June 9, 2011, Introduced by Rep. Agema and referred to the Committee on Appropriations.
A bill to amend 1939 PA 280, entitled
"The social welfare act,"
by amending section 109h (MCL 400.109h), as added by 2004 PA 248.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec.
109h. (1) If the department of community health develops
a
prior authorization process for prescription drugs as part of the
pharmaceutical
services offered under the medical assistance
program
administered under this act, it shall not require prior
authorization
for the following single source brand name, generic
equivalent
of a multiple source brand name, or other prescription
drugs:
(a)
A central nervous system prescription drug that is
classified
as an anticonvulsant, antidepressant, antipsychotic, or
a
noncontrolled substance antianxiety drug in a generally accepted
standard
medical reference.
(b)
A prescription drug that is cross-indicated for a central
nervous
system drug exempted under subdivision (a) as documented in
a
generally accepted standard medical reference.
(c)
Unless the prescription drug is a controlled substance or
the
prescription drug is being prescribed to treat a condition that
is
excluded from coverage under this act, a prescription drug that
is
recognized in a generally accepted standard medical reference as
effective
in the treatment of conditions specified in the most
recent
diagnostic and statistical manual of mental disorders
published
by the American psychiatric association. The department
or
the department's agent shall not deny a request for prior
authorization
of a controlled substance under this subdivision
unless
the department or the department's agent determines that the
controlled
substance or the dosage of the controlled substance
being
prescribed is not consistent with its licensed indications or
with
generally accepted medical practice as documented in a
standard
medical reference.
(d)
A prescription drug that is recognized in a generally
accepted
standard medical reference for the treatment of and is
being
prescribed to a patient for the treatment of any of the
following:
(i) Human immunodeficiency virus infections or the
complications
of the human immunodeficiency virus or acquired
immunodeficiency
syndrome.
(ii) Cancer.
(iii) Organ replacement therapy.
(iv) Epilepsy or seizure disorder.
(1) If the department develops a prior authorization process
for prescription drugs as part of the pharmaceutical services
offered under the medical assistance program administered under
this act, it shall not require prior authorization for a single
source brand name, generic equivalent of a multiple source brand
name, or other prescription drug that is recognized in a generally
accepted standard medical reference for the treatment of and is
being prescribed to a patient for the treatment of any of the
following:
(a) Human immunodeficiency virus infections or the
complications of the human immunodeficiency virus or acquired
immunodeficiency syndrome.
(b) Cancer.
(c) Organ replacement therapy.
(2) This section does not apply to drugs being provided under
a contract between the department and a health maintenance
organization.
(3) As used in this section:
(a)
"Controlled substance" means that term as defined in
section
7104 of the public health code, 1978 PA 368, MCL 333.7104.
(b)
"Cross-indicated" means a drug which is used for a purpose
generally
held to be reasonable, appropriate, and within community
standards
of practice even though the use is not included in the
federal
food and drug administration's approved labeled indications
for
that drug.
(a) (c)
"Department" means the
department of community health.
(b) (d)
"Prescriber" means that
term as defined in section
17708 of the public health code, 1978 PA 368, MCL 333.17708.
(c) (e)
"Prescription" or
"prescription drug" means that term
as defined in section 17708 of the public health code, 1978 PA 368,
MCL 333.17708.
(d) (f)
"Prior authorization"
means a process implemented by
the
department of community health that conditions, delays, or
denies
the delivery of particular pharmaceutical services to
medicaid
beneficiaries upon application of predetermined criteria
by
the department or the department's agent for those
pharmaceutical
services covered by the department on a fee-for-
service
basis or pursuant to a contract for those services. The the
process that may require a prescriber to verify with the department
or the department's agent that the proposed medical use of a
prescription drug being prescribed for a patient meets the
predetermined criteria for a prescription drug that is otherwise
covered under this act or require a prescriber to obtain
authorization from the department or the department's agent before
prescribing or dispensing a prescription drug that is not included
on a preferred drug list or that is subject to special access or
reimbursement restrictions.