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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