Alabama 2025 Regular Session

Alabama Senate Bill SB161 Compare Versions

Only one version of the bill is available at this time.

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1	1	SB161INTRODUCED
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3	3	SB161
4	4	46XZIR3-1
5	5	By Senator Jones
6	6	RFD: Healthcare
7	7	First Read: 11-Feb-25
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12	12	5 46XZIR3-1 02/05/2025 JC (L)lg 2025-441
13	13	Page 1
14	14	First Read: 11-Feb-25
15	15	SYNOPSIS:
16	16	Under existing law, drugs covered under the
17	17	Medicaid program are reviewed by a Medicaid Pharmacy
18	18	and Therapeutics Committee for approval on a preferred
19	19	drug list.
20	20	This bill would require that pain medications
21	21	that are not opioids or narcotics and that receive
22	22	approval from the U.S. Food and Drug Administration be
23	23	included on the preferred drug list on terms of
24	24	coverage that are no less restrictive than those given
25	25	to opioid pain medications on the list.
26	26	A BILL
27	27	TO BE ENTITLED
28	28	AN ACT
29	29	Relating to Medicaid; to amend Section 22-6-123, Code
30	30	of Alabama 1975, to further provide for the Medicaid preferred
31	31	drug plan by requiring that nonopioid pain medications that
32	32	have been approved by the U.S. Food and Drug Administration
33	33	receive the same coverage as opioid pain medications.
34	34	BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
35	35	Section 1. Section 22-6-123, Code of Alabama 1975, is
36	36	amended to read as follows:
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64	64	28 SB161 INTRODUCED
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66	66	amended to read as follows:
67	67	"§22-6-123
68	68	(a) Drugs will be considered for the Medicaid preferred
69	69	drug list based on clinical efficacy, side effect profiles,
70	70	appropriate usage, and cost effectiveness.
71	71	(b) The Medicaid Pharmacy and Therapeutics Committee
72	72	shall perform a thorough review of relevant clinical and
73	73	medical considerations, including, but not limited to:
74	74	Medicaid Drug Utilization Review (DUR) data; Surveillance
75	75	Utilization Review (SUR) data; potential abuse, misuse, or
76	76	inappropriate use in prescribing and/or dispensing patterns;
77	77	inconsistency with FDA approved labeling ,; and inconsistency
78	78	with uses recognized in the American Hospital Formulary
79	79	Service Drug Information , and the American Medical Association
80	80	Drug Evaluations, or the U.S. Pharmacopoeia Dispensing
81	81	Information.
82	82	(c)(1) For purposes of this subsection, "disadvantaged"
83	83	shall include, but not be limited to, the exclusion of any
84	84	nonopioid drug from the preferred drug list, or setting more
85	85	restrictive or extensive utilization controls on the nonopioid
86	86	drug, such as more restrictive or extensive requirements for
87	87	prior authorization or step therapy.
88	88	(2) In maintaining the preferred drug list, the
89	89	Medicaid Pharmacy and Therapeutics Committee shall ensure that
90	90	no nonopioid drug approved by the U.S. Food and Drug
91	91	Administration for the treatment or management of pain shall
92	92	be disadvantaged with respect to coverage in comparison to any
93	93	opioid or narcotic drug for the treatment or management of
94	94	pain which is included on the preferred drug list.
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124	124	pain which is included on the preferred drug list.
125	125	(3) This subsection shall apply to any nonopioid drug
126	126	immediately upon its approval by the U.S. Food and Drug
127	127	Administration, regardless of whether the drug has been
128	128	reviewed by the Medicaid Pharmacy and Therapeutics Committee
129	129	for inclusion on the preferred drug list, and to any drug
130	130	being provided under a contract between the Medicaid Agency of
131	131	the State of Alabama and any integrated care network pursuant
132	132	to Article 11.
133	133	(c)(d) The Medicaid Pharmacy and Therapeutics Committee
134	134	shall recommend and the Medicaid Agency shall adopt an initial
135	135	Medicaid preferred drug list not later than three months after
136	136	June 18, 2003. Until Medicaid adopts the preferred drug list
137	137	required by this article, Medicaid shall continue to use its
138	138	existing voluntary preferred drug list and prior authorization
139	139	program. Drugs that currently require Medicaid prior
140	140	authorization shall not be subject to review for inclusion on
141	141	the preferred drug list and shall continue to require prior
142	142	authorization unless the Medicaid Pharmacy and Therapeutics
143	143	Committee recommends and the Medicaid Commissioner approves
144	144	changing the requirement.
145	145	(d)(e) Medicaid recipients may appeal prior
146	146	authorization decisions using the Medicaid fair hearing
147	147	process administered by the Alabama Medicaid Agency.
148	148	Physicians may appeal prior authorization decisions to
149	149	Medicaid's Medical Directors."
150	150	Section 2. This act shall become effective on October
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