Senate Bill No. 617

(By Senator Prezioso)


[Introduced February 17, 2003; referred to the Committee on Health and Human Resources; and then to the Committee on Finance.]


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 preferred drug list; setting forth legislative findings; providing for clinical integrity of the preferred drug list; providing coverage for new prescription drugs; and providing for patient continuity of care.

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:

§9-5-15a. Clinical integrity of preferred drugs; coverage of new prescription drugs; patient continuity of care.

(a) The Legislature finds that public sector programs, such as the state's medicaid program, that use economically motivated preferred drug lists often interfere with the treatment recommendations of doctors, which ultimately increases the costs to the medicaid program by delaying the proper treatment of low-income patients, and jeopardizes the patient's health and well-being. Switching of therapies based on economic motives: (1) Exposes a patient whose care is already well managed to the possibility of new side effects and adverse interactions with coexisting therapies or diseases; (2) requires the physician to carefully observe, test and evaluate the patient who is already well managed during the introduction of a new medication into the treatment protocol or therapy, often at considerable cost and risk to the patient's well being; (3) creates confusion and administrative burdens for patients and families who must accommodate new and different dosing schedules, routes of administration, and interactions with food and other medicines; and (4) is an inappropriate interference with the provider-patient relationship.

(b) A medicaid preferred drug list must adhere to the following requirements:
(1) Decisions of the pharmaceutical and therapeutics committee regarding any limitations imposed on any drug or its use for a specific indication shall be based on sound clinical evidence found in labeling, drug compendia, and peer reviewed clinical literature pertaining to the use of the drug in a relevant population.
(2) A prescription drug which is newly approved by the federal food and drug administration is included on the preferred drug list unless the pharmaceutical and therapeutics committee has met and determined that the drug should be excluded from the preferred drug list.
(3) Any patient who is stabilized on a prescription drug medication previously prescribed by a health care provider, and used by the patient for the treatment of a particular indication, is exempted from any requirements related, directly or indirectly, to the preferred drug list developed and implemented by the secretary pursuant to section fifteen of this article.

NOTE: The purpose of this bill is to maintain the coverage and requirements of the medicaid preferred drug list for patients who are stabilized on a medication.

This section is new; therefore, strike-throughs and underscoring have been omitted.