SB161INTRODUCED
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SB161
46XZIR3-1
By Senator Jones
RFD: Healthcare
First Read: 11-Feb-25
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5 46XZIR3-1 02/05/2025 JC (L)lg 2025-441
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First Read: 11-Feb-25
SYNOPSIS:
Under existing law, drugs covered under the
Medicaid program are reviewed by a Medicaid Pharmacy
and Therapeutics Committee for approval on a preferred
drug list.
This bill would require that pain medications
that are not opioids or narcotics and that receive
approval from the U.S. Food and Drug Administration be
included on the preferred drug list on terms of
coverage that are no less restrictive than those given
to opioid pain medications on the list.
A BILL
TO BE ENTITLED
AN ACT
Relating to Medicaid; to amend Section 22-6-123, Code
of Alabama 1975, to further provide for the Medicaid preferred
drug plan by requiring that nonopioid pain medications that
have been approved by the U.S. Food and Drug Administration
receive the same coverage as opioid pain medications.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Section 22-6-123, Code of Alabama 1975, is
amended to read as follows:
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amended to read as follows:
"ยง22-6-123
(a) Drugs will be considered for the Medicaid preferred
drug list based on clinical efficacy, side effect profiles,
appropriate usage, and cost effectiveness.
(b) The Medicaid Pharmacy and Therapeutics Committee
shall perform a thorough review of relevant clinical and
medical considerations, including, but not limited to:
Medicaid Drug Utilization Review (DUR) data; Surveillance
Utilization Review (SUR) data; potential abuse, misuse, or
inappropriate use in prescribing and/or dispensing patterns;
inconsistency with FDA approved labeling ,; and inconsistency
with uses recognized in the American Hospital Formulary
Service Drug Information , and the American Medical Association
Drug Evaluations, or the U.S. Pharmacopoeia Dispensing
Information.
(c)(1) For purposes of this subsection, "disadvantaged"
shall include, but not be limited to, the exclusion of any
nonopioid drug from the preferred drug list, or setting more
restrictive or extensive utilization controls on the nonopioid
drug, such as more restrictive or extensive requirements for
prior authorization or step therapy.
(2) In maintaining the preferred drug list, the
Medicaid Pharmacy and Therapeutics Committee shall ensure that
no nonopioid drug approved by the U.S. Food and Drug
Administration for the treatment or management of pain shall
be disadvantaged with respect to coverage in comparison to any
opioid or narcotic drug for the treatment or management of
pain which is included on the preferred drug list.
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pain which is included on the preferred drug list.
(3) This subsection shall apply to any nonopioid drug
immediately upon its approval by the U.S. Food and Drug
Administration, regardless of whether the drug has been
reviewed by the Medicaid Pharmacy and Therapeutics Committee
for inclusion on the preferred drug list, and to any drug
being provided under a contract between the Medicaid Agency of
the State of Alabama and any integrated care network pursuant
to Article 11.
(c)(d) The Medicaid Pharmacy and Therapeutics Committee
shall recommend and the Medicaid Agency shall adopt an initial
Medicaid preferred drug list not later than three months after
June 18, 2003. Until Medicaid adopts the preferred drug list
required by this article, Medicaid shall continue to use its
existing voluntary preferred drug list and prior authorization
program. Drugs that currently require Medicaid prior
authorization shall not be subject to review for inclusion on
the preferred drug list and shall continue to require prior
authorization unless the Medicaid Pharmacy and Therapeutics
Committee recommends and the Medicaid Commissioner approves
changing the requirement.
(d)(e) Medicaid recipients may appeal prior
authorization decisions using the Medicaid fair hearing
process administered by the Alabama Medicaid Agency.
Physicians may appeal prior authorization decisions to
Medicaid's Medical Directors."
Section 2. This act shall become effective on October
1, 2025.
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