ENGROSSED
Senate Bill No. 693
(By Senators Walker, Prezioso, Sharpe, Boley, Hunter, McCabe,
Redd, Ross, Snyder, Sprouse, Unger and Wooton)
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[Originating in the Committee on Health and Human Resources;
reported March 2, 1999.]
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A BILL to amend article five, chapter nine of the code of West
Virginia, one thousand nine hundred thirty-one, as amended, by
adding thereto a new section, designated section fifteen-a,
relating to the Medicaid program; authorizing the state
Medicaid agency to promulgate a legislative rule setting forth
procedures for requiring prior authorization for any drug or
category of drugs; specifying issues to be addressed in the
rule; defining terms; authorizing the rule to be promulgated
and filed as an emergency rule; and prohibiting the state
Medicaid agency from imposing prior authorization requirements
on a drug or category of drugs until it promulgates the
referenced rule.
Be it enacted by the Legislature of West Virginia:
That article five, chapter nine of the code of West Virginia,
one thousand nine hundred thirty-one, as amended, be amended by
adding thereto a new section, designated section fifteen-a, to read
as follows:
ARTICLE 5. MISCELLANEOUS PROVISIONS.
§9-5-15a. Medicaid program; authorizing rule relating to prior
authorization of prescription drugs; specifying scope of rule;
requiring filing of emergency rule before additional drugs to
be placed on list requiring prior authorization.
(a) On and after the effective date of this section, the state
Medicaid agency may not require that any additional prescription
drug or category of drugs be subject to prior authorization unless
the agency has developed a rule governing requirements for such
prior authorization as provided in this section.
(b) Notwithstanding the provisions of section three, article
one, chapter twenty-nine-a of this code, the state Medicaid agency
shall develop a legislative rule, in accordance with article three,
chapter twenty-nine-a of this code, setting forth the procedure for
imposing a requirement that a drug or category of drugs be subject to a requirement of prior authorization. This rule shall provide,
at a minimum, for the following:
(1) Notice to interested or affected parties that a drug or
category of drugs is being considered for imposition of a prior
authorization requirement;
(2) Opportunity for interested and affected parties to be
heard and present evidence and argument, both written and oral, at
a public hearing, before a drug or category of drugs may be subject
to a requirement for prior authorization;
(3) Issuance of preliminary written findings of fact by the
state Medicaid agency based upon the evidence adduced at the public
hearing conducted pursuant to subdivision (2) of this subsection;
(34) Notice of such preliminary findings of fact to interested
and affected parties;
(45) Opportunity for interested and affected parties to rebut
in writing the preliminary findings of fact issued pursuant to
subdivision (3) of this subsection; and
(56) Issuance of final written findings of fact which include
the effective date, if any, upon which prior authorization of a
drug or category of drugs may be required.
(c) The rule setting forth procedures and governing the
imposition of requirements for prior authorization of a drug or category of drugs authorized by this section may be initially
promulgated and filed as an emergency rule, in accordance with
section fifteen, article three, chapter twenty-nine-a of this code.
(d) As used in this section, the term "interested or affected
party" includes, but is not limited to, Medicaid beneficiaries,
consumers and patients rights groups and advocates, physicians,
pharmacists and pharmaceutical drug manufacturers.
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(NOTE: The purpose of this bill is to authorize the state
Medicaid agency to promulgate a rule setting forth procedures and
requirements for subjecting a drug or category of drugs to
requirements for prior authorization. It also prohibits the agency
from imposing such requirements until the agency promulgates the
rule.
This section is new; therefore, strike-throughs and
underscoring have been omitted.)