May 8, 2018, Introduced by Senator HILDENBRAND and referred to the Committee on Health Policy.
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. 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.
(2) The department may exclude from the department's preferred
drug list a drug described in subsection (1) that is not subject to
prior authorization.
(3) (2)
This section does not apply to
drugs being provided
under a contract between the department and a health maintenance
organization.
(4) (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.
(c)
"Department" means the department of community health.
(c) (d)
"Prescriber" means that
term as defined in section
17708 of the public health code, 1978 PA 368, MCL 333.17708.
(d) (e)
"Prescription" or
"prescription drug" means that term
as defined in section 17708 of the public health code, 1978 PA 368,
MCL 333.17708.
(e) (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 Medicaid
recipients 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 according
to a contract for those
services. The process 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.