2006 Session

Budget Amendments - HB30 (Member Request)

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Chief Patron: Hamilton
Medicaid Specialty Drug Program (language only)

Item 302 #19h

Item 302 #19h

Health And Human Resources
Medical Assistance Services, Department of

Page 269, line 50, after "program.", insert:
"In developing the modifications, the department shall consider input from physicians, pharmacists, pharmaceutical manufacturers, patient advocates, and others as appropriate."
Page 269, line 51, after "program to", insert:
"implement appropriate care management and".
Page 269, line 54, after "utilization", insert:
"through appropriate case management".
Page 269, line 58, after "program", insert:
"and publish same on the department's website".
Page 269, after line 58, insert:
"3.  In the event that the Department of Medical Assistance Services contracts with a vendor, 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."
Page 269, line 59, strike "3" and insert "4".
Page 269, line 59, after "review", strike "and" insert ",".
Page 269, line 59, after "update", insert ", and publish".
Page 270, line 9, strike "4" and insert "5".
Page 270, line 14, after "Care," insert, "the the Pharmacy Liaison Committee"
Page 270, line 16, strike "5" and insert "6".

(This amendment adds language that requires the Department of Medical Assistance Services to work with stakeholders in developing the Specialty Drug Program. Language is added to prohibit the Department of Medical Assistance Services from offering or paying incentives to any potential contractor for the Specialty Drug Program based on denying or delaying medically appropriate prescription drug therapy, should the Department decide to contract for these services.)