CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. HB 2151, 1st Eng.
Amendment No. 1
CHAMBER ACTION
Senate House
.
.
1 .
.
2 .
.
3 .
.
4
5
6
7
8
9
10
11 The Committee on Fiscal Policy recommended the following
12 amendment:
13
14 Senate Amendment (with title amendment)
15 Delete everything after the enacting clause
16
17 and insert:
18 Section 1. Subsection (37) is added to section
19 409.912, Florida Statutes, to read:
20 409.912 Cost-effective purchasing of health care.--The
21 agency shall purchase goods and services for Medicaid
22 recipients in the most cost-effective manner consistent with
23 the delivery of quality medical care. The agency shall
24 maximize the use of prepaid per capita and prepaid aggregate
25 fixed-sum basis services when appropriate and other
26 alternative service delivery and reimbursement methodologies,
27 including competitive bidding pursuant to s. 287.057, designed
28 to facilitate the cost-effective purchase of a case-managed
29 continuum of care. The agency shall also require providers to
30 minimize the exposure of recipients to the need for acute
31 inpatient, custodial, and other institutional care and the
1
5:04 PM 04/26/00 h2151.fp.01
SENATE AMENDMENT
Bill No. HB 2151, 1st Eng.
Amendment No. 1
1 inappropriate or unnecessary use of high-cost services.
2 (37)(a) The agency shall implement a Medicaid
3 prescribed-drug spending-control program that includes the
4 following components:
5 1. Medicaid prescribed-drug coverage for brand-name
6 drugs for adult Medicaid recipients not residing in nursing
7 homes or other institutions is limited to the dispensing of
8 four brand-name drugs per month per recipient. Children and
9 institutionalized adults are exempt from this restriction.
10 Antiretroviral agents are excluded from this limitation. No
11 requirements for prior authorization or other restrictions on
12 medications used to treat mental illnesses such as
13 schizophrenia, severe depression, or bipolar disorder may be
14 imposed on Medicaid recipients. Medications that will be
15 available without restriction for persons with mental
16 illnesses include atypical antipsychotic medications,
17 conventional antipsychotic medications, selective serotonin
18 re-uptake inhibitors, and other medications used for the
19 treatment of serious mental illnesses. The agency shall also
20 limit the amount of a prescribed drug dispensed to no more
21 than a 34-day supply. The agency shall continue to provide
22 unlimited generic drugs, contraceptive drugs and items, and
23 diabetic supplies. The agency may authorize exceptions to the
24 brand-name-drug restriction only when such exceptions are
25 based on prior consultation provided by the agency or an
26 agency contractor, but the agency must establish procedures to
27 ensure that:
28 a. There will be a response to a request for prior
29 consultation by telephone or other telecommunication device
30 within 24 hours after receipt of a request for prior
31 consultation; and
2
5:04 PM 04/26/00 h2151.fp.01
SENATE AMENDMENT
Bill No. HB 2151, 1st Eng.
Amendment No. 1
1 b. A 72-hour supply of the drug prescribed will be
2 provided in an emergency or when the agency does not provide a
3 response within 24 hours as required by sub-subparagraph a.
4 2. Reimbursement to pharmacies for Medicaid prescribed
5 drugs shall be set at the average wholesale price less 13.25
6 percent.
7 3. The agency shall develop and implement a process
8 for managing the drug therapies of Medicaid recipients who are
9 using significant numbers of prescribed drugs each month. The
10 management process may include, but is not limited to,
11 comprehensive, physician-directed medical-record reviews,
12 claims analyses, and case evaluations to determine the medical
13 necessity and appropriateness of a patient's treatment plan
14 and drug therapies. The agency may contract with a private
15 organization to provide drug-program-management services.
16 4. The agency may limit the size of its pharmacy
17 network based on need, competitive bidding, price
18 negotiations, credentialing, or similar criteria. The agency
19 shall give special consideration to rural areas in determining
20 the size and location of pharmacies included in the Medicaid
21 pharmacy network. A pharmacy credentialing process may include
22 criteria such as a pharmacy's full-service status, location,
23 size, patient educational programs, patient consultation,
24 disease-management services, and other characteristics. The
25 agency may impose a moratorium on Medicaid pharmacy enrollment
26 when it is determined that it has a sufficient number of
27 Medicaid-participating providers.
28 5. The agency shall develop and implement a program
29 that requires Medicaid practitioners who prescribe drugs to
30 use a counterfeit-proof prescription pad for Medicaid
31 prescriptions. The agency shall require the use of
3
5:04 PM 04/26/00 h2151.fp.01
SENATE AMENDMENT
Bill No. HB 2151, 1st Eng.
Amendment No. 1
1 standardized counterfeit-proof prescription pads by
2 Medicaid-participating prescribers. The agency may implement
3 the program in targeted geographic areas or statewide.
4 6. The agency may enter into arrangements that require
5 manufacturers of generic drugs prescribed to Medicaid
6 recipients to provide rebates of at least 15.1 percent of the
7 average manufacturer price for the manufacturer's generic
8 products. These arrangements shall require that if a
9 generic-drug manufacturer pays federal rebates for
10 Medicaid-reimbursed drugs at a level below 15.1 percent, the
11 manufacturer must provide a supplemental rebate to the state
12 in an amount necessary to achieve a 15.1-percent rebate level.
13 If a generic-drug manufacturer raises its price in excess of
14 the Consumer Price Index (Urban), the excess amount shall be
15 included in the supplemental rebate to the state.
16 (b) The agency shall implement this subsection to the
17 extent that funds are appropriated to administer the Medicaid
18 prescribed-drug spending-control program. The agency may
19 contract all or any part of this program to private
20 organizations.
21 (c) The agency shall submit a report to the Governor,
22 the President of the Senate, and the Speaker of the House of
23 Representatives by January 15 of each year. The report must
24 include, but need not be limited to, the progress made in
25 implementing Medicaid cost-containment measures and their
26 effect on Medicaid prescribed-drug expenditures.
27 Section 2. There is created a Medicaid Pharmaceutical
28 and Therapeutics Committee. The committee shall develop and
29 implement a voluntary Medicaid preferred prescribed drug
30 designation program. The program shall provide information to
31 Medicaid providers on medically appropriate and cost efficient
4
5:04 PM 04/26/00 h2151.fp.01
SENATE AMENDMENT
Bill No. HB 2151, 1st Eng.
Amendment No. 1
1 prescription drug therapies through the development and
2 publication of a voluntary Medicaid preferred prescribed-drug
3 list.
4 (1) The Medicaid Pharmaceutical and Therapeutics
5 Committee shall be comprised of nine members appointed as
6 follows: one practicing physician licensed under chapter 458,
7 Florida Statutes, appointed by the Speaker of the House of
8 Representatives from a list of recommendations from the
9 Florida Medical Association; one practicing physician licensed
10 under chapter 459, Florida Statutes, appointed by the Speaker
11 of the House of Representatives from a list of recommendations
12 from the Florida Osteopathic Medical Association; one
13 practicing physician licensed under chapter 458, Florida
14 Statutes, appointed by the President of the Senate from a list
15 of recommendations from the Florida Academy of Family
16 Physicians; one practicing podiatric physician licensed under
17 chapter 461, Florida Statutes, appointed by the President of
18 the Florida Senate from a list of recommendations from the
19 Florida Podiatric Medical Association; one trauma surgeon
20 licensed under chapter 458, Florida Statutes, appointed by the
21 Speaker of the House of Representatives from a list of
22 recommendations from the American College of Surgeons; one
23 practicing dentist licensed under chapter 466, Florida
24 Statutes, appointed by the President of the Senate from a list
25 of recommendations from the Florida Dental Association; one
26 practicing pharmacist licensed under chapter 465, Florida
27 Statutes, appointed by the Governor from a list of
28 recommendations from the Florida Pharmacy Association; one
29 practicing pharmacist licensed under chapter 465, Florida
30 Statutes, appointed by the Governor from a list of
31 recommendations from the Florida Society of Health System
5
5:04 PM 04/26/00 h2151.fp.01
SENATE AMENDMENT
Bill No. HB 2151, 1st Eng.
Amendment No. 1
1 Pharmacists; and one health care professional with expertise
2 in clinical pharmacology appointed by the Governor from a list
3 of recommendations from the Pharmaceutical Research and
4 Manufacturers Association. The members shall be appointed to
5 serve for terms of 2 years from the date of their appointment.
6 Members may be appointed to more than one term. The Agency for
7 Health Care Administration shall serve as staff for the
8 committee and assist them with all ministerial duties.
9 (2) Upon recommendation by the committee, the Agency
10 for Health Care Administration shall establish the voluntary
11 Medicaid preferred prescribed-drug list. Upon further
12 recommendation by the committee, the agency shall add to,
13 delete from, or modify the list. The committee shall also
14 review requests for additions to, deletions from, or
15 modifications of the list. The list shall be adopted by the
16 committee in consultation with medical specialists, when
17 appropriate, using the following criteria: use of the list
18 shall be voluntary by providers and the list must provide for
19 medically appropriate drug therapies for Medicaid patients
20 which achieve cost savings in the Medicaid program.
21 (3) The Agency for Health Care Administration shall
22 publish and disseminate the voluntary Medicaid preferred
23 prescribed drug list to all Medicaid providers in the state.
24 Section 3. This act shall take effect July 1, 2000.
25
26
27 ================ T I T L E A M E N D M E N T ===============
28 And the title is amended as follows:
29 Delete everything before the enacting clause
30
31 and insert:
6
5:04 PM 04/26/00 h2151.fp.01
SENATE AMENDMENT
Bill No. HB 2151, 1st Eng.
Amendment No. 1
1 A bill to be entitled
2 An act relating to the Agency for Health Care
3 Administration; amending s. 409.912, F.S.,
4 relating to cost-effective purchasing of health
5 care under the Medicaid program; requiring the
6 agency to implement a Medicaid prescribed-drug
7 spending-control program; specifying program
8 components; providing for implementation to the
9 extent funds are appropriated; authorizing
10 contracts; requiring an annual report; creating
11 the Medicaid Pharmaceutical Therapeutics
12 Committee; providing for membership; providing
13 for the adoption of a voluntary preferred
14 prescribed-drug list by the committee;
15 providing an effective date.
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
7
5:04 PM 04/26/00 h2151.fp.01