based on denying or delaying medically appropriate prescription drug therapy, should the Department decide to contract for these services.)