Florida Senate - 2013                          SENATOR AMENDMENT
       Bill No. CS for CS for SB 966
       
       
       
       
       
       
                                Barcode 931602                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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       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