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First Substitute S.B. 41

This document includes House Committee Amendments incorporated into the bill on Thu, Feb 18, 2010 at 12:20 PM by lerror. --> This document includes House Committee Amendments incorporated into the bill on Mon, Feb 22, 2010 at 5:11 PM by lerror. -->

Senator Peter C. Knudson proposes the following substitute bill:





Chief Sponsor: Peter C. Knudson

House Sponsor: Ronda Rudd Menlove


             8      LONG TITLE
             9      General Description:
             10          This bill amends the drug prior approval program within the state's Medicaid program.
             11      Highlighted Provisions:
             12          This bill:
             13          .    permits the Drug Utilization Review Board to consider costs, as well as other
             14      factors, when determining whether a drug should be placed on the prior approval
             15      program;
             16          .    amends notice requirements;
             17          .    amends number of days before implementation of a decision of the board;
             18          .    provides more discretion to the Drug Utilization Review Board to restrict the use of
             19      a drug for off label indications; and
             20          .    makes technical changes.
             21      Monies Appropriated in this Bill:
             22          None
             23      Other Special Clauses:
             24          None
             25      Utah Code Sections Affected:

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             27          26-18-105, as last amended by Laws of Utah 2006, Chapter 14

             29      Be it enacted by the Legislature of the state of Utah:
             30          Section 1. Section 26-18-105 is amended to read:
             31           26-18-105. Drug prior approval program.
             32          [Any]     (1) A drug prior approval program approved or implemented by the board shall
             33      meet the following conditions:
             34          [(1) no drug may] (a) except as provided in Subsection (2), a drug may not be placed
             35      on prior approval for other than medical reasons;
             36          [(2)] (b) the board shall hold a public hearing at least [90] 30 days prior to placing a
             37      drug on prior approval;
             38          [(3)] (c) notwithstanding the provisions of Section 52-4-202 , the board shall provide
             39      not less than [30] 14 days' notice to the public before holding a public hearing under
             40      Subsection [(2)] (1)(b);
             41          [(4)] (d) the board shall consider written and oral comments submitted by interested
             42      parties prior to or during the hearing held in accordance with Subsection [(2)] (1)(b);
             43          [(5)] (e) the board shall provide evidence that placing a drug class on prior approval:
             44          (i) will not impede quality of recipient care; and
             45          (ii) that the drug class is subject to clinical abuse or misuse;
             46          (f) the board shall reconsider its decision to place a drug on prior approval:
             47          [(6)] (i) no later than nine months after any drug class is placed on prior approval[, it
             48      shall be reconsidered in]; and
             49          (ii) at a public hearing with notice as provided in Subsection [(3)] (1)(b);
             50          [(7)] (g) the program shall provide [either telephone or fax] an approval or denial of a
             51      request for prior approval:
             52          (i) by either:
             53          (A) fax;
             54          (B) telephone; or
             55          (C) electronic transmission;
             56          (ii) at least Monday through Friday, except for state holidays; and

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House Committee Amendments 2-22-2010 le/cjd

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House Committee Amendments 2-18-2010 le/cjd
         (iii) within 24 hours after receipt of the prior approval request;
             58          [(8)] (h) the program shall provide for the dispensing of at least a 72-hour supply of the
             59      drug on the prior approval program:
             60          (i) in an emergency situation; or
             61          (ii) on weekends or state holidays;
             62          [(9)] (i) the program may [not] be applied to [prevent] allow acceptable medical use of
             63      a drug on prior approval for appropriate off-label indications; and
             64          [(10) any drug class placed on prior approval shall receive a majority vote by the board
             65      for that placement, after meeting the requirements described in Subsections (1) through (10).]
             66          (j) before placing a drug class on the prior approval program, the board shall:
             67          (i) determine that the requirements of Subsections (1)(a) through (i) have been met;
             68      and
             69          (ii) by majority vote, place the drug class on prior approval.
             70          (2) H. [ (a) ] .H The board may, H. [ when the board determines it is appropriate ]
             70a1      H. only .H after
             70a      complying with Subsections (1)(b) through (j) .H , consider the cost:
             71           H. [ (i) ] (a) .H of a drug when placing a drug on the prior approval program; and
             72           H. [ (ii) ] (b) .H associated with including, or excluding a drug from the prior approval
             72a      process,
             73      including:
             74           H. [ (A) ] (i) .H potential side effects associated with a drug; or
             75           H. [ (B) ] (ii) .H potential hospitalizations or other complications that may occur as a result
             75a      of a
             76      drug's inclusion on the prior approval process.
             77           H. [ (b) If the board considers the cost of a drug under Subsection (2)(a), the provisions of
             78      Subsections (1)(b) through (j) apply.
] .H

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