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