HF 855

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; removing the sunset for a
provision exempting certain antihemophilic factor
drugs from prior authorization under medical
assistance; amending Minnesota Statutes 2004, section
256B.0625, subdivision 13f.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2004, section 256B.0625,
subdivision 13f, is amended to read:

Subd. 13f.

Prior authorization.

(a) The Formulary
Committee shall review and recommend drugs which require prior
authorization. The Formulary Committee shall establish general
criteria to be used for the prior authorization of brand-name
drugs for which generically equivalent drugs are available, but
the committee is not required to review each brand-name drug for
which a generically equivalent drug is available.

(b) Prior authorization may be required by the commissioner
before certain formulary drugs are eligible for payment. The
Formulary Committee may recommend drugs for prior authorization
directly to the commissioner. The commissioner may also request
that the Formulary Committee review a drug for prior
authorization. Before the commissioner may require prior
authorization for a drug:

(1) the commissioner must provide information to the
Formulary Committee on the impact that placing the drug on prior
authorization may have on the quality of patient care and on
program costs, information regarding whether the drug is subject
to clinical abuse or misuse, and relevant data from the state
Medicaid program if such data is available;

(2) the Formulary Committee must review the drug, taking
into account medical and clinical data and the information
provided by the commissioner; and

(3) the Formulary Committee must hold a public forum and
receive public comment for an additional 15 days.

The commissioner must provide a 15-day notice period before
implementing the prior authorization.

(c) Prior authorization shall not be required or utilized
for any atypical antipsychotic drug prescribed for the treatment
of mental illness if:

(1) there is no generically equivalent drug available; and

(2) the drug was initially prescribed for the recipient
prior to July 1, 2003; or

(3) the drug is part of the recipient's current course of
treatment.

This paragraph applies to any multistate preferred drug list or
supplemental drug rebate program established or administered by
the commissioner.

(d) Prior authorization shall not be required or utilized
for any antihemophilic factor drug prescribed for the treatment
of hemophilia and blood disorders where there is no generically
equivalent drug available if the prior authorization is used in
conjunction with any supplemental drug rebate program or
multistate preferred drug list established or administered by
the commissioner. deleted text begin This paragraph expires July 1, 2005.
deleted text end

(e) The commissioner may require prior authorization for
brand name drugs whenever a generically equivalent product is
available, even if the prescriber specifically indicates
"dispense as written-brand necessary" on the prescription as
required by section 151.21, subdivision 2.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 30, 2005.
new text end