2003 Session

Budget Amendments - HB1400 (Member Request)

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Chief Patron: Morgan
Co-Patron(s): Landes
Medicaid Preferred Drug List Design (language only)

Item 325 #9h

Item 325 #9h

Health And Human Resources
Medical Assistance Services, Department of

Page 322, line 56, after "ZZ.", insert "1.".
Page 322, after line 23, insert:
"2. The Preferred Drug List program shall include the following provisions:  (i) if a drug is safe and effective for a medical condition and has been covered by the Department of Medical Assistance Services for an individual's medical condition, coverage under the State Plan for such drug shall not be limited or excluded when prescribed for the covered medical condition of that individual; (ii) any formulary adopted by the Board of Medical Assistance Services shall include each therapeutic class in which there are two or more FDA-approved controlled substances and, for each therapeutic class in which there are two or more FDA-approved pharmaceutical or biological agents, shall provide coverage of at least two such pharmaceutical or biological agents without an administrative preference for one over the other; (iii) no prior authorization of new medicines that have been approved by the federal Food and Drug Administration for indications shall be required until the Department of Medical Assistance Services has compiled at least six months of drug utilization review experience with Medicaid recipients being treated with the new drug for an authorized indication.  Further, prior authorization for such new medicines shall not occur until the "Prior Authorization Committee" makes such a ruling at its next regularly scheduled meeting; (iv) filling of a limited 7-day supply of the original prescribed drug in all cases while contact with the prescriber is being made and the prescriber is given a reasonable opportunity to submit a written or oral request for prior authorization to prevent interruption; (v) prior authorization decisions must be made within 72 hours, with the full amount originally prescribed automatically approved if the department or its contractor is not able to make oral contact with the prescriber or his agent within 12 hours of the request for prior authorization having been submitted; (vi) failure to provide coverage of drugs in every therapeutic class, with the exception of drugs listed in 42USCA 1396r-8 (d)(2), constitutes denial of medically necessary patient care; and (vii) these restrictions shall not apply to recipients and uninsured children who are enrolled in managed care organizations in the Medicaid (Title XIX) and Family Access to Medical Insurance Security (Title XXI) programs."

(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 for recipients. The Preferred Drug List must cover at least 2 drugs in each therapeutic class without preference for at least 2 of the products in that therapeutic class. No prior authorization would be required for new FDA-approved prescription drugs, until 6 months of drug utilization review has been performed and prior authorization could not take place on new prescription drugs until allowed by the Prior Authorization Committee. It also adds language allowing for a limited supply of an individual's prescription to be covered in all instances while physicians are given an opportunity to request authorization for a prescription and requires immediate prior authorization decisions. Finally, it exempted these requirements for prescriptions made for Medicaid and FAMIS recipients in managed care programs.)