Bill Text: MI SB0987 | 2017-2018 | 99th Legislature | Introduced
Bill Title: Human services; medical services; prior authorization for drugs not on preferred drug list; modify. Amends sec. 9709 of 1978 PA 368 (MCL 333.9709).
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2018-05-10 - Referred To Committee On Appropriations [SB0987 Detail]
Download: Michigan-2017-SB0987-Introduced.html
SENATE BILL No. 987
May 8, 2018, Introduced by Senator HILDENBRAND and referred to the Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending section 9709 (MCL 333.9709), as added by 2004 PA 250.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 9709. (1) Except as otherwise provided by law or in this
part, a prescriber shall obtain prior authorization for drugs that
are
being provided to medicaid Medicaid
beneficiaries directly
through
the department on a fee for service basis or pursuant to
under
a contract for such the pharmaceutical
services and that are
not included on the department's preferred drug list. If the
prescriber's prior authorization request is denied, the department
or the department's agent shall inform the requesting prescriber of
his or her option to speak to the agent's physician on duty
regarding his or her request. If immediate contact with the agent's
physician on duty cannot be arranged, the department or the
department's agent shall inform the requesting prescriber of his or
her right to request a 72-hour supply of the nonauthorized drug. If
contact with the agent's physician on duty cannot be arranged
within 72 hours due to a legal holiday, the requesting prescriber
may request a longer supply of the nonauthorized drug.
(2) The department or the department's agent shall provide
authorization for prescribed drugs that are not on its preferred
drug list if any of the following are satisfied:
(a) The prescribing physician telephones the department's
agent or certifies in writing on a form as provided by the
department that the drugs are being prescribed consistent with its
licensed indications, that no other drugs included on the preferred
drug list, in the physician's professional opinion, would offer a
comparable benefit to the patient, and that the drugs are necessary
for the continued stabilization of the patient's medical condition.
(b) The prescribing physician telephones the department's
agent or certifies in writing on a form as provided by the
department that following documented failures on earlier
prescription regimens, in the physician's professional opinion, no
other drug or drugs included on the preferred drug list can provide
a comparable benefit.
(c) The prescribing physician telephones the department's
agent or certifies in writing on a form as provided by the
department that no other drugs included on the preferred drug list,
in the physician's professional opinion, would offer a comparable
benefit to the patient and that the drugs are being prescribed to a
patient for the treatment of any symptoms or side effects that are
a direct result of treatment received for any of the following:
(i) Human immunodeficiency virus infections or the
complications of the human immunodeficiency virus or acquired
immunodeficiency syndrome.
(ii) Cancer.
(iii) Organ replacement therapy.
(iv) Epilepsy or seizure disorder.
(3) The department or the department's agent shall provide
authorization for a prescribed drug that is not on its preferred
drug list if each of the following is met:
(a) The prescribing physician has achieved advanced
specialization training and is certified as a specialist by a
specialty
board that is recognized by the American osteopathic
association
Osteopathic Association and the council on graduate
medical
education Council on Graduate
Medical Education or their
successor organizations and provides documentation of his or her
certification.
(b) The prescribing physician described in subdivision (a)
telephones the department or certifies in writing each of the
following:
(i) The prescribed drug is being prescribed consistent with
its licensed indications or with generally accepted medical
practice as documented in a standard medical reference.
(ii) The prescribed drug is being used to treat a condition
that is normally treated within the prescribing physician's
specialty field.
(iii) In the physician's professional opinion, no other drug
or drugs included on the preferred drug list can provide a
comparable benefit.
(4) Documentation of necessity or failures under subsection
(2) or (3) may be provided by telephone, facsimile, or electronic
transmission.
(5) A patient who is under a court order for a particular
prescription
drug before becoming a recipient of medicaid Medicaid
is exempt from the prior authorization process and may continue on
that medication for the duration of the order.
(6) Except as otherwise provided under this subsection, a
patient who is currently under medical treatment and whose
condition has been stabilized under a given prescription regimen
before
becoming a recipient of medicaid Medicaid is exempt from the
prior authorization process and may continue on that medication for
the current course of treatment if without that prescription
regimen the patient would suffer serious health consequences.
Unless a controlled substance is currently being prescribed under a
patient's hospice plan of care, a continuing prescription for a
controlled substance under this subsection requires prior
authorization. The department or the department's agent shall not
deny a request for prior authorization of a controlled substance
under this subsection unless the department or the department's
agent determines that the controlled substance or the dosage of the
controlled substance being prescribed is not consistent with its
licensed indications or with generally accepted medical practice as
documented in a standard medical reference.
(7) This section does not apply to drugs being provided under
a contract between the department and a health maintenance
organization.
(8) The department may exclude from the department's preferred
drug list a drug described in subsection (2) or (3) that is not
subject to prior authorization.
