General Assembly Raised Bill No. 6545
January Session, 2013 LCO No. 3790
*03790_______HS_*
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
General Assembly
Raised Bill No. 6545
January Session, 2013
LCO No. 3790
*03790_______HS_*
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT CONCERNING DRUG PRIOR AUTHORIZATION FOR MEDICAID RECIPIENTS.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Section 17b-491a of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2013):
(a) The Commissioner of Social Services may require prior authorization of any prescription for a drug covered under a medical assistance program administered by the Department of Social Services, including an over-the-counter drug. The authorization for a brand name drug product shall be valid for one year from the date the prescription is first filled. 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.
(b) When prior authorization is required for coverage of a prescription drug under a medical assistance program administered by the Department of Social Services and a pharmacist is unable to obtain the prescribing physician's authorization at the time the prescription is presented to be filled, the pharmacist shall dispense a one-time fourteen-day supply. The commissioner shall process a prior authorization request from a physician or pharmacist not later than two hours after the commissioner's receipt of the request. 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.
(c) The Commissioner of Social Services, not later than October 1, 2012, shall issue a flier to pharmacies for distribution to Medicaid recipients who receive such one-time prescription supplies in the absence of prior prescription authorization. The flier shall notify recipients that (1) prior authorization is required for the prescription to be fully filled, (2) the fourteen-day supply is a one-time supply, and (3) recipients must contact the prescriber to arrange for prior authorization of a full prescription. The commissioner shall require pharmacists who receive Medicaid reimbursements for prescriptions to provide said flier to such Medicaid recipients.
(d) The commissioner shall provide written notice to a Medicaid recipient when the department electronically denies or partially denies Medicaid prescription payments at the pharmacy immediately after the denial or partial denial or by mail not later than twenty-four hours after such denial or partial denial. Such notice shall identify (1) the drug, (2) the reason for denial or partial denial, (3) the procedures for appealing such denial or partial denial, and (4) options for obtaining a supply of such drug or a substitute drug. The commissioner shall give notice to the prescriber, in writing or electronically, not later than two business days after the denial or partial denial of applicable prior authorization requirements and alternative drugs which do not require prior authorization. If the prescriber does not request prior authorization or prescribe a substitute drug within twelve calendar days after such notice, the commissioner shall contact the prescriber concerning such options.
[(d)] (e) Notwithstanding the provisions of section 17b-262 and any regulation adopted thereunder, on or after July 1, 2000, the Commissioner of Social Services may establish a schedule of maximum quantities of oral dosage units permitted to be dispensed at one time for prescriptions covered under a medical assistance program administered by the Department of Social Services, including prescriptions for over-the-counter drugs, based on a review of utilization patterns.
[(e)] (f) A schedule established pursuant to subsection [(d)] (e) of this section and on and after July 1, 2005, any revisions thereto shall be submitted to the joint standing committees of the General Assembly having cognizance of matters relating to public health, human services and appropriations and the budgets of state agencies. Within sixty days of receipt of such a schedule or revisions thereto, said joint standing committees of the General Assembly shall approve or deny the schedule or any revisions thereto and advise the commissioner of their approval or denial of the schedule or any revisions thereto. The schedule or any revisions thereto shall be deemed approved unless all committees vote to reject such schedule or revisions thereto within sixty days of receipt of such schedule or revisions thereto.
This act shall take effect as follows and shall amend the following sections:
Section 1 July 1, 2013 17b-491a
This act shall take effect as follows and shall amend the following sections:
Section 1
July 1, 2013
17b-491a
Statement of Purpose:
To make changes in Medicaid prior authorization requirements to ensure that eligible recipients and prescribers are informed of prior authorization denials.
[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.]