First Substitute S.B. 41

This document includes House Committee Amendments incorporated into the bill on Thu, Feb 18, 2010 at 12:20 PM by lerror. --> This document includes House Committee Amendments incorporated into the bill on Mon, Feb 22, 2010 at 5:11 PM by lerror. -->

Senator Peter C. Knudson proposes the following substitute bill:

1 DRUG UTILIZATION REVIEW BOARD
2 AMENDMENTS
3 2010 GENERAL SESSION
4 STATE OF UTAH
5 Chief Sponsor: Peter C. Knudson
6 House Sponsor: Ronda Rudd Menlove
7
8 LONG TITLE
9 General Description:
10 This bill amends the drug prior approval program within the state's Medicaid program.
11 Highlighted Provisions:
12 This bill:
13 . permits the Drug Utilization Review Board to consider costs, as well as other
14 factors, when determining whether a drug should be placed on the prior approval
15 program;
16 . amends notice requirements;
17 . amends number of days before implementation of a decision of the board;
18 . provides more discretion to the Drug Utilization Review Board to restrict the use of
19 a drug for off label indications; and
20 . makes technical changes.
21 Monies Appropriated in this Bill:
22 None
23 Other Special Clauses:
24 None
25 Utah Code Sections Affected:

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- 2 - 26 AMENDS:
27 26-18-105, as last amended by Laws of Utah 2006, Chapter 14
28
29 Be it enacted by the Legislature of the state of Utah:
30 Section 1. Section 26-18-105 is amended to read:
31 26-18-105. Drug prior approval program.
32 [Any] (1) A drug prior approval program approved or implemented by the board shall
33 meet the following conditions:
34 [(1) no drug may] (a) except as provided in Subsection (2), a drug may not be placed
35 on prior approval for other than medical reasons;
36 [(2)] (b) the board shall hold a public hearing at least [90] 30 days prior to placing a
37 drug on prior approval;
38 [(3)] (c) notwithstanding the provisions of Section 52-4-202 , the board shall provide
39 not less than [30] 14 days' notice to the public before holding a public hearing under
40 Subsection [(2)] (1)(b);
41 [(4)] (d) the board shall consider written and oral comments submitted by interested
42 parties prior to or during the hearing held in accordance with Subsection [(2)] (1)(b);
43 [(5)] (e) the board shall provide evidence that placing a drug class on prior approval:
44 (i) will not impede quality of recipient care; and
45 (ii) that the drug class is subject to clinical abuse or misuse;
46 (f) the board shall reconsider its decision to place a drug on prior approval:
47 [(6)] (i) no later than nine months after any drug class is placed on prior approval[, it
48 shall be reconsidered in]; and
49 (ii) at a public hearing with notice as provided in Subsection [(3)] (1)(b);
50 [(7)] (g) the program shall provide [either telephone or fax] an approval or denial of a
51 request for prior approval:
52 (i) by either:
53 (A) fax;
54 (B) telephone; or
55 (C) electronic transmission;
56 (ii) at least Monday through Friday, except for state holidays; and

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House Committee Amendments 2-22-2010 le/cjd

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House Committee Amendments 2-18-2010 le/cjd 57

(iii) within 24 hours after receipt of the prior approval request;
58 [(8)] (h) the program shall provide for the dispensing of at least a 72-hour supply of the
59 drug on the prior approval program:
60 (i) in an emergency situation; or
61 (ii) on weekends or state holidays;
62 [(9)] (i) the program may [not] be applied to [prevent] allow acceptable medical use of
63 a drug on prior approval for appropriate off-label indications; and
64 [(10) any drug class placed on prior approval shall receive a majority vote by the board
65 for that placement, after meeting the requirements described in Subsections (1) through (10).]
66 (j) before placing a drug class on the prior approval program, the board shall:
67 (i) determine that the requirements of Subsections (1)(a) through (i) have been met;
68 and
69 (ii) by majority vote, place the drug class on prior approval.
70 (2) H. [ (a) ] .H The board may, H. [ when the board determines it is appropriate ]
70a1 H. only .H after
70a complying with Subsections (1)(b) through (j) .H , consider the cost:
71 H. [ (i) ] (a) .H of a drug when placing a drug on the prior approval program; and
72 H. [ (ii) ] (b) .H associated with including, or excluding a drug from the prior approval
72a process,
73 including:
74 H. [ (A) ] (i) .H potential side effects associated with a drug; or
75 H. [ (B) ] (ii) .H potential hospitalizations or other complications that may occur as a result
75a of a
76 drug's inclusion on the prior approval process.
77 H. [ (b) If the board considers the cost of a drug under Subsection (2)(a), the provisions of
78 Subsections (1)(b) through (j) apply. ] .H