CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. HB 2151, 1st Eng.
Amendment No. 1
CHAMBER ACTION
Senate House
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11 The Committee on Health, Aging and Long-Term Care recommended
12 the following amendment:
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14 Senate Amendment (with title amendment)
15 Delete everything after the enacting clause
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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
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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. Persons with
9 Alzheimer's disease, children, and institutionalized adults
10 are exempt from this restriction. Antiretroviral agents are
11 excluded from this limitation. No requirements for prior
12 authorization or other restrictions on medications used to
13 treat mental illnesses such as schizophrenia, severe
14 depression, or bipolar disorder may be imposed on Medicaid
15 recipients. Medications that will be available without
16 restriction for persons with mental illnesses include atypical
17 antipsychotic medications, conventional antipsychotic
18 medications, selective serotonin re-uptake inhibitors, and
19 other medications used for the treatment of serious mental
20 illnesses. The agency shall also limit the amount of a
21 prescribed drug dispensed to no more than a 34-day supply. The
22 agency shall continue to provide unlimited generic drugs,
23 contraceptive drugs and items, and diabetic supplies. The
24 agency may authorize exceptions to the brand-name-drug
25 restriction only when such exceptions are based on prior
26 consultation provided by the agency or an agency contractor,
27 but the agency must establish procedures to 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;
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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.;
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5 c. A process is established for the provision of
6 medically necessary drugs in excess of the limit.
7 2. Reimbursement to pharmacies for Medicaid prescribed
8 drugs shall be set at the average wholesale price less 14
9 percent.
10 3. The agency shall develop and implement a process
11 for managing the drug therapies of Medicaid recipients who are
12 using significant numbers of prescribed drugs each month. The
13 management process may include, but is not limited to,
14 comprehensive, physician-directed medical-record reviews,
15 claims analyses, and case evaluations to determine the medical
16 necessity and appropriateness of a patient's treatment plan
17 and drug therapies. The agency may contract with a private
18 organization to provide drug-program-management services.
19 4. The agency is authorized to establish pharmacy
20 network controls directed only at reducing fraud, such as
21 establishing minimum initial pharmacy drug inventories. The
22 agency may not limit the size of its pharmacy network based on
23 need, competitive bidding, price negotiations, credentialing,
24 or similar criteria.
25 5. The agency shall develop and implement a program
26 that requires Medicaid practitioners who prescribe drugs to
27 use a counterfeit-proof prescription pad for Medicaid
28 prescriptions. The agency shall require the use of
29 standardized counterfeit-proof prescription pads by
30 Medicaid-participating prescribers. The agency may implement
31 the program in targeted geographic areas or statewide. If a
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SENATE AMENDMENT
Bill No. HB 2151, 1st Eng.
Amendment No. 1
1 pharmacist receives a request to fill a prescription that is
2 not written on a counterfeit-proof prescription form and the
3 pharmacist is unable to verify authorization for the
4 prescription with the prescriber, a pharmacist may dispense,
5 on a one-time basis, up to a 72-hour supply of the prescribed
6 medication if:
7 a. The prescription is not a medicinal drug listed in
8 Schedule II in chapter 893;
9 b. The medication is essential to the maintenance of
10 life or the continuation of therapy for a chronic condition;
11 c. In the pharmacist's professional judgment, the
12 interruption of therapy might reasonably produce undesirable
13 health consequences or may cause physical or mental
14 discomfort;
15 d. The pharmacist creates a second written order that
16 contains all of the prescription information required by
17 chapters 465, 499, and 893 and signs that order; and
18 e. The pharmacist notifies the prescriber within a
19 reasonable time after dispensing the medication and notifies
20 the agency that the prescription was not written on a
21 counterfeit-proof prescription form.
22 6. Manufacturers of generic drugs prescribed to
23 Medicaid recipients must guarantee the state a rebate of at
24 least 15.1 percent of the total Medicaid payment for their
25 generic products. Generic-drug manufacturers who pay federal
26 rebates for Medicaid-reimbursed drugs at a level below 15.1
27 percent must provide a supplemental rebate to the state in an
28 amount necessary to achieve a 15.1-percent rebate level. If a
29 generic-drug manufacturer raises its price in excess of the
30 Consumer Price Index (Urban), the excess amount shall be
31 included in the supplemental rebate to the state.
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SENATE AMENDMENT
Bill No. HB 2151, 1st Eng.
Amendment No. 1
1 (b) The agency shall implement this subsection to the
2 extent that funds are appropriated to administer the Medicaid
3 prescribed-drug spending-control program. The agency may
4 contract all or any part of this program to private
5 organizations.
6 (c) The agency shall submit a report to the Governor,
7 the Speaker of the House of Representatives, and the President
8 of the Senate by January 15 of each year. The report must
9 include, but need not be limited to, the progress made in
10 implementing Medicaid cost-containment measures and their
11 effect on Medicaid prescribed-drug expenditures.
12 Section 2. There is created a Medicaid Pharmaceutical
13 and Therapeutics Committee. The committee shall develop and
14 implement a voluntary Medicaid preferred prescribed drug
15 designation program. The program shall provide information to
16 Medicaid providers on medically appropriate and cost efficient
17 prescription drug therapies through the development and
18 publication of a voluntary Medicaid preferred prescribed drug
19 list.
20 (1) The Medicaid Pharmaceutical and Therapeutics
21 Committee shall be comprised of seven members appointed as
22 follows: one practicing physician licensed under chapter 458,
23 Florida Statutes, appointed by the Speaker of the House of
24 Representatives from a list of recommendations from the
25 Florida Medical Association; one practicing physician licensed
26 under chapter 459, Florida Statutes, appointed by the Speaker
27 of the House of Representatives from a list of recommendations
28 from the Florida Osteopathic Medical Association; one
29 practicing physician licensed under chapter 458, Florida
30 Statutes, appointed by the President of the Senate from a list
31 of recommendations from the Florida Academy of Family
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SENATE AMENDMENT
Bill No. HB 2151, 1st Eng.
Amendment No. 1
1 Physicians; one practicing dentist licensed under chapter 466,
2 Florida Statutes, appointed by the President of the Senate
3 from a list of recommendations from the Florida Dental
4 Association; one practicing pharmacist licensed under chapter
5 465, Florida Statutes, appointed by the Governor from a list
6 of recommendations from the Florida Pharmacy Association; one
7 practicing pharmacist licensed under chapter 465, Florida
8 Statutes, appointed by the Governor from a list of
9 recommendations from the Florida Society of Health System
10 Pharmacists; and one representative of the Pharmaceutical
11 Research and Manufacturers Association with expertise in
12 clinical pharmacology appointed by the Governor from a list of
13 recommendations from that association. The members shall be
14 appointed to serve for terms of 2 years from the date of their
15 appointment. The Agency for Health Care Administration shall
16 serve as staff for the committee and assist them with all
17 ministerial duties.
18 (2) Upon recommendation by the committee, the Agency
19 for Health Care Administration shall establish the voluntary
20 Medicaid preferred prescribed drug list by rule. Upon further
21 recommendation by the committee, the agency shall add to,
22 delete from, or modify the list by rule. Notwithstanding any
23 provision of chapter 120, Florida Statutes, to the contrary,
24 the list shall become effective 60 days after the date it is
25 filed with the Secretary of State. The committee shall also
26 review requests for additions to, deletions from, or
27 modifications of the list. The list shall be adopted by the
28 committee in consultation with medical specialists, when
29 appropriate, using the following criteria: use of the list
30 shall be voluntary by providers, and the list must provide for
31 medically appropriate drug therapies for Medicaid patients
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SENATE AMENDMENT
Bill No. HB 2151, 1st Eng.
Amendment No. 1
1 which achieve cost savings in the Medicaid program.
2 (3) The Agency for Health Care Administration shall
3 publish and disseminate the voluntary Medicaid preferred
4 prescribed drug list to all Medicaid providers in the state.
5 Section 3. This act shall take effect July 1, 2000.
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9 And the title is amended as follows:
10 On page 1, line 10, after the second semicolon
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12 insert:
13 creating the Medicaid Pharmaceutical
14 Therapeutics Committee; providing for
15 membership; providing for the adoption by rule
16 of a voluntary preferred prescribed drug list
17 by the committee;
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