HF 3726

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

A bill for an act
relating to human services; limiting the use of prior authorization under medical
assistance program for certain prescription drugs; amending Minnesota Statutes
2005 Supplement, section 256B.0625, subdivision 13f.

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

Section 1.

Minnesota Statutes 2005 Supplement, 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. Prior authorization shall
automatically be granted for 60 days for brand name drugs prescribed for treatment of
mental illness within 60 days of when a generically equivalent drug becomes available,
provided that the brand name drug was part of the recipient's course of treatment at the
time the generically equivalent drug became available.

(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.

(e) new text begin Prior authorization shall not be required or utilized for any prescription drug
prescribed for the treatment of cancer, human immunodeficiency virus infection, acquired
immunodeficiency syndrome, or transplantation where there is no generically equivalent
drug available. The commissioner shall provide authorization for a prescribed drug
identified under this paragraph if the following requirements are met:
new text end

new text begin (1) the prescribing physician is certified as a specialist by a specialty board and
provides documentation of the certification; and
new text end

new text begin (2) the prescribing physician telephones the department or certifies in writing that:
new text end

new text begin (i) the prescribed drug is being prescribed consistent with its licensed indication or
with generally accepted medical practices as documented in a standard medical reference;
new text end

new text begin (ii) the prescribed drug is being used to treat a condition that is normally treated
within the prescribing physician's specialty field; and
new text end

new text begin (iii) in the physician's professional opinion, no other drug or drugs included on the
preferred drug list can provide a comparable benefit.
new text end

new text begin An individual who was under a court order for a particular prescription drug
before becoming a medical assistance recipient is exempt from the prior authorization
process and may continue on that medication for the duration of the order. An individual
who is under medical treatment and whose condition has been stabilized under a given
prescription drug regimen before becoming a medical assistance recipient is exempt
from the prior authorization process and may continue on that medication for the current
course of treatment if without that prescription drug regimen the individual would suffer
serious health consequences.
new text end

new text begin This paragraph does not apply to drugs being provided under a prepaid medical
assistance program contract between the commissioner and a health maintenance
organization.
new text end

new text begin (f) new text end 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.

deleted text begin (f) deleted text end new text begin (g) new text end Notwithstanding this subdivision, the commissioner may automatically
require prior authorization, for a period not to exceed 180 days, for any drug that is
approved by the United States Food and Drug Administration on or after July 1, 2005.
The 180-day period begins no later than the first day that a drug is available for shipment
to pharmacies within the state. The Formulary Committee shall recommend to the
commissioner general criteria to be used for the prior authorization of the drugs, but
the committee is not required to review each individual drug. In order to continue prior
authorizations for a drug after the 180-day period has expired, the commissioner must
follow the provisions of this subdivision.