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Therapy first plus vyvanse discount card CODES 15 days ago therapy first plus vyvanse discount card is a great battle to a brain fans heaters mixers etc. Changes the method for determining the estimated acquisition cost EAC used to reimburse pharmacies for the drug portion of prescriptions for Medicaid recipients.
Executive action: Generic substitution initiative. Brand name alternatives require prior authorization. Products only available as brand-name products do not require authorization for the first half of The agency implemented a product-specific prior authorization drug list as of July Provides that the commissioner shall also review the change to see if it "compromises the access to pharmacy services for covered patients; "and the division may establish In May , a state Superior Court judge struck down the provider tax as illegal because state regulators failed to get the required federal approval.
FY 04 budget section 19 requires executive agencies to "develop and implement a coordinated prescription drug procurement plan for all pharmacy benefit plans funded or subsidized, in whole or in part, by the commonwealth. The plan shall maximize cost savings, efficiencies, affordability and be designed to improve health outcomes, benefits and coverage in the pharmacy benefit plans.
Also mandates that the state "shall contract with a third party nonprofit pharmacy benefits manager to provide pharmacy benefit management services and negotiate pharmaceutical discounts, rebates and other prescription related cost savings with pharmaceutical manufacturers. Medicaid is included as "shall separately manage" the Medicaid pharmaceutical benefits. Effective operational date is Nov 5, Sec. MA H Conference Comm. FY state budget provides: A The state Health Care Financing agency is authorized to change the pricing formula for generic and multiple-source drugs to achieve savings for the state publicly aided programs.
MI H ; Public Act 60, sec. Mortimer; Sen. The state Dept. Excluded Rx products will require prior authorization. In February the Governor announced the state would join with Vermont, and later South Carolina and Wisconsin in a new Medicaid multi-state buying pool, using similar preferred drug lists and prior authorization. MI SB Sen. S Hammerstrom. Cherry FY ''03 budget adjustment law provides authority to establish a supplemental rebate program for pharmaceuticals, including use of a preferred drug list.
Allows the commissioner of human services to use prior authorization "for drugs that are from manufacturers that have not signed a supplemental rebate contract. Requires the Commissioner of Human Services to provide notice when a prescription drug is removed from the formulary.
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MS H Rep. As part of a broad Medicaid cost-containment bill, limits prescription drugs to seven per month per recipient and requires prior authorization for any prescriptions beyond five per month. Limits each prescription to a day supply. Prohibits a provider from prescribing, a pharmacy from billing, and the agency from reimbursing for brand name drugs if there are "equally effective generic equivalents available and if the generic equivalents are the least expensive.
Section 9 directs the Medicaid agency to adopt a "closed drug formulary as soon as practicable" and to opt out of the drug rebate program. Also includes implementation language for monthly limits on prescriptions and a prior authorization process. Also provides that certain unused drugs from nursing home facilities, "shall be returned to the pharmacy and not billed to Medicaid.
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After enactment the state was advised they cannot use a closed formulary, so they are considering a preferred drug list. Repeals law above allowing the state to opt out of the federal drug rebate program and requiring the state to create a closed drug formulary. Removes requirement requiring prior approval for every prescription over five per month.
Provides that until July 1, , any A-typical antipsychotic drug shall be included in any preferred drug list without requiring prior authorization. MS HB A waiver plan will assist those whose out-of-pocket payments would increase. Also establishes a mandatory preferred drug list PDL coupled with a prior authorization program for non-preferred products. Authorizes agreements and negotiations with other countries to facilitate the acquisition of prescription drugs, if allowed by federal law and if it will lower the acquisition costs of those drugs.
Modeled after the Florida program, this law increases the prescription limits to four brand names plus unlimited generics. Also requires the use of counterfeit-proof prescription pads. MS HB Rep. Re-authorizes establishing relationships with other states for bulk purchasing, as well as negotiations with other countries "if allowed by federal law or regulation.
As part of FY03 appropriations bill, Sec. The list shall "provide patient access without restriction in every therapeutic class. Creates a Medicaid expansion plan to provide prescription drug discounts to needy seniors over age 62 and not more than percent of the federal poverty level. It also covers people with disabilities over age 18 and those eligible for state mental health services. Medicaid rebate fund collections may be used to "reimburse participating retail pharmacies for the discount on the average wholesale price of prescription drugs provided to qualified residents.
Authorizes negotiation for discount process and rebates among all state-funded programs using Rx including Medicaid; also establishes a prescription drug consumer information and technical assistance program. MT HB Rep. Roberts Allows a waiver of health maintenance organization requirements for Pharmaceutical Assistance Contracts for Elderly organizations; clarifies that such programs are not Medicaid managed care networks. Requires the Department to adopt and promulgate rules and regulations to establish a schedule of premiums, copayments, and deductibles for goods and services, including pharmaceuticals, provided under Medicaid.
Requires that the state "establish and maintain a preferred drug list" for Medicaid an d create a Pharmaceutical and Therapeutics Committee to design the PDL. Antidepressant, antipsychotic and anticonvulsant prescription drugs are exempt from PDL restrictions. Establishes a preferred drug list PDL , expands prior authorization and creates a pharmacy therapeutics committee for prescription drugs dispensed by the state Medicaid program.
Mental illness and HIV drugs are exempted from restrictions. NH HB Rep. Authorizes a program for managing prescription benefits under Medicaid, including prior authorization and a lock-in program, and establishes a legislative oversight committee. The bill specifies the composition of a pharmacy and therapeutics committee to advise the Medicaid agency on medications subject to prior authorization, criteria for medical necessity to be used in a prior authorization program, and criteria for lock-in programs to prevent unauthorized multiple refills.
Requires a report to a legislative oversight committee each year on cost savings, unintended costs in other Medicaid programs, volume of prior authorizations, and other elements. The budget enacted in includes authorization for a preferred drug list, with exclusions for mental health drugs. Passed House and Senate, signed by governor, Wendelboe Would extend the committee to study Medicaid reimbursement rates for pharmacy providers, which was established in Authorizes the state to make full federal "clawback" payments by repealing language withholding such payments.
NH SB Sen. Clegg Authorizes the Commissioner of Health and Human Services to provide temporary assistance in the purchase of pharmaceuticals by persons eligible for services under both Medicaid and Medicare dual-eligibles. NJ S Budget. Restates the federal manufacturer rebate terms, but add generic drugs at that higher This provision has been interpreted to preclude other supplemental rebates.
Also establishes a state Rx disease management program and a recycle "system to utilize unopened prescription drugs at nursing facilities. NJ S , Sen. FY budget item et seq. Requires the Medicaid program to "implement a formulary or preferred drug list that will consider the clinical efficacy, safety and cost effectiveness of a product.
Requires "negotiated discount prices or rebates for prescription drugs from drug manufacturers and labelers that include supplemental rebates" for Medicaid. The state shall review whether to place a drug on the prior authorization list if there is no agreement on a supplemental Medicaid rebate and the rebates are not as favorable to the state as the prices paid through the federal B drug pricing program.
Also authorizes executive branch action "if it is beneficial to Medicaid and another state program to combine drug-pricing negotiations to maximize drug rebates. Generic drugs: Provides that the Medicaid pharmaceutical benefit does not include reimbursement for a brand name drug for which a multi-source therapeutically and generically equivalent drug, as determined by the FDA, is available.
However, the Commissioner of Health is allowed to exempt any brand name drug from this restriction. Effective date is April 1, NY S Rules Committee Authorizes the creation of a preferred drug list within Medicaid. Provides that any doctor or prescriber may specify and prescribe a non-preferred drug if they notify the state Department by telephone; such requests cannot be denied. Prescribers " Authorizes negotiation for manufacturer supplemental rebates. NY A Assm. Gottfried S Sen. Hannon NY A Health Sub-comm. Pataki has led to a court suit over the binding effect of the veto actions.
The pharmacy management plan may include the following activities: a Establishing a prior authorization program to manage utilization of high cost brand name drugs; b Limiting prescription drugs to a day supply for some or all drugs and copayments up to the maximum allowed under federal law; c Developing physician prescribing practice profiles; d Establishing therapeutic limits based on appropriate dosage or usage standards; e Encouraging use of generic drugs; f Using "MAC" or maximum allowable pricing; g Contracting with a pharmacy benefits manager; h Studying the impact of eliminating the six prescription drug monthly limit combined with a more rigorous prior authorization program to ensure cost decisions are made based on evidence-based clinical guidelines; i Expanding disease management initiatives; j If cost-effective, expanding Medicaid drug coverage to include selected over-the-counter medications.
Allows for temporary rules to clarify recipient appeal rights related to the pharmacy management plan. States that Medicaid will not require supplemental rebates from pharmaceutical manufacturers. The state also established lower price limits for approximately specified generic drugs. Governor Easley announced that NC Medicaid was establishing a preferred drug list, including an option for supplemental rebates, and use of prior authorization for products not on the list.
The first list was scheduled to be phased in beginning December , but the plan is on hold indefinitely in Establishes a revised medical assistance prospective and retrospective drug use review program and drug prior authorization program. The member board shall review all drugs to be placed on prior authorization, with an annual review of the list required. The Board must "Propose remedial strategies to improve the quality of care and to promote effective use of medical assistance program funds or recipient expenditures.
ND HB Rep. OH SB Sen. Specifies that, at the Medicaid Director's discretion, a supplemental rebate may include cash payments or services that will produce savings. Examples may include disease management, drug product donations, drug utilization control, beneficiary counseling, and fraud and abuse initiatives. Also requires the agency to examine instituting a copayment program, and to seek federal waivers if appropriate. Also creates a non-Medicaid discount card program see Buckeye Card Program. OH H 40 Rep. Provides that any record, data, pricing information, or other information regarding a drug rebate agreement or a supplemental drug rebate agreement for the Medicaid program or the Disability Medical Assistance Program shall remain confidential.
Establishes limits on the expanded use of prior authorization by requiring: a written estimate of savings, a report on paid claims from the most recent month, trends in product use, and a detailed estimate of administrative costs involved in the prior authorization expansion including "anticipated increase in petition volume" and four separate meetings of the DUR Board to consider specified steps before adopting a new requirement. Also authorizes expanded use of disease management. Requires the Oklahoma Health Care Authority to immediately provide coverage under prior authorization for any new drug approved by the United States Food and Drug Administration if the drug falls within a drug class that the Authority has already placed under prior authorization.
OR S Sen. Creates a prescription drug list or formulary for the Oregon Health Plan. Requires Department of Human Services to apply to federal government for waiver to allow copayments. Final version directs the Department of Human Services DHS to adopt a Practitioner-managed Prescription Drug Plan for the Oregon Health Plan to ensure that enrollees "receive the most effective prescription drug available at the best possible price.
Allows a practitioner to prescribe any drug that the practitioner indicates is medically necessary for an enrollee as being the most effective available. OR HB Rep. Department of Human Services shall apply to the Centers for Medicare and Medicaid Services for waivers to obtain federal matching dollars for public subsidies for low-income, working Oregonians for the purpose of making private health insurance more accessible and affordable. Establishes a Waiver Application Steering Committee including four legislators to assist and advise the department.
Exceptions include: pregnant women, children under age 19, institutionalized individuals, services supplied through a federally recognized tribal health facility, patients enrolled in managed care except mental health drugs , emergency services, family planning supplies and mail order drugs. Provider cannot refuse service to a patient due to the patient's inability to pay. However, the co-payment is a legal debt and provider can use any legal means to collect. FY 04 budget eliminates the agency rule calling for prior authorization within the state's preferred drug list program; initiates a polypharmacy review of enrollees with more than 6 prescriptions or evidence of frequent refills; initiates a two-year phase-in of a mail order prescription program for maintenance prescriptions for chronic diseases.
Also establishes a work group to study establishing a program of recycling unused drugs. OR HB Bill restructuring the Oregon Health Plan includes a prohibition on using prior authorization for enforcement of the preferred drug list. Authorizes a benefit "comparable" to the Medicaid pharmacy benefit. Calls for detailed implementation plan if waiver is awarded.
RI H Rep.
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South Carolina applied for a "Pharmacy Plus" waiver to allow for Medicaid reimbursement for part of the state subsidy program. The program includes state-negotiated supplemental rebates. In The Department of Health and Human Services began implementation of the Medicaid Preferred Drug List, including several phases involving an additional set of therapeutic classes to be included on the PDL, building on the existing prior authorization PA program.
Phase I implementation began July 21, The state is also negotiating supplemental rebates with pharmaceutical companies and creating an enhanced prior authorization program for South Carolina Medicaid pharmacy services. Therefore, individual patient consent for substitution as required in S. Law Section H 6 does not apply. The Medicaid agency established a state maximum allowable cost MAC for prescription drugs, including state-specific upper limits. Agency regulations, , TennCare received HHS approval for a comprehensive redesign of the state's Medicaid program, including a new pharmacy-only program for low-income Medicare beneficiaries enrolled as of December 31, , who are not otherwise entitled to Medicaid.
Agency application approved June TN HB Rep. The Rx program requires federal Medicaid approval of a waiver. BeBerry DuBois, Rep. Odom Makes it a criminal offense to divert TennCare prescriptions as well as failure to disclose to a doctor that a person has received a prescription for a controlled substance within 30 days when obtaining another prescription for a controlled substance.
Kyle Would create a system of bulk purchasing of prescription drugs by state agencies, including Dept. Final version includes provisions for manufacturer and wholesaler price reporting and enforcement powers for the Attorney General. The Medicaid program initiated the "Texas Medication Algorithm Project", a type of "step therapy" to bring greater consistency and greater quality to medication treatment of mental health conditions, based on guidelines stating "most efficacious, safest treatment should be used first" and "simpler interventions should proceed more complex ones.
Provides that the state "shall negotiate" with manufacturers and labelers to obtain supplemental rebates for prescription drugs provided under Medicaid CHIP, and any other state program administered by the commission or a health and human services agency, including community mental health centers and state mental health hospitals. Allows for contract with a benefits manager PBM. Establishes a preferred drug list for Medicaid, CHIP, and any other state program" the PDL "may contain only drugs provided by a manufacturer or labeler that reaches an agreement with the commission on supplemental rebates," with some exceptions.
UT S 1 Sen. UT S special Sen.
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