Senate Bill 2376
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 SB 2376
By Senator Grant
41-1538-00
1 A bill to be entitled
2 An act relating to Medicaid prescribed-drug
3 services; amending s. 409.912, F.S.; providing
4 for a Medicaid preferred-drug designation
5 program and drug cost-containment initiatives;
6 prescribing criteria for the designation of
7 preferred drugs; creating a pharmacy and
8 therapeutics committee for the program and
9 prescribing its membership and duties;
10 providing for reimbursement of members for
11 travel and expenses; requiring reports;
12 providing an effective date.
13
14 Be It Enacted by the Legislature of the State of Florida:
15
16 Section 1. Subsection (37) is added to section
17 409.912, Florida Statutes, to read:
18 409.912 Cost-effective purchasing of health care.--The
19 agency shall purchase goods and services for Medicaid
20 recipients in the most cost-effective manner consistent with
21 the delivery of quality medical care. The agency shall
22 maximize the use of prepaid per capita and prepaid aggregate
23 fixed-sum basis services when appropriate and other
24 alternative service delivery and reimbursement methodologies,
25 including competitive bidding pursuant to s. 287.057, designed
26 to facilitate the cost-effective purchase of a case-managed
27 continuum of care. The agency shall also require providers to
28 minimize the exposure of recipients to the need for acute
29 inpatient, custodial, and other institutional care and the
30 inappropriate or unnecessary use of high-cost services.
31
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 SB 2376
41-1538-00
1 (37)(a) The agency may implement a Medicaid
2 preferred-drug designation program. Prior consultation is
3 required for prescribed drugs without a preferred-drug
4 designation. The Medicaid preferred-drug designation program
5 must be developed and implemented with the advice of the
6 pharmacy and therapeutics committee. The agency may also
7 implement prescribed-drug cost-containment initiatives,
8 including, but not limited to, limits on the number of brand
9 name prescribed drugs available to adult Medicaid recipients
10 on a monthly basis; capitation of the prescribed-drug benefit
11 for nursing home residents or alternative cost-control
12 measures; negotiating and collecting additional supplemental
13 rebates from pharmaceutical manufacturers; and other
14 initiatives to promote the cost-effective purchasing of
15 prescribed drugs, in accordance with the requirements of
16 federal law. Florida Medicaid shall maintain an open formulary
17 consistent with this subsection.
18 (b) There is created a pharmacy and therapeutics
19 committee to guide the development and maintenance of the
20 Medicaid preferred-drug designation program. The pharmacy and
21 therapeutics committee shall consist of nine members, as
22 required by federal law, each appointed by the Governor or the
23 Governor's designee to serve a 4-year term. Committee members
24 may be reappointed upon the expiration of their terms. The
25 committee shall consist of four physicians licensed to
26 practice medicine in this state, one of whom as experience in
27 managing a preferred prescribed drug designation program; four
28 pharmacists who are licensed in this state; and one consumer
29 representative. There shall be no liability on the part of,
30 and no cause of action of any nature shall arise against, any
31 member of the pharmacy and therapeutics committee for any
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 SB 2376
41-1538-00
1 action taken by the committee in the performance of its powers
2 and duties under this subsection. The agency shall provide
3 staff support to the pharmacy and therapeutics committee in
4 the performance of its duties.
5 (c) The duties of the pharmacy and therapeutics
6 committee include, but are not limited to:
7 1. Initially determining the prescribed drugs that
8 will receive preferred-drug designations for the Medicaid
9 preferred-drug designation program. The criteria the committee
10 may use to recommend the prescribed drugs that will receive
11 preferred-drug designations include, but are not limited to:
12 a. Preferences among physicians and other health care
13 providers who have traditionally prescribed significant
14 numbers of prescribed drugs to Medicaid patients;
15 b. Preferences among pharmacists who have
16 traditionally provided significant numbers of prescribed drugs
17 to Medicaid patients;
18 c. The effectiveness of the prescribed drug;
19 d. The safety of the prescribed drug;
20 e. The potential for misuse of the prescribed drug;
21 f. The essential need for and value of the prescribed
22 drug;
23 g. Comparisons with other prescribed drugs in the same
24 therapeutic class on the criteria listed in this subsection;
25 h. The therapeutic advantages, if any, as indicated by
26 review of pharmaceutical manufacturer materials filed with the
27 U.S. Food and Drug Administration, review of other
28 pharmacological studies, review of peer-reviewed literature,
29 periodic surveys of Medicaid patients using the drug, surveys
30 of physicians and other prescribers who serve a significant
31
3
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 SB 2376
41-1538-00
1 number of Medicaid patients, and surveys of pharmacists who
2 serve a significant number of Medicaid patients;
3 i. The potential effects on other Medicaid-program
4 spending;
5 j. Existing or proposed discounts from pharmaceutical
6 manufacturers through supplemental rebate agreements or other
7 verifiable cost-reduction proposals; and
8 k. The willingness of a pharmaceutical manufacturer to
9 participate in and finance Medicaid disease-management
10 initiatives;
11 2. Reviewing and recommending on an ongoing basis
12 additional prescribed drugs to receive preferred-drug
13 designations under subparagraph 1.;
14 3. Reviewing and recommending on an ongoing basis the
15 removal of preferred-drug designations made under subparagraph
16 1.;
17 4. Reviewing and conducting special
18 prescribed-drug-therapy evaluations to assess the adequacy of
19 Medicaid preferred-drug designations using an appropriate
20 methodology including, but not limited to, pre-designation and
21 post-designation program-outcome measurements with respect to
22 hospital utilization, physician office visits, emergency-room
23 visits, patient and provider satisfaction, quality-of-life
24 indicators, per capita drug utilization and expenditures,
25 total Medicaid-program costs, and indicators of adequate
26 administrative support; and
27 5. Assisting the agency in developing clinical
28 guidelines, particularly for prescribed-drug therapies.
29 (d) Members of the pharmacy and therapeutics committee
30 shall serve without compensation; however, the agency shall
31 reimburse committee members for travel and expenses incurred
4
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 SB 2376
41-1538-00
1 in the performance of their duties in accordance with s.
2 112.061.
3 (e) The agency shall submit an annual report to the
4 Governor, the President of the Senate, and the Speaker of the
5 House of Representatives by January 15 of each year which
6 includes, but is not limited to, the progress that has been
7 made to control costs in Medicaid prescribed-drug services.
8 Section 2. This act shall take effect July 1, 2000.
9
10 *****************************************
11 SENATE SUMMARY
12 Provides for a Medicaid preferred-drug designation
program and drug cost-containment initiatives. Prescribes
13 criteria for the designation of preferred drugs. Creates
a pharmacy and therapeutics committee and prescribes its
14 membership and duties. Requires annual reports.
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
5