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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