CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. CS for SB 2034, 1st Eng.
Amendment No. ___
CHAMBER ACTION
Senate House
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11 Senator Silver moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 66, between lines 22 and 23,
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17 Section 38. Subsection (37) is added to section
18 409.912, Florida Statutes, to read:
19 409.912 Cost-effective purchasing of health care.--The
20 agency shall purchase goods and services for Medicaid
21 recipients in the most cost-effective manner consistent with
22 the delivery of quality medical care. The agency shall
23 maximize the use of prepaid per capita and prepaid aggregate
24 fixed-sum basis services when appropriate and other
25 alternative service delivery and reimbursement methodologies,
26 including competitive bidding pursuant to s. 287.057, designed
27 to facilitate the cost-effective purchase of a case-managed
28 continuum of care. The agency shall also require providers to
29 minimize the exposure of recipients to the need for acute
30 inpatient, custodial, and other institutional care and the
31 inappropriate or unnecessary use of high-cost services.
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SENATE AMENDMENT
Bill No. CS for SB 2034, 1st Eng.
Amendment No. ___
1 (37)(a) The agency shall implement a Medicaid
2 prescribed-drug spending-control program that includes the
3 following components:
4 1. Medicaid prescribed-drug coverage for brand-name
5 drugs for adult Medicaid recipients not residing in nursing
6 homes or other institutions is limited to the dispensing of
7 four brand-name drugs per month per recipient. Children and
8 institutionalized adults are exempt from this restriction.
9 Antiretroviral agents are excluded from this limitation. No
10 requirements for prior authorization or other restrictions on
11 medications used to treat mental illnesses such as
12 schizophrenia, severe depression, or bipolar disorder may be
13 imposed on Medicaid recipients. Medications that will be
14 available without restriction for persons with mental
15 illnesses include atypical antipsychotic medications,
16 conventional antipsychotic medications, selective serotonin
17 re-uptake inhibitors, and other medications used for the
18 treatment of serious mental illnesses. The agency shall also
19 limit the amount of a prescribed drug dispensed to no more
20 than a 34-day supply. The agency shall continue to provide
21 unlimited generic drugs, contraceptive drugs and items, and
22 diabetic supplies. The agency may authorize exceptions to the
23 brand-name-drug restriction, based upon the treatment needs of
24 the patients, only when such exceptions are based on prior
25 consultation provided by the agency or an agency contractor,
26 but the agency must establish procedures to ensure that:
27 a. There will be a response to a request for prior
28 consultation by telephone or other telecommunication device
29 within 24 hours after receipt of a request for prior
30 consultation; and
31 b. A 72-hour supply of the drug prescribed will be
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SENATE AMENDMENT
Bill No. CS for SB 2034, 1st Eng.
Amendment No. ___
1 provided in an emergency or when the agency does not provide a
2 response within 24 hours as required by sub-subparagraph a.
3 2. Reimbursement to pharmacies for Medicaid prescribed
4 drugs shall be set at the average wholesale price less 13.25
5 percent.
6 3. The agency shall develop and implement a process
7 for managing the drug therapies of Medicaid recipients who are
8 using significant numbers of prescribed drugs each month. The
9 management process may include, but is not limited to,
10 comprehensive, physician-directed medical-record reviews,
11 claims analyses, and case evaluations to determine the medical
12 necessity and appropriateness of a patient's treatment plan
13 and drug therapies. The agency may contract with a private
14 organization to provide drug-program-management services.
15 4. The agency may limit the size of its pharmacy
16 network based on need, competitive bidding, price
17 negotiations, credentialing, or similar criteria. The agency
18 shall give special consideration to rural areas in determining
19 the size and location of pharmacies included in the Medicaid
20 pharmacy network. A pharmacy credentialing process may include
21 criteria such as a pharmacy's full-service status, location,
22 size, patient educational programs, patient consultation,
23 disease-management services, and other characteristics. The
24 agency may impose a moratorium on Medicaid pharmacy enrollment
25 when it is determined that it has a sufficient number of
26 Medicaid-participating providers.
27 5. The agency shall develop and implement a program
28 that requires Medicaid practitioners who prescribe drugs to
29 use a counterfeit-proof prescription pad for Medicaid
30 prescriptions. The agency shall require the use of
31 standardized counterfeit-proof prescription pads by
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SENATE AMENDMENT
Bill No. CS for SB 2034, 1st Eng.
Amendment No. ___
1 Medicaid-participating prescribers. The agency may implement
2 the program in targeted geographic areas or statewide.
3 6. The agency may enter into arrangements that require
4 manufacturers of generic drugs prescribed to Medicaid
5 recipients to provide rebates of at least 15.1 percent of the
6 average manufacturer price for the manufacturer's generic
7 products. These arrangements shall require that if a
8 generic-drug manufacturer pays federal rebates for
9 Medicaid-reimbursed drugs at a level below 15.1 percent, the
10 manufacturer must provide a supplemental rebate to the state
11 in an amount necessary to achieve a 15.1-percent rebate level.
12 If a generic-drug manufacturer raises its price in excess of
13 the Consumer Price Index (Urban), the excess amount shall be
14 included in the supplemental rebate to the state.
15 (b) The agency shall implement this subsection to the
16 extent that funds are appropriated to administer the Medicaid
17 prescribed-drug spending-control program. The agency may
18 contract all or any part of this program to private
19 organizations.
20 (c) The agency shall submit a report to the Governor,
21 the President of the Senate, and the Speaker of the House of
22 Representatives by January 15 of each year. The report must
23 include, but need not be limited to, the progress made in
24 implementing Medicaid cost-containment measures and their
25 effect on Medicaid prescribed-drug expenditures.
26 Section 39. There is created a Medicaid Pharmaceutical
27 and Therapeutics Committee. The committee shall develop and
28 implement a voluntary Medicaid preferred prescribed drug
29 designation program. The program shall provide information to
30 Medicaid providers on medically appropriate and cost efficient
31 prescription drug therapies through the development and
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SENATE AMENDMENT
Bill No. CS for SB 2034, 1st Eng.
Amendment No. ___
1 publication of a voluntary Medicaid preferred prescribed-drug
2 list.
3 (1) The Medicaid Pharmaceutical and Therapeutics
4 Committee shall be comprised of nine members appointed as
5 follows: one practicing physician licensed under chapter 458,
6 Florida Statutes, appointed by the Speaker of the House of
7 Representatives from a list of recommendations from the
8 Florida Medical Association; one practicing physician licensed
9 under chapter 459, Florida Statutes, appointed by the Speaker
10 of the House of Representatives from a list of recommendations
11 from the Florida Osteopathic Medical Association; one
12 practicing physician licensed under chapter 458, Florida
13 Statutes, appointed by the President of the Senate from a list
14 of recommendations from the Florida Academy of Family
15 Physicians; one practicing podiatric physician licensed under
16 chapter 461, Florida Statutes, appointed by the President of
17 the Florida Senate from a list of recommendations from the
18 Florida Podiatric Medical Association; one trauma surgeon
19 licensed under chapter 458, Florida Statutes, appointed by the
20 Speaker of the House of Representatives from a list of
21 recommendations from the American College of Surgeons; one
22 practicing dentist licensed under chapter 466, Florida
23 Statutes, appointed by the President of the Senate from a list
24 of recommendations from the Florida Dental Association; one
25 practicing pharmacist licensed under chapter 465, Florida
26 Statutes, appointed by the Governor from a list of
27 recommendations from the Florida Pharmacy Association; one
28 practicing pharmacist licensed under chapter 465, Florida
29 Statutes, appointed by the Governor from a list of
30 recommendations from the Florida Society of Health System
31 Pharmacists; and one health care professional with expertise
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Amendment No. ___
1 in clinical pharmacology appointed by the Governor from a list
2 of recommendations from the Pharmaceutical Research and
3 Manufacturers Association. The members shall be appointed to
4 serve for terms of 2 years from the date of their appointment.
5 Members may be appointed to more than one term. The Agency for
6 Health Care Administration shall serve as staff for the
7 committee and assist them with all ministerial duties.
8 (2) Upon recommendation by the committee, the Agency
9 for Health Care Administration shall establish the voluntary
10 Medicaid preferred prescribed-drug list. Upon further
11 recommendation by the committee, the agency shall add to,
12 delete from, or modify the list. The committee shall also
13 review requests for additions to, deletions from, or
14 modifications of the list. The list shall be adopted by the
15 committee in consultation with medical specialists, when
16 appropriate, using the following criteria: use of the list
17 shall be voluntary by providers and the list must provide for
18 medically appropriate drug therapies for Medicaid patients
19 which achieve cost savings in the Medicaid program.
20 (3) The Agency for Health Care Administration shall
21 publish and disseminate the voluntary Medicaid preferred
22 prescribed drug list to all Medicaid providers in the state.
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24 (Redesignate subsequent sections.)
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28 And the title is amended as follows:
29 On page 6, line 4, following the semicolon
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SENATE AMENDMENT
Bill No. CS for SB 2034, 1st Eng.
Amendment No. ___
1 amending s. 409.912, F.S., relating to
2 cost-effective purchasing of health care under
3 the Medicaid program; requiring the agency to
4 implement a Medicaid prescribed-drug
5 spending-control program; specifying program
6 components; providing for implementation to the
7 extent funds are appropriated; authorizing
8 contracts; requiring an annual report; creating
9 the Medicaid Pharmaceutical Therapeutics
10 Committee; providing for membership; providing
11 for the adoption of a voluntary preferred
12 prescribed-drug list by the committee;
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