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SB 351/FN (BR 2429) - J. Pendleton, N. Kafoglis, R. Roeding
AN ACT relating to pharmaceutical services for Medicaid.
Create various new sections of KRS 205.510 to 205.630 to define the terms "available" and "new drug"; direct that no prior authorization be required for reimbursement of any claim involving a drug covered by Medicaid on the effective date of the Act, for a period of at least 12 months, during which time the Drug Management Review Advisory Board may review the product; require the Drug Management Review Advisory Board to coordinate the use of utilization data to identify appropriate use of pharmaceuticals and determine any need for educational interventions; require prospective drug utilization review and retrospective drug utilization review measures to be utilized to monitor the success of the interventions; require interventions to be evaluated for at least 6 months; set forth conditions which must be met before the Drug Management Review Advisory Board may require prior authorization of a product; direct the Drug Management Review Advisory Board not utilize the prior authorization program to require a recipient to utilize or fail with a drug or drug therapy prior to allowing the recipient to receive any product for therapy recommended to the recipient's physician; direct the Department for Medicaid Services to promulgate an administrative regulation setting forth procedures by which all products are placed in the prior authorization drug file; allow the commissioner of the Medicaid Services Department to prior authorize any product the commissioner determines may pose any significant safety issues; require public notice of prior authorization; provide for appeals of an adverse decision of the commissioner; direct that drug reviews related to prior authorization decisions not take longer than 60 days or prohibit prior authorization of the drug and require approval of the drug for the drug formulary; require the Cabinet for Human Resources secretary to establish and appoint membership for the Drug Management Review Advisory Board; set forth membership, terms of office, and staffing; amend KRS 205.561, relating to the annual report to the Governor and LRC on the cost to pharmacies of dispensing prescription medications to Medicaid recipients, to also include an estimate of the cost to pharmacies of dispensing prescription medications through any managed care entities providing services to Medicaid recipients; require the report to also include data on the most utilized and abused drugs in Medicaid, a determination of factors causing high drug costs and drug usage rates of Medicaid recipients, objectives and timelines for cost containment in the Medicaid drug program, comparative data from other states, and the cost effectiveness of the drug formulary and prior authorization process; require the annual report to be developed with the advice of the Drug Management Review Advisory Board.
SB 351 - AMENDMENTS
SCS/FN - Create various new sections of KRS 205.510 to 205.630 to define the terms "available" and "new drug"; direct that no prior authorization be required for reimbursement of any claim involving a drug covered by Medicaid on the effective date of the Act, for a period of at least 12 months, during which time the Drug Management Review Advisory Board may review the product; require the Department for Medicaid Services to promulgate administrative regulations for drug submission program and require drug class reviews and continued prior authorization of drugs having inappropriate economic impact on the department, and require that 50% of class reviews be conducted with 12 months of the effective date of the Act; require the Drug Management Review Advisory Board to coordinate the use of utilization data to identify appropriate use of pharmaceuticals and determine any need for educational interventions; require prospective drug utilization review and retrospective drug utilization review measures to be utilized to monitor success of interventions and evaluate interventions for at least 6 months; commissioner may require prior authorization of a drug for safety or financial reasons which will initiate review by the Drug Management Review Advisory Board, decisions on prior authorization must be made within 90 days, assign duties of drug review to staff of the cabinet; require the Cabinet for Human Resources Secretary to establish and appoint membership of the Drug Management Review Advisory Board, set forth membership, terms of office, duties, meetings, appeals from decisions and staffing; amend KRS 205.561, relating to the annual report to the Governor and LRC on the cost to pharmacies of dispensing prescription medications to Medicaid recipients, to also include data on the most utilized and abused drugs in Medicaid, a determination of factors causing high drug costs and drug usage rates of Medicaid recipients, objectives and timelines for cost containment in the Medicaid drug program, comparative data from other states, and the cost effectiveness of the drug formulary and prior authorization process; require the annual report to be developed with the advice of the Drug Management Review Advisory Board.
HCS - Create various new sections of KRS 205.510 to 205.630 to define the terms "available" and "new drug" with certain exclusions; Direct that no prior authorization be required for reimbursement of any claim involving a drug covered by Medicaid on the effective date of the Act, for a period of at least 12 months, during which time the Drug Management Review Advisory Board may review the product; require the Department of Medicaid Services to analyze drug class reviews and economic impact until administrative regulations are promulgated, and require completion of 50% of class reviews within 12 months of effective date; Require the Drug Management Advisory Review Board to coordinate the use of utilization data to identify appropriate use of pharmaceuticals and determine any need for educational interventions; require interventions to be evaluated for at least 6 months; direct the Department for Medicaid Services to promulgate an administrative regulation setting forth procedures by which all products are placed in the prior authorization drug file; Allow the commissioner of the Medicaid Services Department to prior authorize any product the commissioner determines may pose any significant safety issues; placement on prior authorization file shall initiate review by Drug Management Review Advisory Board; Direct that drug reviews related to prior authorization decisions not take longer than 90 days; Require cabinet to implement specified provisions; Require the Cabinet for Human Resources Secretary to establish and appoint membership the a Drug Management Review Advisory Board; set forth membership; terms of office; with staffing support provided by the cabinet; Establish duties of Drug Management Review Advisory Board including review standards for prospective and retrospective drug reviews; identify and evaluate educational interventions, standards for identification of abuse and fraud; submit annual report containing nature and scope of retrospective drug utilization program including all criteria used, summary of educational activities and their effectiveness, evaluation of prospective drug use software, policies for pharmacies that do not use computers; advise cabinet on cost-effective quality care and criteria for publication of information about new products; require the Board to conduct open meeting and maintain open records; Require the Board establish procedures for interested parties to present to the Board and establish procedures for parties aggrieved by the Board's recommendations, including appeals of decisions of the commissioner; Amend KRS 205.561, relating to the annual report to the Governor and LRC on the cost to pharmacies of dispensing prescription medications to Medicaid recipients, to also include data on the most utilized and abused drugs in Medicaid, a determination of factors causing high drug costs and drug usage rates of Medicaid recipients, objectives and timelines for cost containment in the Medicaid drug program, comparative data from other states, and the cost effectiveness of the drug formulary and prior authorization process; require the annual report to be developed with the advice of the Drug Management Review Advisory Board.
HFA (1, M. Long) - Modify the requirements for the Cabinet for Human Resources's annual report to the Governor and the Legislative Research Commission on the costs to pharmacists of dispensing prescription medications to Mediciad recipients.
HFA (2, T. Burch) - Make technical corrections.
Feb 24-introduced in Senate
Feb 25-to Health and Welfare (S)
Mar 12-reported favorably, 1st reading, to Consent Calendar with Committee Substitute
Mar 13-2nd reading, to Rules
Mar 16-posted for passage in the Consent Orders of the Day for March 18, 1998
Mar 18-3rd reading, passed 37-0 with Committee Substitute
Mar 19-received in House
Mar 20-to Health and Welfare (H)
Mar 23-posted in committee; posting waived
Mar 24-reported favorably, 1st reading, to Calendar with Committee Substitute
Mar 25-2nd reading, to Rules; floor amendment (1) filed to Committee Substitute
Mar 26-floor amendment (2) filed to Committee Substitute; posted for passage in the Regular Orders of the Day
Mar 30-3rd reading, passed 94-0 with Committee Substitute and floor amendment (2)
Mar 31-received in Senate; posted for passage for concurrence in House amendments on March 31, 1998; Senate concurred in House Committee Substitute and House floor amendment (2); passed 30-0
Apr 1-enrolled, signed by each presiding officer, delivered to Governor
Apr 13-signed by Governor
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