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H.B. 105






Chief Sponsor: Mark W. Walker

Senate Sponsor: Sheldon L. Killpack

             8      LONG TITLE
             9      General Description:
             10          This bill amends the Pharmacy Practice Act to permit the state's Medicaid program to
             11      reimburse for nongeneric drugs when the brand name drug is cheaper to the state than
             12      the generic form of the drug.
             13      Highlighted Provisions:
             14          This bill:
             15          .    amends the provision that requires the Medicaid program to use generic drugs when
             16      available.
             17      Monies Appropriated in this Bill:
             18          None
             19      Other Special Clauses:
             20          None
             21      Utah Code Sections Affected:
             22      AMENDS:
             23          58-17b-606, as enacted by Chapter 280, Laws of Utah 2004
             25      Be it enacted by the Legislature of the state of Utah:
             26          Section 1. Section 58-17b-606 is amended to read:
             27           58-17b-606. Restrictive drug formulary prohibited.

             28          (1) As used in this section:
             29          (a) "Generic form" means a prescription drug that is available in generic form and has
             30      an A rating in the United States Pharmacopeia and Drug Index.
             31          (b) "Legend drug" means any drug that requires a prescription under state or federal
             32      law.
             33          (c) "Restrictive drug formulary" means a list of legend drugs, other than drugs for
             34      cosmetic purposes, that are prohibited by the Department of Health from dispensation, but are
             35      approved by the Federal Food and Drug Administration.
             36          (2) A practitioner may prescribe legend drugs in accordance with this chapter that, in
             37      his professional judgment and within the lawful scope of his practice, he considers appropriate
             38      for the diagnosis and treatment of his patient.
             39          (3) Except as provided in Subsection (4), the Department of Health may not maintain a
             40      restrictive drug formulary that restricts a physician's ability to treat a patient with a legend drug
             41      that has been approved and designated as safe and effective by the Federal Food and Drug
             42      Administration, except for drugs for cosmetic purposes.
             43          (4) When a multisource legend drug is available in the generic form, the Department of
             44      Health may only reimburse for the generic form of the drug unless:
             45          (a) the treating physician demonstrates to the Department of Health a medical necessity
             46      for dispensing the nongeneric, brand-name legend drug[.]; or
             47          (b) reimbursement to the state for the brand name drug makes the brand name drug less
             48      expensive to the state than the cost of the generic form of the drug.
             49          (5) This section does not affect the state's ability to exercise the exclusion options
             50      available under the Federal Omnibus Budget Reconciliation Act of 1990.

Legislative Review Note
    as of 11-22-05 11:26 AM

Based on a limited legal review, this legislation has not been determined to have a high
probability of being held unconstitutional.

Office of Legislative Research and General Counsel

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