2008 Legislation
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SENATE BILL NO. 1386<br /> – Pharmacy/Therapeutics comm


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Bill Status

S1386.................................................by HEALTH AND WELFARE
AUTHORIZATION OF MEDICATIONS - Adds to existing law relating to prior
authorization of medications to provide for the Pharmacy and Therapeutics
Committee; to provide for exemption and exceptions to prior authorization
of medications; and to provide for application.

02/07    Senate intro - 1st rdg - to printing
02/08    Rpt prt - to Health/Wel

Bill Text

  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-ninth Legislature                   Second Regular Session - 2008


                                       IN THE SENATE

                                    SENATE BILL NO. 1386

                              BY HEALTH AND WELFARE COMMITTEE

  1                                        AN ACT
  3        IDAHO  CODE,  BY  THE  ADDITION OF NEW SECTIONS 56-258, 56-259 AND 56-260,

  7    Be It Enacted by the Legislature of the State of Idaho:

  8        SECTION  1.  That  Chapter  2,  Title  56, Idaho Code, be, and the same is
  9    hereby amended by the addition thereto of NEW SECTIONS, to be known and desig-
 10    nated as Sections 56-258, 56-259 and 56-260, Idaho Code, and to read  as  fol-
 11    lows:

 12        56-258.  PHARMACY  AND THERAPEUTICS COMMITTEE. (1) There is hereby created
 13    in the office of the director of the department  of  health  and  welfare  the
 14    pharmacy  and  therapeutics committee composed of eight (8) voting members who
 15    shall be appointed by the governor. The membership of the committee shall be:
 16        (a)  Four (4) physicians licensed to practice medicine within the state of
 17        Idaho;
 18        (b)  Three (3) pharmacists licensed to practice within the state of Idaho;
 19        and
 20        (c)  One (1) advanced nurse practitioner or physician assistant authorized
 21        to practice within the state of Idaho.
 22    The governor shall designate the chair of the committee from  among  its  mem-
 23    bers.
 24        (2)  The  pharmacy  and  therapeutics  committee  shall have the following
 25    responsibilities:
 26        (a)  Serve in an evaluative, educational  and  advisory  capacity  to  the
 27        director specific to the prior authorization of drugs;
 28        (b)  Receive  evidence-based  clinical  information  and  recommend to the
 29        director those drugs that should be considered for  exemption  from  prior
 30        authorization  requirements  in selected classes of drugs, based upon such
 31        data. The recommendation of the committee for drugs to be  considered  for
 32        exemption  from  prior authorization requirements shall be based on objec-
 33        tive evaluations  of  the  relative  safety,  effectiveness  and  clinical
 34        outcomes  of  the drug in comparison with other drugs in the same class of
 35        drugs. The committee shall not consider, nor be provided  with,  price  or
 36        rebate information relating to the drugs being evaluated;
 37        (c)  Recommend  to  the  state department the classes of medications to be
 38        reviewed through evidence-based evaluation; and
 39        (d)  Review drug utilization outcome studies and intervention reports from
 40        the drug utilization review board as part of the process of reviewing  and
 41        developing recommendations to the department.
 42        (3)  Pharmacy  and  therapeutics  committee  meetings shall be open to the
 43    public.


  1        (a)  Portions of each meeting shall be set aside to hear and review public
  2        comment concerning individual drugs or drug classes  being  considered  by
  3        the committee at such meeting.
  4        (b)  All recommendations and decisions of the committee shall be made pur-
  5        suant  to motions duly adopted in an open and public meeting and shall set
  6        forth the findings upon which such recommendations or decisions are made.

  8    (1)  The  director  may  exempt  a drug from prior authorization requirements,
  9    adopted by state department rule, based upon safety, effectiveness and  clini-
 10    cal  outcomes  of  the  drug in comparison with other alternative drugs in the
 11    same class of drugs, the recommendations of the pharmacy and therapeutics com-
 12    mittee and costs.
 13        (2)  If a prescriber determines that a covered drug is medically necessary
 14    for a specific medicaid participant, prior authorization by the state  depart-
 15    ment shall not be required, if:
 16        (a)  The   prescriber   endorses  legibly  on  the  prescription,  in  the
 17        prescriber's handwriting, or indicates in some  other  reasonable  manner,
 18        that the prescribed drug is "medically necessary" or to "dispense as writ-
 19        ten." A prescribed drug is "medically necessary" for purposes of this sub-
 20        section  if, in the opinion of the prescriber, it is reasonably calculated
 21        to prevent, diagnose or treat conditions in the medicaid participant  that
 22        endanger  life  or  cause pain, functionally significant deformity or mal-
 23        function and there is no  other  equally  effective  course  of  treatment
 24        available  or  suitable for the specific medicaid participant that is more
 25        conservative or substantially less costly; or
 26        (b)  The drug previously has been approved by the state department for the
 27        medicaid participant's medical condition.
 28        (3)  The state department shall not require prior authorization of a  drug
 29    under the following circumstances:
 30        (a)  Notwithstanding the generic drugs that may be available in each ther-
 31        apeutic  chemical  class,  if the federal drug administration has approved
 32        more than one (1) drug in a therapeutic chemical class, the state  depart-
 33        ment  shall include a minimum of two (2) drug choices within a therapeutic
 34        chemical class.
 35        (b)  Although an acceptable generic drug form may exist for a  brand  name
 36        drug,  the  state department shall not require prior authorization for the
 37        brand name drug if the generic drug is more expensive than the brand  name
 38        drug.
 39        (c)  The  state  department shall not restrict coverage of a drug approved
 40        by the federal drug administration for an indication if the drug is  in  a
 41        class of drugs that has not been reviewed by the pharmacy and therapeutics
 42        committee or, if the class has been reviewed but the drug was not included
 43        in  the  class at the time of review, until the committee has reviewed the
 44        class that includes the drug at issue and the committee has made its  rec-
 45        ommendations.  The  provisions  of this paragraph shall not apply to those
 46        drugs or drug classes that may be restricted or excluded according  to  42
 47        U.S.C. section 1396r-8.

 48        56-260.  APPLICATION.  Nothing  in sections 56-258 and 56-259, Idaho Code,
 49    shall be construed to affect the designation of  certain  drugs  as  preferred
 50    drugs  or  nonpreferred  drugs  by the state department prior to the effective
 51    date of those sections.

Statement of Purpose / Fiscal Impact

                          STATEMENT OF PURPOSE


  The proposed legislation statutorily creates a Pharmacy and Therapeutics
  Committee in the office of the Director, Department of Health and
  Welfare. Members of the Committee shall be appointed by the Governor,
  for the purpose of receiving evidence-based clinical information and
  making non-binding recommendations to the Director of Health and
  Welfare, concerning administration of the prescription drug program
  within the Department of Health and Welfare. The Committee's charge is
  to make objective evaluations of the relative safety, effectiveness and
  clinical outcomes of specific drugs in comparison to other drugs in the
  same drug classes. Cost information relating to drugs will not be
  considered by the committee. However, cost of drugs would be considered
  by the Director, in addition to his consideration of the committee's
  clinical recommendations and other evidence, to determine which, if any
  drugs should require prior authorization from the Department prior to
  being prescribed for a Medicaid patient. 
  The committee membership is to consist of four physicians licensed to
  practice medicine, three licensed pharmacists, and one nurse
  practitioner or physician's assistant authorized to practice in the
  state of Idaho.
  In addition, the proposed legislation does the following:

        Authorizes a physician to prescribe medication without prior
        departmental authorization if, in the physician's opinion the
        medication is medically necessary for a specific patient or if
        the drug has previously been approved by the department for that
        patient's medical condition, and 
        Defines other limited exceptions to prior authorization
   The legislation further provides that the provision of this act shall
   not affect the designation of certain drugs as preferred or non-
   preferred drugs by the state department prior to the effective date of
   this act.

                            FISCAL NOTE
  There is no increased fiscal impact associated with this legislation. It
  is anticipated that reorganization of the P & T Committee within the
  Office of the Director and the reduction of prior authorization
  requirements in limited cases will also result in administrative cost
  Name:          Bill Roden
  Representing:  PhRMA
  Telephone:     (208) 343-1231
  STATEMENT OF PURPOSE/FISCAL NOTE                                 S 1386