MR. PRESIDENT:
The Senate Committee on Health and Provider Services, to which was referred House Bill
No. 1749, has had the same under consideration and begs leave to report the same back to the
Senate with the recommendation that said bill be AMENDED as follows:
SOURCE: Page 2, line 20; (03)CR174901.2. -->
Page 2, between lines 20 and 21, begin a new paragraph and insert:
SOURCE: IC 12-15-35-28; (03)CR174901.2. -->
"SECTION 2.
IC 12-15-35-28
, AS AMENDED BY P.L.107-2002,
SECTION 17, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 28. (a) The board has the
following duties:
(1) The adoption of rules to carry out this chapter, in accordance
with the provisions of
IC 4-22-2
and subject to any office
approval that is required by the federal Omnibus Budget
Reconciliation Act of 1990 under Public Law 101-508 and its
implementing regulations.
(2) The implementation of a Medicaid retrospective and
prospective DUR program as outlined in this chapter, including
the approval of software programs to be used by the pharmacist
for prospective DUR and recommendations concerning the
provisions of the contractual agreement between the state and
any other entity that will be processing and reviewing Medicaid
drug claims and profiles for the DUR program under this chapter.
(3) The development and application of the predetermined
criteria and standards for appropriate prescribing to be used in
retrospective and prospective DUR to ensure that such criteria
and standards for appropriate prescribing are based on the
compendia and developed with professional input with
provisions for timely revisions and assessments as necessary.
(4) The development, selection, application, and assessment of
interventions for physicians, pharmacists, and patients that are
educational and not punitive in nature.
(5) The publication of an annual report that must be subject to
public comment before issuance to the federal Department of
Health and Human Services and to the Indiana legislative council
by December 1 of each year.
(6) The development of a working agreement for the board to
clarify the areas of responsibility with related boards or agencies,
including the following:
(A) The Indiana board of pharmacy.
(B) The medical licensing board of Indiana.
(C) The SURS staff.
(7) The establishment of a grievance and appeals process for
physicians or pharmacists under this chapter.
(8) The publication and dissemination of educational information
to physicians and pharmacists regarding the board and the DUR
program, including information on the following:
(A) Identifying and reducing the frequency of patterns of
fraud, abuse, gross overuse, or inappropriate or medically
unnecessary care among physicians, pharmacists, and
recipients.
(B) Potential or actual severe or adverse reactions to drugs.
(C) Therapeutic appropriateness.
(D) Overutilization or underutilization.
(E) Appropriate use of generic drugs.
(F) Therapeutic duplication.
(G) Drug-disease contraindications.
(H) Drug-drug interactions.
(I) Incorrect drug dosage and duration of drug treatment.
(J) Drug allergy interactions.
(K) Clinical abuse and misuse.
(9) The adoption and implementation of procedures designed to
ensure the confidentiality of any information collected, stored,
retrieved, assessed, or analyzed by the board, staff to the board,
or contractors to the DUR program that identifies individual
physicians, pharmacists, or recipients.
(10) The implementation of additional drug utilization review
with respect to drugs dispensed to residents of nursing facilities
shall not be required if the nursing facility is in compliance with
the drug regimen procedures under 410 IAC 16.2-3-8 and 42
CFR 483.60.
(11) The research, development, and approval of a preferred drug
list for:
(A) Medicaid's fee for service program;
(B) Medicaid's primary care case management program; and
(C) the primary care case management component of the
children's health insurance program under IC 12-17.6;
in consultation with the therapeutics committee.
(12) The approval of the review and maintenance of the preferred
drug list at least two (2) times per year.
(13) The preparation and submission of a report concerning the
preferred drug list at least two (2) times per year to the select joint
commission on Medicaid oversight established by
IC 2-5-26-3.
(14) The collection of data reflecting prescribing patterns related
to treatment of children diagnosed with attention deficit disorder
or attention deficit hyperactivity disorder.
(15) Advising the Indiana comprehensive health insurance
association established by
IC 27-8-10-2.1
concerning
implementation of chronic disease management and
pharmaceutical management programs under
IC 27-8-10-3.5.
(b) The board shall use the clinical expertise of the therapeutics
committee in developing a preferred drug list. The board shall also
consider expert testimony in the development of a preferred drug list.
(c) In researching and developing a preferred drug list under
subsection (a)(11), the board shall do the following:
(1) Use literature abstracting technology.
(2) Use commonly accepted guidance principles of disease
management.
(3) Develop therapeutic classifications for the preferred drug list.
(4) Give primary consideration to the clinical efficacy or
appropriateness of a particular drug in treating a specific medical
condition.
(5) Include in any cost effectiveness considerations the cost
implications of other components of the state's Medicaid program
and other state funded programs.
(d) Prior authorization is required for coverage under a program
described in subsection (a)(11) of a drug that is not included on the
preferred drug list.
(e) The board shall determine whether to include a single source
covered outpatient drug that is newly approved by the federal Food and
Drug Administration on the preferred drug list not later than sixty (60)
days after the date of the drug's approval. However, if the board
determines that there is inadequate information about the drug
available to the board to make a determination, the board may have an
additional sixty (60) days to make a determination from the date that
the board receives adequate information to perform the board's review.
Prior authorization may not be automatically required for a single
source drug that is newly approved by the federal Food and Drug
Administration and that is:
(1) in a therapeutic classification:
(A) that has not been reviewed by the board; and
(B) for which prior authorization is not required; or
(2) the sole drug in a new therapeutic classification that has not
been reviewed by the board.
(f) The board may not exclude a drug from the preferred drug list
based solely on price.
(g) The following requirements apply to a preferred drug list
developed under subsection (a)(11):
(1) The office or the board may require prior authorization for a
drug that is included on the preferred drug list under the following
circumstances:
(A) To override a prospective drug utilization review alert.
(B) To permit reimbursement for a medically necessary brand
name drug that is subject to generic substitution under
IC 16-42-22-10.
(C) To prevent fraud, abuse, waste, overutilization, or
inappropriate utilization.
(D) To permit implementation of a disease management
program.
(E) To implement other initiatives permitted by state or federal
law.
(2) All drugs described in
IC 12-15-35.5-3
(b) must be included on
the preferred drug list.
(3) The office may add a new single source drug that has been
approved by the federal Food and Drug Administration to the
preferred drug list without prior approval from the board.
(4) The board may add a new single source drug that has been
approved by the federal Food and Drug Administration to the
preferred drug list.
(h) At least two (2) times each year, the board shall provide a report
to the select joint commission on Medicaid oversight established by
IC 2-5-26-3.
The report must contain the following information:
(1) The cost of administering the preferred drug list.
(2) Any increase in Medicaid physician, laboratory, or hospital
costs or in other state funded programs as a result of the preferred
drug list.
(3) The impact of the preferred drug list on the ability of a
Medicaid recipient to obtain prescription drugs.
(4) The number of times prior authorization was requested, and
the number of times prior authorization was:
(A) approved; and
(B) disapproved.
(i) The board shall provide the first report required under subsection
(h) not later than six (6) months after the board submits an initial
preferred drug list to the office.".
SOURCE: Page 12, line 23; (03)CR174901.12. -->
Page 12, delete lines 23 through 42.
Delete pages 13 through 14.
Page 15, delete lines 1 through 17.
Page 15, line 21, delete "use the Medicaid preferred drug list
developed under" and insert " approve and implement chronic disease
management and pharmaceutical management programs based on:
(A) an analysis of the highest cost health care services
covered under association policies;
(B) a review of chronic disease management and
pharmaceutical management programs used in
populations similar to insureds; and
(C) a determination of the chronic disease management
and pharmaceutical management programs expected to
best improve health outcomes in a cost effective manner;
(2) consider recommendations of the drug utilization review
board established by
IC 12-15-35-19
concerning chronic
disease management and pharmaceutical management
programs;
(3) when practicable, coordinate programs adopted under this
section with comparable programs implemented by the state;
and
(4) implement a copayment structure for prescription drugs
covered under an association policy.
(b) A program approved and implemented under this section
may not require prior authorization for a prescription drug that is
prescribed for the treatment of:
(1) human immunodeficiency virus (HIV) or acquired
immune deficiency syndrome (AIDS) and is included on the
AIDS drug assistance program formulary adopted by the
state department of health under the federal Ryan White
CARE Act (42 U.S.C. 300ff); or
(2) hemophilia according to recommendations of the:
(A) Advisory Committee on Blood Safety and Availability
of the United States Department of Health and Human
Services; or
(B) Medical and Scientific Advisory Council of the
National Hemophilia Foundation.".
Page 15, delete lines 22 through 27.
Page 15, line 28, delete "(b)" and insert " (c)".
Page 15, delete lines 30 through 35.
Page 15, line 36, delete "(b)" and insert " (d)".
Page 15, line 39, delete "(c)" and insert " (e)".
Page 16, line 3, delete "IC 27-8-10-3.7" and insert "IC 27-8-10-3.6".
Page 16, line 5, delete "3.7." and insert " 3.6.".
Page 16, between lines 22 and 23, begin a new paragraph and insert:
SOURCE: IC 27-8-10-4; (03)CR174901.10. -->
"SECTION 10.
IC 27-8-10-4
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 4. (a) Subject to the
limitation provided in subsection (c), an association policy offered in
accordance with this chapter must impose a five hundred dollar ($500)
deductible on a per person per policy year basis in an amount that is:
(1) equal to five hundred dollars ($500) for a policy year
beginning in 2003; and
(2) determined for each policy year beginning after 2003 by
an annual adjustment based on the percentage increase in the
medical care component of the Consumer Price Index
prepared by the United States Department of Labor.
The deductible must be applied to the first five hundred dollars ($500)
of eligible expenses, other than prescription drug expenses, first
incurred by the covered person during the policy year.
(b) Subject to the limitation provided in subsection (c), a mandatory
coinsurance requirement shall be imposed at the rate of twenty percent
(20%) of eligible expenses in excess of the mandatory deductible.
(c) The maximum aggregate out-of-pocket payments for eligible
expenses, other than prescription drug expenses, by the insured in
the form of deductibles and coinsurance may not exceed:
(1) one thousand five hundred dollars ($1,500) per individual or
two thousand five hundred dollars ($2,500) per family, per policy
year for a policy year beginning in 2003; and
(2) an amount that is determined for each policy year
beginning after 2003 by an annual adjustment based on the
percentage increase in the medical care component of the
Consumer Price Index prepared by the United States
Department of Labor.".
SOURCE: Page 16, line 25; (03)CR174901.16. -->
Page 16, line 25, delete "A person is not eligible for an".
Page 16, delete line 26.
Page 16, line 27, delete "(b)".
Page 16, run in lines 25 through 27.
Page 16, line 27, strike "subsections" and insert " subsection".
Page 16, line 27, reset in roman "(b)".
Page 16, line 27, after "(b)" insert ",".
Page 16, line 27, delete "(c)".
Page 16, line 27, strike "and".
Page 16, line 27, delete "(d),".
Page 16, line 34, reset in roman "(b)".
Page 16, line 34, delete "(c)".
Page 16, line 34, after "IC 27-13-16-4" insert ",".
Page 16, line 34, delete "and subsection (a),".
Page 17, line 16, delete "(d)" and insert " (c)".
Page 17, line 26, reset in roman "(d)".
Page 17, line 26, delete "(e)".
Page 17, line 42, reset in roman "(e)".
and when so amended that said bill do pass.
Miller
CR174901/DI 104 2003