SB-0832, As Passed House, June 22, 2004

HOUSE SUBSTITUTE FOR

SENATE BILL NO. 832

                                                                             A bill to amend 1939 PA 280, entitled                                             

"The social welfare act,"                                                   

(MCL 400.1 to 400.119b) by adding section 109h.                             

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

1   Sec. 109h.  (1) If the department of community health                       

2   develops a prior authorization process for prescription drugs as            

3   part of the pharmaceutical services offered under the medical               

4   assistance program administered under this act, it shall not                

5   require prior authorization for the following single source brand           

6   name, generic equivalent of a multiple source brand name, or                

7   other prescription drugs:                                                   

8       (a) A central nervous system prescription drug that is                      

9   classified as an anticonvulsant, antidepressant, antipsychotic,             

10  or a noncontrolled substance antianxiety drug in a generally                

11  accepted standard medical reference.                                        

Senate Bill No. 832 (H-2) as amended June 22, 2004

1       (b) A prescription drug that is cross-indicated for a central               

2   nervous system drug exempted under subdivision (a) as documented            

3   in a generally accepted standard medical reference.                         

4       (c) Unless the prescription drug is a controlled substance or               

5   the prescription drug is being prescribed to treat a condition              

6   that is excluded from coverage under this act, a prescription               

7   drug that is recognized in a generally accepted standard medical            

8   reference as effective in the treatment of conditions specified             

9   in the most recent diagnostic and statistical manual of mental              

10  disorders published by the American psychiatric association.  The           

11  department or the department's agent shall not deny a request for           

12  prior authorization of a controlled substance under this                    

13  subdivision unless the department or the department's agent                 

14  determines that the controlled substance or the dosage of the               

15  controlled substance being prescribed is not consistent with its            

16  licensed indications or with generally accepted medical practice            

17  as documented in a standard medical reference.                              

18      (d) A prescription drug that is recognized in a generally                   

19  accepted standard medical reference for the treatment of and is             

20  being prescribed to a patient for the treatment of any of the               

21  following:                                                                  

22                                                                               (i) Human immunodeficiency virus infections or the                                  

23  complications of the human immunodeficiency virus or acquired               

24  immunodeficiency syndrome.                                                  

25      (ii) Cancer.                                                                 

26      (iii) Organ replacement therapy.                                             

27   (iv) Epilepsy or seizure disorder.

[(2) This section does not apply to drugs being provided under a contract between the department and a health maintenance organization.]

Senate Bill NO. 832 (H-2) as amended June 22, 2004

1       [(3)] As used in this section:                                              

2       (a) "Controlled substance" means that term as defined in                    

3   section 7104 of the public health code, 1978 PA 368, MCL                    

4   333.7104.                                                                   

5       (b) "Cross-indicated" means a drug which is used for a                      

6   purpose generally held to be reasonable, appropriate, and within            

7   community standards of practice even though the use is not                  

8   included in the federal food and drug administration's approved             

9   labeled indications for that drug.                                          

10      (c) "Department" means the department of community health.                  

11      (d) "Prescriber" means that term as defined in section 17708                

12  of the public health code, 1978 PA 368, MCL 333.17708.                      

13      (e) "Prescription" or "prescription drug" means that term as                

14  defined in section 17708 of the public health code, 1978 PA 368,            

15  MCL 333.17708.                                                              

16      (f) "Prior authorization" means a process implemented by the                

17  department of community health that conditions, delays, or denies           

18  the delivery of particular pharmaceutical services to medicaid              

19  beneficiaries upon application of predetermined criteria by the             

20  department or the department's agent for those pharmaceutical               

21  services covered by the department on a fee-for-service basis or            

22  pursuant to a contract for those services.  The process may                 

23  require a prescriber to verify with the department or the                   

24  department's agent that the proposed medical use of a                       

25  prescription drug being prescribed for a patient meets the                  

26  predetermined criteria for a prescription drug that is otherwise            

27  covered under this act or require a prescriber to obtain                    

1   authorization from the department or the department's agent                 

2   before prescribing or dispensing a prescription drug that is not            

3   included on a preferred drug list or that is subject to special             

4   access or reimbursement restrictions.