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Regular Session, 2014
HOUSE BILL NO. 1180
BY REPRESENTATIVE HOFFMANN
MEDICAID: Provides for a feasibility study concerning a pharmaceutical and therapeutics
committee for Medicaid managed care
AN ACT1
To amend and reenact R.S. 46:460.32 and to enact R.S. 46:460.36, relative to the Medicaid2
managed care pharmacy program; provides for a special committee to study3
feasibility of establishing a pharmaceutical and therapeutics committee for Medicaid4
managed care organizations; to provide conditions and premises for the feasibility5
study; to provide for reporting to certain legislative committees; to provide for6
termination of laws relative to the feasibility study committee and to certain7
pharmaceutical and therapeutics committees; and to provide for related matters.8
Be it enacted by the Legislature of Louisiana:9
Section 1. R.S. 46:460.32 is hereby amended and reenacted and R.S. 46:460.36 is10
hereby enacted to read as follows:11
§460.32. Prepaid coordinated care networks; pharmaceutical and therapeutics12
committees; termination13
A. On or before January 1, 2014, each prepaid coordinated care network14
shall form a body to be designated as a "Pharmaceutical and Therapeutics15
Committee" which shall develop a drug formulary and preferred drug list for the16
prepaid coordinated care network. Each Pharmaceutical and Therapeutics17
Committee created pursuant to the provisions of this Section shall meet no less18
frequently than semiannually in Baton Rouge, Louisiana. Such meetings shall be19 HLS 14RS-2410 ORIGINAL
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open to the public and shall allow for public comment prior to voting by the1
committee on any change in the preferred drug list or formulary.2
B. The provisions of Subsection A of this Section shall terminate and3
become null and void on and after the date on which the department establishes a4
single pharmaceutical and therapeutics committee to serve all Medicaid managed5
care organizations uniformly through adoption of rules duly promulgated in6
accordance with the Administrative Procedure Act.7
* * *8
§460.36. Medicaid managed care pharmaceutical and therapeutics committee;9
feasibility study; termination10
A. On or before October 1, 2014, the department shall convene a special11
committee to study the feasibility of establishing a single pharmaceutical and12
therapeutics committee to serve Medicaid managed care organizations uniformly.13
The study committee shall operate in accordance with the provisions of this Section.14
B.(1) The study committee shall be composed of the following members:15
(a) The secretary of the department.16
(b) One person who is a member of the Medicaid Pharmaceutical and17
Therapeutics Committee provided for in R.S. 46:153.3.18
(c) Persons representing each managed care organization contracted to19
provide primary care case management services to Medicaid recipients, in the20
number of one member per managed care organization.21
(d) One practicing physician who is participating in the Medicaid program22
as a family practitioner recommended by the Louisiana Academy of Family23
Physicians.24
(e) One practicing physician who is participating in the Medicaid program25
and has expertise in pharmacology recommended by the Louisiana State Medical26
Society.27 HLS 14RS-2410 ORIGINAL
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(f) One practicing physician who is participating in the Medicaid program1
as a pediatrician recommended by the Louisiana chapter of the American Academy2
of Pediatrics.3
(g) One practicing physician who is participating in the Medicaid program4
as an obstetrician and gynecologist recommended by the Louisiana Chapter of the5
American College of Obstetricians and Gynecologists.6
(h) One practicing physician who is participating in the Medicaid program7
as a psychiatrist recommended by the Louisiana Psychiatric Medical Association.8
(i) Two practicing pharmacists who are participating in the Medicaid9
pharmacy program recommended by the Louisiana Pharmacy Association. One10
pharmacist shall be an independent pharmacist, and one pharmacist shall be a11
pharmacist representing a chain pharmacy.12
(2) The secretary of the department shall serve as chairman of the committee.13
C. With respect to the functions of a prospective Medicaid managed care14
pharmaceutical and therapeutics committee, the premises of the feasibility study15
shall include the following:16
(1) That the prospective pharmaceutical and therapeutics committee shall17
serve Medicaid managed care organizations uniformly so that these organizations18
may coordinate care for Medicaid enrollees throughout this state in a reliable,19
equitable, and cost-effective manner.20
(2) That the process for a prescriber to obtain a prior authorization for a21
prescription drug from the prospective pharmaceutical and therapeutics committee22
shall be conducted with an appropriate degree of administrative simplicity for the23
purpose of reducing unnecessary wait times and denials pursuant to prescription of24
medications for Medicaid enrollees.25
(3) That the prospective pharmaceutical and therapeutics committee shall26
meet only in public and shall permit public comment prior to voting on any changes27
in any preferred drug list it develops.28 HLS 14RS-2410 ORIGINAL
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(4) That the pharmacopoeia developed by the prospective pharmaceutical1
and therapeutics committee shall comply with all applicable state and federal laws,2
rules, and regulations; and, further, that the committee shall have the following3
authorizations and duties relative to the pharmacopoeia:4
(a) The committee may recommend additions and deletions to the5
pharmacopoeia, and the pharmacopoeia may change in accordance with those6
recommendations.7
(b) The committee shall advise the secretary of the department concerning8
policy recommendations related to the prudent administration of a Medicaid9
managed care drug program.10
(c) The committee shall make clinical decisions regarding the preferred drug11
list transparent through a written report that is publicly available. If a decision of the12
committee is contrary to clinical evidence found in labeling, drug compendia, or peer13
reviewed literature, such decisions shall be justified in writing.14
(5) That the prospective pharmaceutical and therapeutics committee may15
establish a drug list to be utilized by all managed care organizations that utilize a16
prior approval process or any other process or combination of processes that prove17
to be cost-effective in the medical assistance program. At minimum, any prior18
approval process that the committee may establish shall meet all of the following19
criteria:20
(a) Provide for a response by telephone or other form of telecommunication21
device within a maximum of twenty-four hours of a request for prior authorization.22
(b) Provide for the dispensing of a minimum of a seventy-two hour supply23
of a covered outpatient prescription drug in an emergency situation as provided by24
federal rule or regulation.25
(c) Comply with all applicable federal laws, rules, and regulations.26
(d) Involve medical personnel, including but not limited to pharmacists,27
pharmacy technicians, nurses, and physicians.28 HLS 14RS-2410 ORIGINAL
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(e) Assure that a qualified, licensed physician is available for consultation1
during the prior approval process.2
(6) That the prospective pharmaceutical and therapeutics committee will add3
any drug approved by the United States Food and Drug Administration to the4
formulary as soon as it becomes commercially available, and that the committee will5
conduct an evidence-based analysis of each such drug to determine if it will be6
maintained on the formulary.7
D. The special study committee shall consider the premises set forth in8
Subsection C of this Section, and shall determine the means by which a single9
pharmaceutical and therapeutics committee to serve Medicaid managed care10
organizations may be implemented in a manner that minimizes cost.11
E. No later than thirty days prior to the convening of the 2015 Regular12
Session of the Legislature of Louisiana, the chairman of the special study committee13
shall submit a written report of findings from the feasibility study provided for herein14
to the House Committee on Health and Welfare, the Senate Committee on Health15
and Welfare, and the Joint Legislative Committee on the Budget.16
F. The provisions of this Section shall terminate on June 30, 2015.17
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Hoffmann HB No. 1180
Abstract: Provides for a feasibility study concerning potential establishment of a single
pharmaceutical and therapeutics committee to serve Medicaid managed care
organizations uniformly.
Present law relative to the Medicaid managed care pharmacy program provides for the
following definitions:
(1)"Managed care organization" shall have the same meaning as provided for that term
in federal regulations (42 CFR 438.2) and also means any entity providing primary
care case management services to Medicaid recipients pursuant to a contract with the
Dept. of Health and Hospitals ( DHH).
(2)"Prepaid coordinated care network" means a private entity that contracts with DHH
to provide Medicaid benefits and services to enrollees of the Medicaid coordinated HLS 14RS-2410 ORIGINAL
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care program known as "Bayou Health" in exchange for a monthly prepaid capitated
amount per member.
Present law provides that on or before Jan. 1, 2014, each prepaid coordinated care network
shall form a body to be designated as a "Pharmaceutical and Therapeutics Committee" which
shall develop a drug formulary and preferred drug list for the network. Proposed law
provides that present law relative to Pharmaceutical and Therapeutics Committees of prepaid
coordinated care networks shall terminate on the date on which the department establishes
a single pharmaceutical and therapeutics committee to serve all Medicaid managed care
organizations uniformly.
Proposed law provides that on or before Oct. 1, 2014, DHH shall convene a special
committee to study the feasibility of establishing a single pharmaceutical and therapeutics
committee (hereafter "P&T committee") to serve Medicaid managed care organizations
uniformly. Provides that the study committee shall be composed of the following members:
(1)The secretary of DHH.
(2)One person who is a member of the Medicaid Pharmaceutical and Therapeutics
Committee provided for in present law, R.S. 46:153.3.
(3)Persons representing each managed care organization contracted to provide primary
care case management services to Medicaid recipients, in the number of one member
per managed care organization.
(4)One practicing physician who is participating in the Medicaid program as a family
practitioner recommended by the La. Academy of Family Physicians.
(5)One practicing physician who is participating in the Medicaid program and has
expertise in pharmacology recommended by the La. State Medical Society.
(6)One practicing physician who is participating in the Medicaid program as a
pediatrician recommended by the La. Chapter of the American Academy of
Pediatrics.
(7)One practicing physician who is participating in the Medicaid program as an
obstetrician and gynecologist recommended by the La. chapter of the American
College of Obstetricians and Gynecologists.
(8)One practicing physician who is participating in the Medicaid program as a
psychiatrist recommended by the La. Psychiatric Medical Association.
(9)Two practicing pharmacists who are participating in the Medicaid pharmacy program
recommended by the La. Pharmacy Association. One pharmacist shall be an
independent pharmacist, and one pharmacist shall be a pharmacist representing a
chain pharmacy.
Proposed law provides that the secretary of DHH shall serve as chairman of the feasibility
study committee.
With respect to the functions of a prospective Medicaid managed care P&T committee,
proposed law provides that the premises of the feasibility study shall include the following:
(1)That the prospective P&T committee shall serve Medicaid managed care
organizations uniformly so that these organizations may coordinate care for
Medicaid enrollees throughout this state in a reliable, equitable, and cost-effective
manner. HLS 14RS-2410 ORIGINAL
HB NO. 1180
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are additions.
(2)That the process for a prescriber to obtain a prior authorization for a prescription
drug from the prospective P&T committee shall be conducted with an appropriate
degree of administrative simplicity for the purpose of reducing unnecessary wait
times and denials pursuant to prescription of medications for Medicaid enrollees.
(3)That the prospective P&T committee shall meet only in public and shall permit
public comment prior to voting on any changes in any preferred drug list it develops.
(4)That the prospective P&T committee may establish a drug list to be utilized by all
managed care organizations that utilize a prior approval process or any other process
or combination of processes that prove to be cost-effective. At minimum, any prior
approval process that the P&T committee may establish shall meet all of the
following criteria:
(a)Provide for a response by telephone or other form of telecommunication
device within a maximum of 24 hours of a request for prior authorization.
(b)Provide for the dispensing of a minimum of a 72 hour supply of a covered
outpatient prescription drug in an emergency situation as provided by federal
rule or regulation.
(c)Comply with all applicable federal laws, rules, and regulations.
(d)Involve medical personnel, including but not limited to pharmacists,
pharmacy technicians, nurses, and physicians.
(e)Assure that a qualified, licensed physician is available for consultation during
the prior approval process.
Proposed law provides that the special feasibility study committee shall consider the
premises set forth in proposed law, and shall determine the means by which a single P&T
committee to serve Medicaid managed care organizations may be implemented in a manner
that minimizes cost.
Proposed law requires the chairman of the special feasibility study committee to submit a
written report of findings from the study to the legislative committees on health and welfare
and the Joint Legislative Committee on the Budget no later than 30 days prior to the
convening of the 2015 R.S.
Proposed law terminates on June 30, 2015.
(Amends R.S 46:460.32; Adds R.S 46:460.36)