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House Amendment 3860

Amendment Text

PAG LIN
  1  1    Amend the amendment, H-3765, to Senate File 462, as
  1  2 amended, passed, and reprinted by the Senate, as
  1  3 follows:
  1  4    #1.  Page 1, line 17, by inserting after the word
  1  5 "paragraph." the following:  "The department shall not
  1  6 expand the requirement of prior authorization for
  1  7 drugs other than the "A" rated generic bioequivalents
  1  8 authorized under this paragraph, without prior
  1  9 approval of the general assembly for such expansion."
  1 10    #2.  Page 1, by inserting after line 21 the
  1 11 following:
  1 12    "aa.  The department shall amend the contract with
  1 13 the department's fiscal agent regarding prior
  1 14 authorization of prescription drugs to provide for
  1 15 review by the fiscal agent of inquiries for prior
  1 16 authorization during pharmacy business hours,
  1 17 evenings, Saturdays and during pharmacy peak business
  1 18 hours on Sundays, and shall consider providing for
  1 19 review by the fiscal agent of inquiries on a seven-
  1 20 day-per-week, 24-hour-per-day basis.
  1 21    aaa.  (1)  The department of human services shall
  1 22 conduct a study of the prior authorization program
  1 23 based upon the program data collected during fiscal
  1 24 year 1994-1995, including a review of a sampling of
  1 25 specific drugs for which prior authorization is
  1 26 required.  The study shall be completed by October 1,
  1 27 1995, and a report of the findings of the study shall
  1 28 be submitted to the chairpersons and ranking members
  1 29 of the senate and house appropriations committees, to
  1 30 the chairpersons and ranking members of the joint
  1 31 human services appropriations committee, and to the
  1 32 legislative fiscal bureau.  The study shall address
  1 33 and include information and recommendations regarding
  1 34 all of the following:
  1 35    (a)  A comparison of the costs associated with the
  1 36 prescribing of generic drugs rather than brand name
  1 37 drugs, taking into consideration any rebates or other
  1 38 cost reductions associated with the use of brand name
  1 39 drugs.
  1 40    (b)  A review of the time associated with the prior
  1 41 authorization process including telephone
  1 42 communications between providers and the department's
  1 43 prior authorization fiscal agent and with delays for
  1 44 either party.  The review shall include an analysis of
  1 45 the average time associated with each inquiry by
  1 46 classification of drug.
  1 47    (c)  A review of the number of denials of
  1 48 authorization by classification of drug by the fiscal
  1 49 agent and the rationale for the denials.
  1 50    (d)  A review of the actual and projected cost
  2  1 savings and workability of the prior authorization
  2  2 program.
  2  3    (e)  A review of the services provided by the
  2  4 fiscal agent including a comparison of the services of
  2  5 the fiscal agent with private pay insurers in
  2  6 providing a similar service, and an evaluation of the
  2  7 current availability of the fiscal agent and any
  2  8 improvements to the program which might result from
  2  9 increased availability.
  2 10    (f)  A review of the volume of inquiries for prior
  2 11 authorization during a weekly period including an
  2 12 analysis of the days and times of peak volume as
  2 13 compared with the availability of the fiscal agent for
  2 14 responding to inquiries.
  2 15    (g)  An analysis of the time which elapses between
  2 16 the submission of a bill to the department for
  2 17 reimbursement and actual reimbursement.
  2 18    (2)  Following receipt of the report from the
  2 19 department, the legislative fiscal bureau shall review
  2 20 the study.  The review shall include all of the
  2 21 following:
  2 22    (a)  An evaluation of the cost and savings
  2 23 methodology utilized by the department, including an
  2 24 analysis of whether all governmental costs and savings
  2 25 were included or adequately addressed in the savings
  2 26 methodology used during fiscal year 1994-1995.  If the
  2 27 legislative fiscal bureau determines that the cost and
  2 28 savings methodology utilized by the department or the
  2 29 fiscal agent did not include or adequately address all
  2 30 governmental costs, the legislative fiscal bureau
  2 31 shall provide recommendations to the general assembly
  2 32 to improve the cost and savings methodology for future
  2 33 application.
  2 34    (b)  An individualized assessment of the prior
  2 35 authorization program based on a random sample of not
  2 36 more than 50 individual prior authorization actions,
  2 37 of which one-half shall be approval actions and one-
  2 38 half shall be denial actions.  The random sample shall
  2 39 be provided by the department to the legislative
  2 40 fiscal bureau based upon a random sampling methodology
  2 41 submitted by the legislative fiscal bureau.  All data
  2 42 deemed necessary by the legislative fiscal bureau to
  2 43 conduct the assessment shall be provided by the
  2 44 department including but not limited to the date and
  2 45 time of the prior authorization contact between the
  2 46 fiscal agent and the provider; the name, address, and
  2 47 telephone number of the provider; and the
  2 48 classification of the drug for which prior
  2 49 authorization was sought.  If the action was an
  2 50 approval action, the department shall provide a
  3  1 statement of the actual cost associated with the
  3  2 substituted drug and the cost associated with the
  3  3 alternative drug.  If the action was a denial action,
  3  4 the department shall provide the rationale for the
  3  5 denial."
  3  6    #3.  Page 1, by striking lines 26 through 29.
  3  7    #4.  Page 1, by striking lines 30 through 38 and
  3  8 inserting the following:
  3  9    "   .  The department shall develop a plan to
  3 10 administratively pursue reimbursement for pharmacy
  3 11 services for which a recipient of medical assistance
  3 12 also has third-party coverage.  The department shall
  3 13 develop the plan in cooperation with the insurance
  3 14 division of the department of commerce and with
  3 15 representatives of the Iowa pharmacists association.
  3 16 The department shall submit the plan to the general
  3 17 assembly on or before January 1, 1996, and shall
  3 18 implement the plan on or before May 1, 1996.  The
  3 19 department shall also include a preliminary estimate
  3 20 of the costs of administratively pursuing
  3 21 reimbursement for pharmacy services in the budget
  3 22 submitted to the council of human services for fiscal
  3 23 year 1996-1997."
  3 24    #5.  By relettering as necessary.  
  3 25 
  3 26 
  3 27                              
  3 28 HOUSER of Pottawattamie
  3 29 SF 462.720 76
  3 30 pf/sc
     

Text: H03859                            Text: H03861
Text: H03800 - H03899                   Text: H Index
Bills and Amendments: General Index     Bill History: General Index

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