Florida Senate - 2013 SENATOR AMENDMENT Bill No. CS for CS for SB 966 Barcode 931602 LEGISLATIVE ACTION Senate . House . . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— Senator Bean moved the following: 1 Senate Amendment (with title amendment) 2 3 Delete lines 2420 - 2425 4 and insert: 5 4. Managed care plans must permit an enrollee who was 6 receiving a prescription drug and was on the plan’s formulary 7 and subsequently removed or changed, to continue receiving that 8 drug if the provider submits a written request demonstrating 9 that the drug is medically necessary and that the enrollee meets 10 clinical criteria to receive the drug. 11 5. Managed care plans must establish procedures to ensure 12 that: 13 a. There is a response to a request for prior consultation 14 by telephone or other telecommunication device within 24 hours 15 after receipt of a request for prior consultation. 16 b. A 72-hour supply of the drug prescribed is provided in 17 an emergency or if the managed care plan does not provide a 18 response within 24 hours. 19 c. The prior authorization process for prescribed drugs is 20 readily accessible to health care providers, including posting 21 appropriate contact information on the managed care plan’s 22 website and providing timely responses to providers. 23 d. If a drug, determined to be medically necessary and 24 prescribed for an enrollee by a physician using sound clinical 25 judgment, is subject to prior authorization and approved, a 26 managed care plan provides for sufficient refills to complete 27 the duration of the prescription. If the medication is still 28 clinically appropriate for ongoing therapy after the initial 29 prior authorization expires, the plan must provide a process of 30 expedited review to evaluate ongoing therapy. 31 6. Managed care plans shall implement a step-therapy prior 32 authorization approval process for medications excluded from the 33 preferred drug list. Medications on the preferred drug list must 34 be used within the previous 12 months before using alternative 35 medications that are not listed. The trial period between the 36 specified steps may vary according to the medical indication. 37 The step-therapy approval process shall be developed in 38 accordance with the Medicaid Pharmaceutical and Therapeutics 39 Committee, as provided in s. 409.91195(7) and (8). A drug 40 product may be approved without meeting the step-therapy prior 41 authorization criteria if the prescribing physician provides the 42 managed care plan with additional written medical or clinical 43 documentation that the product is medically necessary because: 44 a. There is no acceptable clinical alternative drug on the 45 preferred drug list to treat the disease or medical condition; 46 b. The alternatives have been ineffective in the treatment 47 of the beneficiary’s disease; or 48 c. Based on historic evidence and known characteristics of 49 the patient and the drug, the drug is likely to be ineffective, 50 or the number of doses have been ineffective. 51 52 Managed care plans shall work with physicians to determine the 53 best alternative for patients. The agency may adopt rules 54 waiving the requirements for written clinical documentation for 55 specific drugs in limited clinical situations. 56 57 ================= T I T L E A M E N D M E N T ================ 58 And the title is amended as follows: 59 Delete line 215 60 and insert: 61 plan’s formulary; requiring managed care plans to 62 establish procedures relating to prior authorization 63 review and to ensure that patients receive a 64 sufficient supply of drugs to complete ongoing 65 therapy; providing criteria for the implementation of 66 a step-therapy prior authorization process; requiring 67 managed care plans to work with physicians regarding 68 alternative treatments; providing for the adoption of 69 rules; revising references to certain