2003 Session

Budget Amendments - HB1400 (Member Request)

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Chief Patron: Morgan
Medicaid Preferred Drug List Design (language only)

Item 325 #27h

Item 325 #27h

Health And Human Resources
Medical Assistance Services, Department of

Page 322, line 56, after "ZZ.", insert "1."
Page 323, after line 23, insert:
"2. The Preferred Drug List program shall include the following provisions:  (i) individuals who are taking drugs covered by Medicaid when the Preferred Drug List is adopted shall not be required to change their medications or obtain prior authorization to continue Medicaid reimbursement for the same medications; (ii) the Preferred Drug List shall include at least one drug in each therapeutic class; (iii) the Preferred Drug List and prior authorization requirements shall not apply to medications used for the treatment of serious mental illnesses and HIV-related conditions; (iv) in an emergency, a 72-hour supply of the prescribed drug shall be covered without prior authorization and a dispensing fee shall be paid to the pharmacy for such supply; (v) prior authorization decisions must be made within 24 hours and the recipient and/or the prescribing physician shall receive notices of any delays or negative decisions, and have access to an expedited review by the department of denials; (vi) the department shall provide consumer and provider education, training and information regarding the Preferred Drug List prior to implementation, and ongoing communications shall include computer access to information and multilingual material."

(This amendment adds language setting forth criteria for the design of the Medicaid Preferred Drug List program. It restricts the use of the program for any current prescriptions and certain types of prescription drugs. It also adds language allowing for a limited supply of an individual's prescription to be covered in an emergency and requires immediate prior authorization decisions and notification of negative decisions to patients and their physicians. Finally, it requires patient and physician education and training, and ongoing communications on the program.)