31A-29-113.5. Pilot Program for Chronic Disease and Pharmaceutical
Management of Bleeding Disorders.
(1) Beginning July 1, 2005, and ending on July 1, 2010, the pool policy shall include a
pilot program for hemophilia and bleeding disorders in accordance with this section.
(2) In accordance with this Subsection (2), the pool's pilot program shall:
(a) permit enrollees in the pool who have hemophilia or a bleeding disorder to participate
in a pharmaceutical program for people with hemophilia and bleeding disorders administered by
an entity that is qualified as a federal 340B Drug Pricing Program of the Public Health Service
Act, enacted in Public Law 102-585, the Veterans Health Care Act of 1992;
(b) pay the eligible medical expenses for the enrollee's participation in the pilot program
subject to all applicable plan benefits and limitations; and
(c) may not impose cost containment measures on an enrollee who participates in the
pilot program greater than the cost containment measures imposed on other enrollees under the
provisions of Subsection 31A-29-113(6).
(3) (a) The pool may establish the pilot program through the best means available for
obtaining the lowest drug discount pricing, including administering the pilot program through the
Department of Health's 340B Medicaid drug discount program or the Ryan White HIV drug
discount program.
(b) The Department of Health shall assist the pool with administering the pilot program,
including assistance in processing claims for the drug discount and chronic disease management
services.
(4) (a) The board shall report to the commissioner and to the Health and Human Services
Interim Committee prior to October 30, 2010 regarding the claims experience and
pharmaceutical costs under the pilot program.
(b) The board may discontinue the pilot program created in this section prior to July 1,
2010, if prior to discontinuing the pilot program:
(i) the board reports on the need to discontinue the pilot program to the Health and
Human Services Interim Committee and the Commerce and Revenue Appropriations
Subcommittee; and
(ii) either:
(A) the commissioner and the board determine that the requirements of the pilot program
jeopardize the actuarial soundness of the pool; or
(B) the entity that is qualified as a 340B Drug Pricing Program is disqualified by federal
law from providing 340B drug pricing discounts to enrollees in the pool.
Enacted by Chapter 273, 2005 General Session
Download Code Section Zipped WordPerfect 31A29_011305.ZIP 2,865 Bytes
Sections in this Chapter|Chapters in this Title|All Titles|Legislative Home Page
Last revised: Thursday, May 28, 2009