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S.B. 87 Enrolled





Chief Sponsor: Allen M. Christensen

House Sponsor: James A. Dunnigan

             7      LONG TITLE
             8      General Description:
             9          This bill amends the Medical Assistance Act.
             10      Highlighted Provisions:
             11          This bill:
             12          .    removes the automatic override to the preferred drug list in the state Medicaid
             13      program.
             14      Monies Appropriated in this Bill:
             15          None
             16      Other Special Clauses:
             17          None
             18      Utah Code Sections Affected:
             19      AMENDS:
             20          26-18-2.4, as last amended by Laws of Utah 2008, Chapter 180
             22      Be it enacted by the Legislature of the state of Utah:
             23          Section 1. Section 26-18-2.4 is amended to read:
             24           26-18-2.4. Medicaid drug program -- Preferred drug list.
             25          (1) A Medicaid drug program developed by the department under Subsection
             26      26-18-2.3 (2)(f):
             27          (a) shall, notwithstanding Subsection 26-18-2.3 (1)(b), be based on clinical and
             28      cost-related factors which include medical necessity as determined by a provider in
             29      accordance with administrative rules established by the Drug Utilization Review Board;

             30          (b) may include therapeutic categories of drugs that may be exempted from the drug
             31      program;
             32          (c) may include placing some drugs, except the drugs described in Subsection [(3)]
             33      (2), on a preferred drug list to the extent determined appropriate by the department; [and]
             34          (d) notwithstanding the requirements of Part 2, Drug Utilization Review Board, shall
             35      immediately implement the prior authorization requirements for a non-preferred drug that is in
             36      the same therapeutic class as a drug that is:
             37          (i) on the preferred drug list on the date that this act takes effect; or
             38          (ii) added to the preferred drug list after this act takes effect; and
             39          (e) except as prohibited by Subsections 58-17b-606 (4) and (5), the prior authorization
             40      requirements established under Subsections (1)(c) and (d) shall permit a health care provider
             41      or the health care provider's agent to obtain a prior authorization override of the preferred drug
             42      list through the department's pharmacy prior authorization review process, which shall:
             43          (i) provide either telephone or fax approval or denial of the request within 24 hours of
             44      the receipt of a request that is submitted during normal business hours of Monday through
             45      Friday from 8 am to 5 pm;
             46          (ii) provide for the dispensing of a limited supply of a requested drug as determined
             47      appropriate by the department in an emergency situation, if the request for an override is
             48      received outside of the department's normal business hours; and
             49          (iii) require the health care provider to provide the department with documentation of
             50      the medical need for the preferred drug list override in accordance with criteria established by
             51      the department in consultation with the Pharmacy and Therapeutics Committee.
             52          [(d) (i) except as prohibited by Subsections 58-17b-606 (4) and (5), shall permit a
             53      health care provider with prescriptive authority to override the restrictions of a preferred drug
             54      list provided that the medical necessity for the override is documented in the patient's medical
             55      file and by handwriting on the prescription "medically necessary - dispense as written"; and]
             56          [(ii) shall not permit a health care provider with prescriptive authority to override the
             57      restrictions of a preferred drug list with any preprinted instructions for dispense as written, or

             58      no substitutions allowed.]
             59          [(2) If the department implements a drug program under the provisions of Subsection
             60      (1)(c), the department shall:]
             61          [(a) determine the percentage of prescriptions that are paid for by the department
             62      which are overrides to the preferred drug list under Subsection (1)(d)(i);]
             63          [(b) include the information required by Subsection (2)(a) in the report required by
             64      Subsection (2)(c); and]
             65          [(c) report its findings regarding the drug program to the Legislative Health and
             66      Human Services Interim Committee by August 30, 2008, and to the Legislative Health and
             67      Human Services Appropriations Subcommittee during the 2009 General Session.]
             68          [(3)] (2) (a) For purposes of this Subsection [(3)] (2), "immunosuppressive drug":
             69          (i) means a drug that is used in immunosuppressive therapy to inhibit or prevent
             70      activity of the immune system to aid the body in preventing the rejection of transplanted
             71      organs and tissue; and
             72          (ii) does not include drugs used for the treatment of autoimmune disease or diseases
             73      that are most likely of autoimmune origin.
             74          (b) A preferred drug list developed under the provisions of this section may not
             75      include:
             76          (i) a psychotropic or anti-psychotic drug; or
             77          (ii) an immunosuppressive drug.
             78          (c) The state Medicaid program shall reimburse for a prescription for an
             79      immunosuppressive drug as written by the health care provider for a patient who has
             80      undergone an organ transplant. For purposes of Subsection 58-17b-606 (4), and with respect
             81      to patients who have undergone an organ transplant, the prescription for a particular
             82      immunosuppressive drug as written by a health care provider meets the criteria of
             83      demonstrating to the Department of Health a medical necessity for dispensing the prescribed
             84      immunosuppressive drug.
             85          (d) Notwithstanding the requirements of Part 2, Drug Utilization Review Board, the

             86      state Medicaid drug program may not require the use of step therapy for immunosuppressive
             87      drugs without the written or oral consent of the health care provider and the patient.
             88          (3) The department shall report to the Health and Human Services Interim Committee
             89      and to the Health and Human Services Appropriations Subcommittee prior to November 1,
             90      2010 regarding the savings to the Medicaid program resulting from the use of the preferred
             91      drug list permitted by Subsection (1).

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