Text: HSB00194 Text: HSB00196 Text: HSB00100 - HSB00199 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 249A.30 IOWA DRUG UTILIZATION
1 2 REVIEW COMMISSION CREATED.
1 3 1. A drug utilization review commission is established
1 4 within the department. The meetings of the commission are
1 5 subject to chapter 21.
1 6 2. The commission shall consist of the following members:
1 7 a. Two physicians licensed pursuant to chapter 148, at
1 8 least one of whom maintains a practice which includes a large
1 9 percentage of patients who are recipients of medical
1 10 assistance, recommended by the Iowa medical society.
1 11 b. Two physicians of osteopathic medicine and surgery
1 12 licensed pursuant to chapter 150A, at least one of whom
1 13 maintains a practice which includes a large percentage of
1 14 patients who are recipients of medical assistance, recommended
1 15 by the Iowa society of osteopathic medicine.
1 16 c. One academically credentialed pharmacist, recommended
1 17 by the president of Drake university or the president of the
1 18 university of Iowa.
1 19 d. One hospital-based pharmacist, recommended by the
1 20 association of Iowa hospitals and health systems.
1 21 e. One retail pharmacist, recommended by the Iowa
1 22 pharmacists association.
1 23 f. One public member representing persons eligible for
1 24 medical assistance.
1 25 3. The physician and pharmacist members of the commission
1 26 shall have knowledge and expertise in at least one of the
1 27 following areas:
1 28 a. Clinically appropriate prescribing of drugs used on an
1 29 outpatient basis which are covered under the medical
1 30 assistance program.
1 31 b. Clinically appropriate dispensing and monitoring of
1 32 drugs used on an outpatient basis which are covered under the
1 33 medical assistance program.
1 34 c. Drug use review, evaluation, and intervention.
1 35 d. Medical quality assurance.
2 1 4. The members of the commission shall be appointed by and
2 2 serve at the pleasure of the governor. Appointments are
2 3 subject to sections 69.16 and 69.16A. Members of the
2 4 commission shall serve two-year terms and shall not serve more
2 5 than three consecutive terms. The members shall receive a per
2 6 diem and expenses in accordance with section 7E.6, subsection
2 7 1.
2 8 5. The commission shall perform the activities prescribed
2 9 under federal law and regulations including the application of
2 10 predetermined standards, the performance of retrospective and
2 11 prospective drug utilization, the provision of education
2 12 programs, the making of recommendations pursuant to subsection
2 13 6 regarding drugs to be subject to prior authorization
2 14 requirements, and such other duties as may be required for
2 15 compliance with federal laws and regulations and for federal
2 16 approval of the department's state medical assistance plan.
2 17 6. If the commission recommends a drug for inclusion on
2 18 the list of drugs for which prior authorization is required,
2 19 the commission shall include in its recommendation to the
2 20 department an impact statement concerning the effect of the
2 21 administrative delay on patient care; the administrative cost
2 22 to pharmacies, physicians, health care facilities, and
2 23 patients; and the quality of life implications for patients.
2 24 Drugs recommended by the commission for prior authorization
2 25 shall only be added to the listing by rule pursuant to chapter
2 26 17A. Six months following placement of a drug on the prior
2 27 authorization list, the commission shall conduct a review to
2 28 determine whether that drug should remain on the list.
2 29 7. The department shall do all of the following:
2 30 a. Implement a drug review program designed to measure and
2 31 assess the proper uses of drugs prescribed on an outpatient
2 32 basis under the medical assistance program, to ensure that
2 33 prescriptions are appropriate, medically necessary, and not
2 34 likely to result in adverse medical outcomes. The department
2 35 shall consider any recommendations of the drug utilization
3 1 review commission in designing the program.
3 2 b. Develop the criteria and standards to be used
3 3 prospectively, before a drug is dispensed, and
3 4 retrospectively, based on historical review of drug use data.
3 5 The standards shall reflect prescribing practices in order to
3 6 monitor therapeutic appropriateness, over-utilization and
3 7 under-utilization, therapeutic duplication, drug-disease
3 8 contraindications, drug-drug interactions, incorrect drug
3 9 dosage, duration of drug treatment, and clinical drug abuse or
3 10 misuse. Retrospective drug utilization review shall identify
3 11 patterns of fraud, abuse, gross overuse or underuse and
3 12 inappropriate or medically unnecessary care.
3 13 c. With respect to administering a prior authorization
3 14 program:
3 15 (1) Only place a drug on the prior authorization listing
3 16 for clinical reasons.
3 17 (2) Comply with chapter 17A when adopting rules in adding
3 18 a drug to the prior authorization listing.
3 19 (3) Include any recommendations of the drug utilization
3 20 review commission in a notice of intended action under chapter
3 21 17A.
3 22 (4) Provide telephone or facsimile approval or denial
3 23 within twenty-four hours of receipt of a prior authorization
3 24 request.
3 25 (5) Permit a seventy-two hour supply of any drug on the
3 26 prior authorization listing to be dispensed in emergencies, as
3 27 defined by rule.
3 28 d. Adopt recommendations of the drug utilization review
3 29 commission as administrative rules, unless the department
3 30 makes a written finding that the recommendations are
3 31 arbitrary, capricious, or without merit in law or fact, which
3 32 finding shall be included in the notice of intended action
3 33 related to adoption of rules which incorporate the subject
3 34 matter of the recommendation of the commission.
3 35 e. Provide administrative support to the drug utilization
4 1 review commission.
4 2 Sec. 2. COMMISSION ABOLISHED. The department of human
4 3 services shall adopt rules to replace the current drug
4 4 utilization review commission with the drug utilization review
4 5 commission created in this Act.
4 6 Sec. 3. EFFECTIVE DATE. This Act, being deemed of
4 7 immediate importance, takes effect upon enactment.
4 8 EXPLANATION
4 9 This bill establishes a drug utilization review commission
4 10 within the department of human services to replace the drug
4 11 utilization review commission which exists under
4 12 administrative rules. The existence of such an entity is
4 13 required under the medical assistance program. The bill
4 14 prescribes the membership of the commission whose members are
4 15 to be appointed by the governor, the terms of the members, and
4 16 the duties of the commission. The bill also directs the
4 17 department of human services to implement a drug review
4 18 program, develop criteria and standards for prospective and
4 19 retrospective drug utilization review, perform certain
4 20 functions with respect to prior authorization, adopt rules to
4 21 incorporate recommendations of the drug utilization review
4 22 commission if not arbitrary, capricious, or without merit in
4 23 law or fact, provide administrative support to the drug
4 24 utilization review commission, and adopt rules to replace the
4 25 current commission with the drug utilization review commission
4 26 created in the bill. The bill takes effect upon enactment.
4 27 LSB 2569HC 78
4 28 pf/jw/5
Text: HSB00194 Text: HSB00196 Text: HSB00100 - HSB00199 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
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