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S.B. 87





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.
             25          (1) A Medicaid drug program developed by the department under Subsection 26-18-2.3
             26      (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 accordance
             29      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; and
             32          (c) may include placing some drugs, except the drugs described in Subsection [(3)] (2),
             33      on a preferred drug list to the extent determined appropriate by the department[; and].
             34          [(d) (i) except as prohibited by Subsections 58-17b-606 (4) and (5), shall permit a
             35      health care provider with prescriptive authority to override the restrictions of a preferred drug
             36      list provided that the medical necessity for the override is documented in the patient's medical
             37      file and by handwriting on the prescription "medically necessary - dispense as written"; and]
             38          [(ii) shall not permit a health care provider with prescriptive authority to override the
             39      restrictions of a preferred drug list with any preprinted instructions for dispense as written, or
             40      no substitutions allowed.]
             41          [(2) If the department implements a drug program under the provisions of Subsection
             42      (1)(c), the department shall:]
             43          [(a) determine the percentage of prescriptions that are paid for by the department which
             44      are overrides to the preferred drug list under Subsection (1)(d)(i);]
             45          [(b) include the information required by Subsection (2)(a) in the report required by
             46      Subsection (2)(c); and]
             47          [(c) report its findings regarding the drug program to the Legislative Health and Human
             48      Services Interim Committee by August 30, 2008, and to the Legislative Health and Human
             49      Services Appropriations Subcommittee during the 2009 General Session.]
             50          [(3)] (2) (a) For purposes of this Subsection [(3)] (2), "immunosuppressive drug":
             51          (i) means a drug that is used in immunosuppressive therapy to inhibit or prevent
             52      activity of the immune system to aid the body in preventing the rejection of transplanted organs
             53      and tissue; and
             54          (ii) does not include drugs used for the treatment of autoimmune disease or diseases
             55      that are most likely of autoimmune origin.
             56          (b) A preferred drug list developed under the provisions of this section may not
             57      include:
             58          (i) a psychotropic or anti-psychotic drug; or

             59          (ii) an immunosuppressive drug.
             60          (c) The state Medicaid program shall reimburse for a prescription for an
             61      immunosuppressive drug as written by the health care provider for a patient who has undergone
             62      an organ transplant. For purposes of Subsection 58-17b-606 (4), and with respect to patients
             63      who have undergone an organ transplant, the prescription for a particular immunosuppressive
             64      drug as written by a health care provider meets the criteria of demonstrating to the Department
             65      of Health a medical necessity for dispensing the prescribed immunosuppressive drug.
             66          (d) Notwithstanding the requirements of Part 2, Drug Utilization Review Board, the
             67      state Medicaid drug program may not require the use of step therapy for immunosuppressive
             68      drugs without the written or oral consent of the health care provider and the patient.

Legislative Review Note
    as of 12-22-08 10:26 AM

Office of Legislative Research and General Counsel

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