S.B. 258

1

MEDICAID DRUG PROGRAM AMENDMENTS
2 2009 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: Lyle W. Hillyard
5 House Sponsor: Ron Bigelow
6
7 LONG TITLE
8 General Description:
9 This bill modifies the Utah Health Code by amending the drug prior approval program
10 to allow cost considerations to be used during the approval process.
11 Highlighted Provisions:
12 This bill:
13 . allows the Drug Utilization Review Board to use cost considerations in addition to
14 other issues in determining which drugs are approved by the board under the drug
15 utilization review in the Medicaid program; and
16 . makes technical changes.
17 Monies Appropriated in this Bill:
18 None
19 Other Special Clauses:
20 None
21 Utah Code Sections Affected:
22 AMENDS:
23 26-18-105, as last amended by Laws of Utah 2006, Chapter 14
24
25 Be it enacted by the Legislature of the state of Utah:
26 Section 1. Section 26-18-105 is amended to read:
27 26-18-105. Drug prior approval program.

28 (1) Any drug prior approval program approved or implemented by the board shall meet
29 the following conditions:
30 [(1)] (a) except as provided under Subsection (2), no drug may be placed on prior
31 approval for other than medical reasons;
32 [(2)] (b) the board shall hold a public hearing at least 90 days prior to placing a drug on
33 prior approval;
34 [(3)] (c) notwithstanding the provisions of Section 52-4-202 , the board shall provide
35 not less than 30 days notice to the public before holding a public hearing under Subsection
36 [(2)] (1)(b);
37 [(4)] (d) the board shall consider written and oral comments submitted by interested
38 parties prior to or during the hearing held in accordance with Subsection [(2)] (1)(b);
39 [(5)] (e) the board shall provide evidence that placing a drug class on prior approval
40 will not impede quality of recipient care and that the drug class is subject to clinical abuse or
41 misuse;
42 [(6)] (f) no later than nine months after any drug class is placed on prior approval, it
43 shall be reconsidered in a public hearing with notice as provided in Subsection [(3)] (1)(c);
44 [(7)] (g) the program shall provide either telephone or fax approval or denial at least
45 Monday through Friday, within 24 hours after receipt of the prior approval request;
46 [(8)] (h) the program shall provide for the dispensing of at least a 72-hour supply of the
47 drug in an emergency situation or on weekends;
48 [(9)] (i) the program may not be applied to prevent acceptable medical use for
49 appropriate off-label indications; and
50 [(10)] (j) any drug class placed on prior approval shall receive a majority vote by the
51 board for that placement, after meeting the requirements [described in Subsections (1) through
52 (10)] in this Subsection (1).
53 (2) The board may consider cost of a drug when determined appropriate by the board.




Legislative Review Note
as of 3-6-09 6:55 PM

Office of Legislative Research and General Counsel