HF 891

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

A bill for an act
relating to human services; changing and clarifying
provisions for prescription drugs under medical
assistance; amending Minnesota Statutes 2004, section
256B.0625, subdivisions 13f, 13g.

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. new text begin A 30-day
notice must be provided for the forum.
new text end

The commissioner must provide a deleted text begin 15-day deleted text end new text begin 30-day new text end notice period
before implementing the prior authorization.

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

(1) there is no generically equivalent drug available; deleted text begin and
deleted text end

(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.

new text begin Nothing in this paragraph requires a person with a mental
illness to switch to a generic medication. new text end 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. This paragraph expires July 1, 2005.

(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 , except as provided in
paragraph (c) new text end .

Sec. 2.

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

Subd. 13g.

Preferred drug list.

(a) The commissioner
shall adopt and implement a preferred drug list by January 1,
2004. The commissioner may enter into a contract with a vendor
or one or more states for the purpose of participating in a
multistate preferred drug list and supplemental rebate program.
The commissioner shall ensure that any contract meets all
federal requirements and maximizes federal financial
participation. The commissioner shall publish the preferred
drug list annually in the State Register and shall maintain an
accurate and up-to-date list on the agency Web site.

(b) The commissioner may add to, delete from, and otherwise
modify the preferred drug list, after consulting with the
Formulary Committee and appropriate medical specialists and
providing public notice and the opportunity for public comment.

(c) The commissioner shall adopt and administer the
preferred drug list as part of the administration of the
supplemental drug rebate program. Reimbursement for
prescription drugs not on the preferred drug list may be subject
to prior authorization, unless the drug manufacturer signs a
supplemental rebate contract.

(d) For purposes of this subdivision, "preferred drug list"
means a list of prescription drugs within designated therapeutic
classes selected by the commissioner, for which prior
authorization based on the identity of the drug or class is not
required.

(e) The commissioner shall seek any federal waivers or
approvals necessary to implement this subdivision.

new text begin (f) The commissioner shall utilize education and management
programs to reduce inefficient and ineffective prescribing
patterns for prescription drug treatment of mental illness. The
definition of such patterns will be based on nationally
recognized treatment protocols, generally accepted drug
utilization review practices, or medication algorithms. These
methods shall be used in lieu of other methods that restrict
access to medications solely on the basis of a preferred drug
list.
new text end