House Bill 2049
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Florida House of Representatives - 2000 HB 2049
By Representative Kelly
1 A bill to be entitled
2 An act relating to Medicaid prescribed drug
3 services; amending s. 409.912, F.S.;
4 authorizing the Agency for Health Care
5 Administration to implement a Medicaid
6 preferred prescribed drug designation program;
7 authorizing the agency to implement prescribed
8 drug cost containment initiatives; providing
9 for a formulary; requiring an annual report;
10 creating s. 409.91203, F.S.; establishing a
11 pharmacy and therapeutics committee to advise
12 the agency regarding the Medicaid preferred
13 prescribed drug designation program; providing
14 for appointment of members; providing duties;
15 providing for reimbursement of committee
16 members' expenses; providing an effective date.
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18 Be It Enacted by the Legislature of the State of Florida:
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20 Section 1. Subsection (37) is added to section
21 409.912, Florida Statutes, to read:
22 409.912 Cost-effective purchasing of health care.--The
23 agency shall purchase goods and services for Medicaid
24 recipients in the most cost-effective manner consistent with
25 the delivery of quality medical care. The agency shall
26 maximize the use of prepaid per capita and prepaid aggregate
27 fixed-sum basis services when appropriate and other
28 alternative service delivery and reimbursement methodologies,
29 including competitive bidding pursuant to s. 287.057, designed
30 to facilitate the cost-effective purchase of a case-managed
31 continuum of care. The agency shall also require providers to
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1 minimize the exposure of recipients to the need for acute
2 inpatient, custodial, and other institutional care and the
3 inappropriate or unnecessary use of high-cost services.
4 (37)(a) The agency is authorized to develop and
5 implement a Medicaid preferred prescribed drug designation
6 program. Consultation with another physician shall be required
7 prior to prescription of a drug that has not received
8 preferred prescribed drug designation under the program. The
9 pharmacy and therapeutics committee established in s.
10 409.91203 shall advise the agency in the development and
11 implementation of the program.
12 (b) The agency is authorized to implement prescribed
13 drug cost containment initiatives, which shall include, but
14 not be limited to: limiting the number of brand name
15 prescribed drugs available to an adult Medicaid recipient on a
16 monthly basis; capitation of the prescribed drug benefit for
17 nursing home residents or alternative cost control measures;
18 negotiating and collecting additional supplemental rebates
19 from pharmaceutical manufacturers; and other initiatives to
20 promote the cost-effective purchasing of prescribed drugs, in
21 accordance with the requirements of federal law.
22 (c) The Medicaid program shall maintain an open
23 formulary consistent with the provisions of this subsection.
24 (d) The agency shall submit a report to the Governor,
25 the Speaker of the House of Representatives, and the President
26 of the Senate, by January 15 of each year, which includes, but
27 is not limited to, the progress that has been made to control
28 costs in Medicaid prescribed drug services.
29 Section 2. Section 409.91203, Florida Statutes, is
30 created to read:
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Florida House of Representatives - 2000 HB 2049
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1 409.91203 Pharmacy and therapeutics committee.--There
2 is created a pharmacy and therapeutics committee to advise the
3 agency and provide guidance in the development and
4 implementation of the Medicaid preferred prescribed drug
5 designation program. The agency shall provide staff support to
6 the committee in the performance of its duties.
7 (1) The committee shall consist of nine members as
8 required by federal law, each appointed by the Governor or the
9 Governor's designee for a 4-year term. Committee members may
10 be reappointed upon the expiration of their terms. The
11 committee shall consist of four physicians licensed in the
12 state, one of whom shall have experience in managing a
13 preferred prescribed drug designation program; four
14 pharmacists licensed in the state; and one consumer
15 representative. There shall be no liability on the part of,
16 and no cause of action of any nature shall arise against, any
17 member of the pharmacy and therapeutics committee for any
18 action taken by the committee in the performance of its powers
19 and duties as established in this section.
20 (2) The duties of the committee include, but are not
21 limited to:
22 (a) Recommending the initial prescribed drugs to
23 receive preferred prescribed drug designation under the
24 Medicaid preferred prescribed drug designation program. In
25 making its recommendations, the committee may use, but is not
26 limited to, the following criteria:
27 1. Preferences among physicians and other health care
28 providers who have traditionally prescribed significant
29 numbers of prescribed drugs to Medicaid patients.
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1 2. Preferences among pharmacists who have
2 traditionally provided significant numbers of prescribed drugs
3 to Medicaid patients.
4 3. The effectiveness of the prescribed drug.
5 4. The safety of the prescribed drug.
6 5. The potential for misuse of the prescribed drug.
7 6. The essential need for and value of the prescribed
8 drug.
9 7. Comparisons with other prescribed drugs in the same
10 therapeutic class, with respect to the criteria listed in this
11 paragraph.
12 8. Therapeutic advantages, if any, as indicated by
13 review of pharmaceutical manufacturer materials filed with the
14 United States Food and Drug Administration, review of other
15 pharmacological studies, review of peer-reviewed literature,
16 periodic surveys of Medicaid patients using the drug, surveys
17 of physicians and other prescribers who serve significant
18 numbers of Medicaid patients, and surveys of pharmacists who
19 serve significant numbers of Medicaid patients.
20 9. The potential effects on other Medicaid program
21 spending.
22 10. Existing or proposed discounts from pharmaceutical
23 manufacturers through a supplemental rebate agreement or other
24 verifiable cost-reduction proposal.
25 11. The willingness of a pharmaceutical manufacturer
26 to participate in and finance Medicaid disease management
27 initiatives.
28 (b) Reviewing and recommending, on an ongoing basis,
29 additional prescribed drugs to receive preferred prescribed
30 drug designation.
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1 (c) Reviewing and recommending, on an ongoing basis,
2 the removal of preferred prescribed drug designations.
3 (d) Reviewing and conducting special prescribed drug
4 therapy evaluations to assess the adequacy of Medicaid
5 preferred prescribed drug designations, using an appropriate
6 methodology, including, but not limited to, outcome
7 measurements before and after implementation of the preferred
8 prescribed drug designation program in areas such as hospital
9 utilization, physician office visits, emergency room visits,
10 patient and provider satisfaction, quality of life indicators,
11 per capita drug utilization and expenditures, total Medicaid
12 program costs, and indicators of adequate administrative
13 support.
14 (e) Assisting the agency with the development of
15 clinical guidelines, particularly for prescribed drug
16 therapies.
17 (3) Members of the committee shall serve without
18 compensation. However, the agency shall reimburse committee
19 members for per diem and travel expenses incurred in the
20 performance of committee duties, in accordance with s.
21 112.061.
22 Section 3. This act shall take effect July 1, 2000.
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Florida House of Representatives - 2000 HB 2049
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2 HOUSE SUMMARY
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Authorizes the Agency for Health Care Administration to
4 implement a Medicaid preferred prescribed drug
designation program and Medicaid prescribed drug cost
5 containment initiatives. Provides for a formulary.
Requires an annual report to the Governor and Legislature
6 on progress in controlling costs for Medicaid prescribed
drug services. Establishes a pharmacy and therapeutics
7 committee to advise the agency regarding the Medicaid
preferred prescribed drug designation program. Provides
8 responsibility of the committee to recommend prescribed
drugs to receive designation under the program, according
9 to specified criteria, and to assist the agency in
developing clinical guidelines, particularly for
10 prescribed drug therapies. Requires the agency to provide
staff support to the committee and reimburse committee
11 members' expenses.
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