HB 543: "An Act relating to medical assistance coverage for prescription drugs; and providing for an effective date."
00 HOUSE BILL NO. 543 01 "An Act relating to medical assistance coverage for prescription drugs; and providing 02 for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 47.07 is amended by adding a new section to read: 05 Sec. 47.07.037. Preferred drug list; limitation of drug coverage. (a) If the 06 department undertakes a cost containment measure under this chapter that involves a 07 preferred drug list or limitation of medical assistance coverage for a drug, the 08 department shall adopt regulations relating to the preferred drug list or the limitation 09 of coverage before the list or limitation may be implemented. The regulations must 10 include 11 (1) standards for placing or not placing a drug on the preferred drug 12 list or for limiting medical assistance coverage for a drug by the department; 13 (2) an opportunity for public comment before the department places or 14 determines not to place a drug on the preferred drug list or limits medical assistance
01 coverage for a drug; 02 (3) an appeal process for a person who is affected by a decision of the 03 department to place or not to place a drug on the preferred drug list or to limit medical 04 assistance coverage for a drug; and 05 (4) a provision under which the department will approve coverage of a 06 drug that is not on a preferred drug list without requiring additional medical 07 justification if a physician documents on the prescription that the drug as prescribed is 08 medically necessary for the patient as being the most effective drug available for the 09 patient's condition by writing on the prescription the phrase "dispense as written," 10 "medically necessary," or other wording with similar import. 11 (b) Subject to AS 36.30 (State Procurement Code), the department may 12 contract for the services necessary to assist the department in developing a preferred 13 drug list or determining whether coverage for a drug should be limited. 14 (c) If the department undertakes to establish a preferred drug list or to 15 determine whether coverage for a drug should be limited, the commissioner shall 16 appoint a Prescription Drug Review Advisory Committee consisting of at least three 17 members who are licensed pharmacists under AS 08.80, at least two members who are 18 licensed to practice medicine under AS 08.64, and at least two members who are 19 dentists licensed under AS 08.36. The duties of the committee include 20 (1) conducting public meetings on developing a preferred drug list or 21 limiting coverage for a drug; 22 (2) assisting the department in setting standards in regulations for the 23 review and selection of drugs for a preferred drug list or for limitation of coverage; 24 and 25 (3) reviewing each drug and making recommendations to the 26 department as to whether the drug should be on a preferred drug list or subject to 27 limitation of coverage under the standards adopted under (2) of this subsection. 28 (d) A committee member appointed under (c) of this section serves without 29 compensation but is entitled to per diem and travel expenses authorized for boards and 30 commissions under AS 39.20.180. The committee shall select a chair from among its 31 membership who may be removed from the position as chair only by a majority vote
01 of the full committee. 02 (e) In this section, 03 (1) "drug" means a prescription drug that is eligible under federal law 04 for coverage under this chapter; 05 (2) "limiting coverage for a drug" means determining that a drug 06 (A) is subject to prior authorization for medical assistance 07 coverage; 08 (B) will not be covered because it does not have a significant, 09 clinically meaningful therapeutic advantage in terms of safety, effectiveness, or 10 clinical outcome of such treatment over other drugs included on a preferred 11 drug list, according to a publicly available written finding of the department; or 12 (C) is otherwise restricted or excluded from coverage under 42 13 U.S.C. 1396r-8(d); 14 (3) "preferred drug list" means a list of drugs 15 (A) that comprise a restrictive formulary; 16 (B) for which the department will not require a prior or 17 retroactive prescription approval process; 18 (C) for which the department will not require medical 19 justification by the prescriber as a condition of coverage under this chapter 20 before the drugs may be dispensed to a recipient of assistance under this 21 chapter; or 22 (D) for which the department will not establish other similar 23 restrictions for coverage under this chapter. 24 * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to 25 read: 26 TRANSITIONAL PROVISIONS. (a) Notwithstanding AS 47.07.037, enacted by 27 sec. 1 of this Act, a preferred drug list adopted by the Department of Health and Social 28 Services before the effective date of this Act may be implemented until the effective date of 29 regulations adopted under this Act or until six months after the effective date of this Act, 30 whichever date occurs first. 31 (b) Notwithstanding (a) of this section and AS 47.07.037, enacted by sec. 1 of this
01 Act, the Department of Health and Social Services may not implement a cost containment 02 measure under AS 47.07.036 or 47.07.037 before January 1, 2005, that would establish a 03 preferred drug list for drugs used to treat mental illness or that would otherwise prohibit a 04 recipient of medical assistance under AS 47.07 from having unrestricted access to drugs 05 prescribed for the recipient for the treatment of mental illness. In this subsection, "mental 06 illness" has the meaning given in AS 47.30.915. 07 (c) A committee appointed before the effective date of this Act by the Department of 08 Health and Social Services to adopt a preferred drug list shall serve as the Prescription Drug 09 Review Advisory Committee under AS 47.07.037, enacted by sec. 1 of this Act. 10 (d) In this section, "preferred drug list" has the meaning given in AS 47.07.037, 11 enacted by sec. 1 of this Act. 12 * Sec. 3. This Act takes effect immediately under AS 01.10.070(c).