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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
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]] Fifty-ninth Legislature Second Regular Session - 2008IN THE SENATE SENATE BILL NO. 1386 BY HEALTH AND WELFARE COMMITTEE 1 AN ACT 2 RELATING TO PRIOR AUTHORIZATION OF MEDICATIONS; AMENDING CHAPTER 2, TITLE 56, 3 IDAHO CODE, BY THE ADDITION OF NEW SECTIONS 56-258, 56-259 AND 56-260, 4 IDAHO CODE, TO PROVIDE FOR THE PHARMACY AND THERAPEUTICS COMMITTEE, TO 5 PROVIDE FOR EXEMPTION AND EXCEPTIONS TO PRIOR AUTHORIZATION OF MEDICATIONS 6 AND TO PROVIDE FOR APPLICATION. 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. 2 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. 7 56-259. EXEMPTION AND EXCEPTIONS TO PRIOR AUTHORIZATION OF MEDICATIONS. 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
RS17800C1
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
requirements.
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
savings.
CONTACT:
Name: Bill Roden
Representing: PhRMA
Telephone: (208) 343-1231
STATEMENT OF PURPOSE/FISCAL NOTE S 1386