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2002 SESSION

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SB 658 Medical assistance services; Medicaid prior authorization of drugs.

Introduced by: Frank M. Ruff | all patrons    ...    notes | add to my profiles

SUMMARY AS PASSED SENATE: (all summaries)

Medicaid; prior authorization of drugs. Requires the Board of Medical Assistance Services to include in the State Plan for Medical Assistance Services a provision relating to the Medicaid Prior Authorization Advisory Committee. This provision will require, upon implementation of the Medicaid Prior Authorization Advisory Committee or other prior drug authorization mechanism, that (i) if a drug is safe and effective for a medical condition and has been covered by the Department of Medical Assistance Services for an individual's medical condition, coverage under the state plan for such drug will not be limited or excluded when prescribed for the covered medical condition of a recipient; (ii) any formulary adopted by the Board must include each therapeutic class in which there are two or more FDA-approved controlled substances and, for each therapeutic class in which there are two or more FDA-approved pharmaceutical or biological agents, must provide coverage of a least two such pharmaceutical or biological agents without an administrative preference for one over the other; (iii) no prior authorization of new medicines that have been approved by the federal Food and Drug Administration for indications will be required until the Department of Medical Assistance Services has compiled at least six months of drug utilization review experience with Medicaid recipients being treated with the new drug for an authorized indication; and (iv) failure to provide coverage of drugs in every therapeutic class constitutes denial of medically necessary patient care.


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