2003 Session

Budget Amendments - SB700 (Member Request)

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Chief Patron: Norment
Preferred Drug List -- Patient Protections (language only)

Item 325 #27s

Item 325 #27s

Health And Human Resources
Medical Assistance Services, Department of

Page 323, after line 23, insert:
"AAA.  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 receiving the same medications under the Medicaid program;
(ii)  The Preferred Drug List shall include at least two drugs 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 illness, cancer 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.  The recipient and/or the prescribing physician shall receive notices of any delays or negative decisions, and have access to an expedited review of denials by the Department.
(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 requires that a preferred drug list be designed so that patients have prompt access to therapies, and that patients, doctors and pharmacies thoroughly understand how the system works. For patients with complex or sensitive medication regimes, switching therapies could result in costly complications that could erase pharmacy cost savings. If patients do not fill prescriptions because prior-authorization is too difficult, they could experience adverse health events that cost more than the medication being prior-authorized.)