The Commonwealth of Massachusetts
_______________
PRESENTED BY:
Tolman, Steven (SEN)
_______________
To the
Honorable Senate and House of Representatives of the Commonwealth of
Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the passage of the accompanying bill:
An Act relative to prior authorizations of prescription medications.
_______________
PETITION OF:
Name: |
District/Address: |
Tolman, Steven (SEN) |
Second Suffolk and Middlesex |
[SIMILAR MATTER FILED IN PREVIOUS
SESSION
SEE SENATE, NO. S00428 OF 2007-2008.]
The Commonwealth of
Massachusetts
_______________
In the Year Two Thousand and Nine
_______________
An Act relative to prior authorizations of prescription
medications.
Be
it enacted by the Senate and House of Representatives in General Court
assembled, and by the authority of the same, as follows:
SECTION 1. Chapter
118E of the General Laws, as appearing in the 2006 official edition, is hereby
amended by adding at the end thereof the following new section:
Section 61. Drug prior authorization process
(a) The division shall maintain a process for the evaluation of drugs to be
placed on the prior authorization list, which shall include:
(1) A public hearing on all medications prior to a decision being made on prior
authorization;
(2) publishing conspicuous notice in at least one newspaper of general circulation
and on the division's website at least thirty (30) days prior to any public
hearing on whether such a drug should be placed on prior authorization;
(3) consideration of the potential impact on patient care, safety and other
sectors of the state health care systems including emergency room visits and
hospitalizations as a result of placement of such drug on prior authorization;
(4) evaluation of recommendations made by the Pharmacy and Therapeutics
Advisory Committee, established in Section 62;
(5) receipt of written approval by a physician who is board certified in the
specialty that most commonly treats the disease or prescribes the relevant
therapeutic class of drugs. Said physician shall not be employed by, nor have
any financial relationship with, any pharmacy benefits management company
managing Medicaid prescription benefits, nor be a member of the Pharmacy and
Therapeutics Advisory Committee. Such written ratification shall be submitted
to the commissioner, members of the Pharmacy and Therapeutics Advisory
Committee, and shall be available to the public upon request; and,
(6) A final decision shall be made within 60 days of the public hearing and
published for public comment for a period of no less than 30 days. The
effective date of the decision shall not be prior to the close of the comment
period and effective notice of the decision’s finality is available to
prescribers.
(b) The Division shall make a report to the house and senate committees on ways
and means and the house and senate committees on health care financing at the
conclusion of all prior authorization proceedings for each therapeutic class or
at least, no less often than annually. Said report shall include but not be
limited to the outcomes of all public hearings and prior authorization
decisions; a list of drugs which are and are not to be prior authorized along
with corresponding information used to make such decisions; sectors of the
state health care program that may be affected by the drug’s availability for
use in treating program beneficiaries; any changes made or proposed to the
prior authorization process; and recommendations including legislation that may
benefit the prior authorization process and program beneficiaries; said report
shall be posted on the division's website.
SECTION 2. Chapter 118E of the General Laws, as appearing in the 2004
official edition, is hereby amended by adding at the end thereof the following
new section:
Section 62. Pharmacy and Therapeutics Advisory Committee
(a) There is hereby established a Pharmacy and Therapeutics Advisory Committee
for the purpose of advising and making recommendations to the Division of
Medical Assistance’s prior authorization program. Said advisory committee shall
consist of thirteen (13) members to be appointed by the Governor and shall
include: five physicians licensed in Massachusetts and actively involved in the
practice of medicine; three pharmacists licensed to do business in the
commonwealth and actively involved in the practice of pharmacy; a
representative of the Massachusetts Medical Society; a representative of the
Massachusetts Pharmacy Association; a representative of medical assistance
beneficiaries in the commonwealth; and, two patient advocates.
In making physician appointments the Governor shall make his selections from a
list of nominees provided by the Massachusetts Medical Society. In making
pharmacist appointments the Governor shall make his selections from a list of
nominees provided by the Massachusetts Pharmacy Association.
Advisory committee members shall serve staggered three-year terms. Two
physicians, one pharmacist and the representative of medical assistance
beneficiaries shall each be appointed for one-year terms. Members may be
reappointed for a period not to exceed three, three-year terms. Advisory
committee members shall select a chairperson and a vice-chairperson by a
majority vote of the committee membership on an annual basis. Said committee
shall meet at least monthly and may meet at other times at the discretion of
the chairperson. Notice of any meeting of the advisory committee shall be
published thirty (30) days before such meeting; and
(b) The advisory committee shall have the power and duty to:
(1) advise and make recommendations regarding the implementation of a drug
prior authorization program for the medical assistance program;
(2) advise and make recommendations regarding rules to be promulgated by the
division regarding outpatient prescription drug prior authorization;
(3) make recommendations for a grievance mechanism for interested parties to
appeal any decision made by the Division to place a drug on prior
authorization;
(4) make recommendations to the Division regarding any inpatient or outpatient
prescription drug covered by the medical assistance program that is to be prior
authorized as well as which drugs are exempt from the prior approval process.
Said recommendation shall be supported by an analysis of prospective and
retrospective DUR data demonstrating
(a) the expected impact of such a decision on the clinical care likely to be
received by beneficiaries for whom the drug is medically necessary;
(b) the expected impact on physicians whose patients require the drug;
(c) the expected fiscal impact on the medical assistance program;
(d) review and make recommendations on a semi-annual basis whether drugs placed
on prior authorization should remain on prior authorization; and
(e) make recommendations for a list of maintenance medications that are needed
for chronic illnesses.