Connecticut Seal

General Assembly

 

Raised Bill No. 1226

January Session, 2005

 

LCO No. 4159

 

*04159_______HS_*

Referred to Committee on Human Services

 

Introduced by:

 

(HS)

 

AN ACT CONCERNING PRIOR AUTHORIZATION REQUIREMENTS FOR PRESCRIPTION DRUGS IN MEDICAL ASSISTANCE PROGRAMS ADMINISTERED BY THE DEPARTMENT OF SOCIAL SERVICES.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Subsection (c) of section 17b-274 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(c) The Commissioner of Social Services shall implement a procedure by which a pharmacist shall obtain approval from an independent pharmacy consultant acting on behalf of the Department of Social Services, under an administrative services only contract, whenever the pharmacist dispenses a brand name drug product to a Medicaid, state-administered general assistance, or ConnPACE recipient and a chemically equivalent generic drug product substitution is available. [, provided such procedure shall not require approval for other than initial prescriptions for such drug product.] The length of authorization for brand name drugs shall be in accordance with section 17b-491a, as amended by this act. In cases where the brand name drug is less costly than the chemically equivalent generic drug when factoring in manufacturers' rebates, the pharmacist shall dispense the brand name drug. If such approval is not granted or denied within two hours of receipt by the commissioner of the request for approval, it shall be deemed granted. Notwithstanding any provision of this section, a pharmacist shall not dispense any initial maintenance drug prescription for which there is a chemically equivalent generic substitution that is for less than fifteen days without the department's granting of prior authorization, provided prior authorization shall not otherwise be required for atypical antipsychotic drugs if the individual is currently taking such drug at the time the pharmacist receives the prescription. The pharmacist may appeal a denial of reimbursement to the department based on the failure of such pharmacist to substitute a generic drug product in accordance with this section.

Sec. 2. Subsection (a) of section 17b-491a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The Commissioner of Social Services may establish a plan, in accordance with this subsection, for the prior authorization of [(1)] any [initial] prescription for a drug covered under the Medicaid, state-administered general assistance, or ConnPACE program, [that costs five hundred dollars or more for a thirty-day supply, or (2)] including (1) any early refill of a prescription drug covered under any of said programs, and (2) brand name drug products when a chemically equivalent generic drug product substitution is available. The plan shall provide that (A) the authorization for any maintenance drug shall be for the life of the therapy, except that if a new chemically equivalent generic drug becomes available, prior authorization will be required for a subsequent prescription for such maintenance drug; (B) the authorization for a nonmaintenance drug and any refills permitted by state or federal law shall be valid for up to six months from the date the original prescription is filled; and (C) the authorization for schedule II controlled substances will be permitted for multiple prescriptions, for up to six months from the date the original prescription is filled, if the prescriber certifies the recipient is under the prescriber's ongoing care and requires the drug on a long term-basis. The Commissioner of Social Services shall establish a procedure by which prior authorization under this subsection shall be obtained from an independent pharmacy consultant acting on behalf of the Department of Social Services, under an administrative services only contract. If prior authorization is not granted or denied within two hours of receipt by the commissioner of the request for prior authorization, it shall be deemed granted.

This act shall take effect as follows and shall amend the following sections:

Section 1

from passage

17b-274(c)

Sec. 2

from passage

17b-491a(a)

Statement of Purpose:

To clarify existing statutes governing prior authorization requirements for prescription drugs in medical assistance programs administered by the Department of Social Services.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]