SF 1842

as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to medical assistance; providing coverage for 
  1.3             a certain over-the-counter drug under certain 
  1.4             circumstances; amending Minnesota Statutes 1998, 
  1.5             section 256B.0625, subdivision 13. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 1998, section 256B.0625, 
  1.8   subdivision 13, is amended to read: 
  1.9      Subd. 13.  [DRUGS.] (a) Medical assistance covers drugs, 
  1.10  except for fertility drugs when specifically used to enhance 
  1.11  fertility, if prescribed by a licensed practitioner and 
  1.12  dispensed by a licensed pharmacist, by a physician enrolled in 
  1.13  the medical assistance program as a dispensing physician, or by 
  1.14  a physician or a nurse practitioner employed by or under 
  1.15  contract with a community health board as defined in section 
  1.16  145A.02, subdivision 5, for the purposes of communicable disease 
  1.17  control.  The commissioner, after receiving recommendations from 
  1.18  professional medical associations and professional pharmacist 
  1.19  associations, shall designate a formulary committee to advise 
  1.20  the commissioner on the names of drugs for which payment is 
  1.21  made, recommend a system for reimbursing providers on a set fee 
  1.22  or charge basis rather than the present system, and develop 
  1.23  methods encouraging use of generic drugs when they are less 
  1.24  expensive and equally effective as trademark drugs.  The 
  1.25  formulary committee shall consist of nine members, four of whom 
  2.1   shall be physicians who are not employed by the department of 
  2.2   human services, and a majority of whose practice is for persons 
  2.3   paying privately or through health insurance, three of whom 
  2.4   shall be pharmacists who are not employed by the department of 
  2.5   human services, and a majority of whose practice is for persons 
  2.6   paying privately or through health insurance, a consumer 
  2.7   representative, and a nursing home representative.  Committee 
  2.8   members shall serve three-year terms and shall serve without 
  2.9   compensation.  Members may be reappointed once.  
  2.10     (b) The commissioner shall establish a drug formulary.  Its 
  2.11  establishment and publication shall not be subject to the 
  2.12  requirements of the Administrative Procedure Act, but the 
  2.13  formulary committee shall review and comment on the formulary 
  2.14  contents.  The formulary committee shall review and recommend 
  2.15  drugs which require prior authorization.  The formulary 
  2.16  committee may recommend drugs for prior authorization directly 
  2.17  to the commissioner, as long as opportunity for public input is 
  2.18  provided.  Prior authorization may be requested by the 
  2.19  commissioner based on medical and clinical criteria before 
  2.20  certain drugs are eligible for payment.  Before a drug may be 
  2.21  considered for prior authorization at the request of the 
  2.22  commissioner:  
  2.23     (1) the drug formulary committee must develop criteria to 
  2.24  be used for identifying drugs; the development of these criteria 
  2.25  is not subject to the requirements of chapter 14, but the 
  2.26  formulary committee shall provide opportunity for public input 
  2.27  in developing criteria; 
  2.28     (2) the drug formulary committee must hold a public forum 
  2.29  and receive public comment for an additional 15 days; and 
  2.30     (3) the commissioner must provide information to the 
  2.31  formulary committee on the impact that placing the drug on prior 
  2.32  authorization will have on the quality of patient care and 
  2.33  information regarding whether the drug is subject to clinical 
  2.34  abuse or misuse.  Prior authorization may be required by the 
  2.35  commissioner before certain formulary drugs are eligible for 
  2.36  payment.  The formulary shall not include:  
  3.1      (i) drugs or products for which there is no federal 
  3.2   funding; 
  3.3      (ii) over-the-counter drugs, except for antacids, 
  3.4   acetaminophen, family planning products, aspirin, insulin, 
  3.5   products for the treatment of lice, vitamins for adults with 
  3.6   documented vitamin deficiencies, vitamins for children under the 
  3.7   age of seven and pregnant or nursing women, 5-hydroxytryptophan 
  3.8   when used to treat neurological problems resulting from 
  3.9   hypoglycemia during infancy, and any other over-the-counter drug 
  3.10  identified by the commissioner, in consultation with the drug 
  3.11  formulary committee, as necessary, appropriate, and 
  3.12  cost-effective for the treatment of certain specified chronic 
  3.13  diseases, conditions or disorders, and this determination shall 
  3.14  not be subject to the requirements of chapter 14; 
  3.15     (iii) anorectics; 
  3.16     (iv) drugs for which medical value has not been 
  3.17  established; and 
  3.18     (v) drugs from manufacturers who have not signed a rebate 
  3.19  agreement with the Department of Health and Human Services 
  3.20  pursuant to section 1927 of title XIX of the Social Security Act 
  3.21  and who have not signed an agreement with the state for drugs 
  3.22  purchased pursuant to the senior citizen drug program 
  3.23  established under section 256.955. 
  3.24     The commissioner shall publish conditions for prohibiting 
  3.25  payment for specific drugs after considering the formulary 
  3.26  committee's recommendations.  
  3.27     (c) The basis for determining the amount of payment shall 
  3.28  be the lower of the actual acquisition costs of the drugs plus a 
  3.29  fixed dispensing fee; the maximum allowable cost set by the 
  3.30  federal government or by the commissioner plus the fixed 
  3.31  dispensing fee; or the usual and customary price charged to the 
  3.32  public.  The pharmacy dispensing fee shall be $3.65.  Actual 
  3.33  acquisition cost includes quantity and other special discounts 
  3.34  except time and cash discounts.  The actual acquisition cost of 
  3.35  a drug shall be estimated by the commissioner, at average 
  3.36  wholesale price minus nine percent.  The maximum allowable cost 
  4.1   of a multisource drug may be set by the commissioner and it 
  4.2   shall be comparable to, but no higher than, the maximum amount 
  4.3   paid by other third-party payors in this state who have maximum 
  4.4   allowable cost programs.  Establishment of the amount of payment 
  4.5   for drugs shall not be subject to the requirements of the 
  4.6   Administrative Procedure Act.  An additional dispensing fee of 
  4.7   $.30 may be added to the dispensing fee paid to pharmacists for 
  4.8   legend drug prescriptions dispensed to residents of long-term 
  4.9   care facilities when a unit dose blister card system, approved 
  4.10  by the department, is used.  Under this type of dispensing 
  4.11  system, the pharmacist must dispense a 30-day supply of drug.  
  4.12  The National Drug Code (NDC) from the drug container used to 
  4.13  fill the blister card must be identified on the claim to the 
  4.14  department.  The unit dose blister card containing the drug must 
  4.15  meet the packaging standards set forth in Minnesota Rules, part 
  4.16  6800.2700, that govern the return of unused drugs to the 
  4.17  pharmacy for reuse.  The pharmacy provider will be required to 
  4.18  credit the department for the actual acquisition cost of all 
  4.19  unused drugs that are eligible for reuse.  Over-the-counter 
  4.20  medications must be dispensed in the manufacturer's unopened 
  4.21  package.  The commissioner may permit the drug clozapine to be 
  4.22  dispensed in a quantity that is less than a 30-day supply.  
  4.23  Whenever a generically equivalent product is available, payment 
  4.24  shall be on the basis of the actual acquisition cost of the 
  4.25  generic drug, unless the prescriber specifically indicates 
  4.26  "dispense as written - brand necessary" on the prescription as 
  4.27  required by section 151.21, subdivision 2.