(Reprinted with amendments adopted on April 21, 2003)

 

Assembly Bill No. 384–Assemblymen Koivisto, McClain, Ohrenschall, Parks, Anderson, Christensen, Claborn, Leslie and Pierce

 

March 17, 2003

____________

 

Referred to Committee on Health and Human Services

 

SUMMARY—Makes various changes concerning provision of prescription drugs by Department of Human Resources. (BDR 38‑775)

 

FISCAL NOTE:  Effect on Local Government: No.

                           Effect on the State: Yes.

 

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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to public welfare; requiring the Department of Human Resources to provide that certain prescription drugs provided by a program administered by the Department must either be on a list of preferred prescription drugs or require prior authorization; creating the Pharmacy and Therapeutics Committee within the Department; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

1-1  Section 1. Title 38 of NRS is hereby amended by adding

1-2  thereto a new chapter to consist of the provisions set forth as

1-3  sections 2 to 15, inclusive, of this act.

1-4  Sec. 2.  As used in this chapter, unless the context otherwise

1-5  requires, the words and terms defined in sections 3 and 4 of this

1-6  act have the meanings ascribed to them in those sections.

1-7  Sec. 3.  “Department” means the Department of Human

1-8  Resources.

1-9  Sec. 4.  “Committee” means the Pharmacy and Therapeutics

1-10  Committee established pursuant to section 6 of this act.

2-1  Sec. 5.  1.  Except as otherwise provided in subsection 2, the

2-2  Department shall include in each program administered by the

2-3  Department that provides prescription drugs a requirement that

2-4  any prescription drug provided by the program must, unless

2-5  exempted by the Department at the recommendation of the

2-6  Committee pursuant to paragraph (e) of subsection 1 of section 9

2-7  of this act, either:

2-8  (a) Be on the list of preferred prescription drugs created

2-9  pursuant to section 12 of this act; or

2-10      (b) Require the person who prescribes the prescription drug to

2-11  obtain prior authorization before the prescription drug may be

2-12  provided.

2-13      2.  The provisions of this section do not apply to:

2-14      (a) Prescription drugs that are prescribed for the treatment of

2-15  a mental illness of a patient who is receiving services pursuant to

2-16  Medicaid other than prescription antidepressant medications or

2-17  prescription antianxiety medications, but including, without

2-18  limitation, prescriptions for atypical and conventional

2-19  antipsychotic medications and anticonvulsant medications; or

2-20      (b) Antiretroviral prescription drugs that are prescribed for a

2-21  patient who is infected with the human immunodeficiency virus

2-22  who is receiving services pursuant to Medicaid.

2-23      3.  As used in this section, “Medicaid” has the meaning

2-24  ascribed to it in NRS 439B.120.

2-25      Sec. 6.  1.  The Pharmacy and Therapeutics Committee,

2-26  consisting of eight members appointed by the Governor, is hereby

2-27  created in the Department.

2-28      2.  The Governor shall appoint to the Committee:

2-29      (a) Four members who are physicians licensed to practice

2-30  medicine in this state, one who must be a psychiatrist licensed to

2-31  practice medicine in this state; and

2-32      (b) Four members who are pharmacists registered in this state,

2-33  one who must have a doctoral degree in pharmacy and be

2-34  employed by a hospital licensed in this state, and one who must

2-35  have a doctoral degree in pharmacy and be employed by a retail

2-36  pharmacy licensed in this state.

2-37      3.  The Governor shall appoint to the Committee persons with

2-38  a broad range of knowledge and expertise in issues concerning

2-39  drug therapy.

2-40      4.  A person must not be appointed to the Committee if he is

2-41  employed by, compensated by in any manner, has a financial

2-42  interest in, or is otherwise affiliated with a business or corporation

2-43  that manufacturers prescription drugs.

2-44      5.  The term of a person appointed to the Committee who fails

2-45  to satisfy the requirements set forth in the paragraph pursuant to

3-1  which he was appointed terminates immediately upon such

3-2  failure.

3-3  Sec. 7.  1.  The Governor shall appoint the Chairman of the

3-4  Committee from among its members.

3-5  2.  After the initial terms, the term of each member of the

3-6  Committee is 2 years. A member may be reappointed.

3-7  3.  A vacancy occurring in the membership of the Committee

3-8  must be filled for the remainder of the unexpired term in the same

3-9  manner as the original appointment.

3-10      4.  The Committee shall meet at least once every 3 months and

3-11  at the times and places specified by a call of the Chairman of the

3-12  Committee.

3-13      5.  A majority of the members of the Committee constitutes a

3-14  quorum for the transaction of business, and the affirmative vote of

3-15  a majority of the members of the Committee is required to take

3-16  action.

3-17      Sec. 8.  1.  Members of the Committee serve without

3-18  compensation, except that a member of the Committee is entitled,

3-19  while engaged in the business of the Committee, to receive the per

3-20  diem allowance and travel expenses provided for state officers and

3-21  employees generally.

3-22      2.  Each member of the Committee who is an officer or

3-23  employee of the State of Nevada or a local government must be

3-24  relieved from his duties without loss of his regular compensation

3-25  so that he may prepare for and attend meetings of the Committee

3-26  and perform any work necessary to carry out the duties of the

3-27  Committee in the most timely manner practicable. A state agency

3-28  or local governmental entity shall not require an officer or

3-29  employee who is a member of the Committee to make up the time

3-30  that he is absent from work to carry out his duties as a member of

3-31  the Committee or to use annual vacation or compensatory time for

3-32  the absence.

3-33      Sec. 9.  1.  The Committee shall:

3-34      (a) Advise the Department on issues relating to the provision

3-35  of prescription drugs by programs administered by the

3-36  Department;

3-37      (b) Recommend guidelines to the Department for prescription

3-38  drugs that are provided by programs administered by the

3-39  Department;

3-40      (c) Identify the prescription drugs which should be included

3-41  on the list of preferred prescription drugs developed by the

3-42  Department pursuant to section 12 of this act;

3-43      (d) Identify classes of therapeutic prescription drugs for its

3-44  review and perform a clinical analysis of each drug included in

3-45  each class that is identified for review; and

4-1  (e) Except as otherwise provided in this section, identify

4-2  prescription drugs which should be exempt from the requirements

4-3  of section 5 of this act because a change of a prescription of a

4-4  patient might be detrimental to the patient.

4-5  2.  In carrying out its duties set forth in subsection 1, the

4-6  Committee may consider the effect that its advice,

4-7  recommendations and decisions may have on persons who receive

4-8  prescription drugs through a program administered by the

4-9  Department.

4-10      Sec. 10.  The Committee may:

4-11      1.  In carrying out its duties, exercise clinical judgment and

4-12  analyze peer review articles, published studies, and other medical

4-13  and scientific information;

4-14      2.  Establish subcommittees to analyze specific issues that

4-15  arise as the Committee carries out its duties;

4-16      3.  Hold hearings in connection with its review and analysis;

4-17  and

4-18      4.  Direct the Department to assist in its research, review and

4-19  analysis.

4-20      Sec. 11.  1.  The Advisory Committee to the Pharmacy and

4-21  Therapeutics Committee consisting of three members is hereby

4-22  created in the Department to advise the Committee concerning

4-23  prescription drugs that are used by seniors, persons who are

4-24  mentally ill or persons with disabilities.

4-25      2.  The Director of the Department shall appoint to the

4-26  Advisory Committee:

4-27      (a) One member appointed from a list of persons provided to

4-28  the Department by the American Association of Retired Persons or

4-29  any successor organization;

4-30      (b) One member appointed from a list of persons provided to

4-31  the Department by the Alliance for the Mentally Ill of Nevada or

4-32  any successor organization; and

4-33      (c) One member appointed from a list of persons provided to

4-34  the Department by the Statewide Independent Living Council

4-35  established in this state pursuant to 29 U.S.C. § 796d.

4-36      3.  The Director shall appoint the Chairman of the Advisory

4-37  Committee from among its members.

4-38      4.  After the initial terms, the term of each member of the

4-39  Advisory Committee is 2 years. A member may be reappointed. A

4-40  vacancy occurring in the membership of the Advisory Committee

4-41  must be filled for the remainder of the unexpired term in the same

4-42  manner as the original appointment.

4-43      5.  Members of the Advisory Committee serve without

4-44  compensation, except that a member of the Advisory Committee is

4-45  entitled, while engaged in the business of the Advisory Committee,

5-1  to receive the per diem allowance and travel expenses provided for

5-2  state officers and employees generally.

5-3  6.  Each member of the Advisory Committee who is an officer

5-4  or employee of the State of Nevada or a local government must be

5-5  relieved from his duties without loss of his regular compensation

5-6  so that he may prepare for and attend meetings of the Advisory

5-7  Committee and perform any work necessary to carry out the duties

5-8  of the Advisory Committee in the most timely manner practicable.

5-9  A state agency or local governmental entity shall not require an

5-10  officer or employee who is a member of the Advisory Committee to

5-11  make up the time that he is absent from work to carry out his

5-12  duties as a member of the Advisory Committee or to use annual

5-13  vacation or compensatory time for the absence.

5-14      Sec. 12.  The Department shall develop a list of preferred

5-15  prescription drugs to be used by each program administered by the

5-16  Department that provides prescription drugs. The list must

5-17  include:

5-18      1.  Prescription drugs identified by the Committee pursuant to

5-19  paragraph (c) of subsection 1 of section 9 of this act;

5-20      2.  Prescription drugs which are prescribed for the treatment

5-21  of the same condition or disease as, but are less expensive than,

5-22  the prescription drugs identified by the Committee pursuant to

5-23  paragraph (c) of subsection 1 of section 9 of this act; and

5-24      3.  Certain prescription drugs which are included in the

5-25  supplemental rebate program operated by the Department

5-26  pursuant to section 13 of this act.

5-27      Sec. 13.  The Department shall:

5-28      1.  Negotiate supplemental rebates with manufacturers of

5-29  prescription drugs, including, without limitation, cash rebates;

5-30      2.  Negotiate other program benefits with manufacturers of

5-31  prescription drugs, including, without limitation, programs for the

5-32  management of disease, programs for the donation of prescription

5-33  drugs, drug utilization control programs, programs to educate and

5-34  counsel prescribers and beneficiaries of prescription drugs, and

5-35  programs for the prevention of fraud and abuse involving

5-36  prescription drugs; and

5-37      3.  Consider the placement of each prescription drug

5-38  manufactured by a manufacturer who agrees to provide a

5-39  supplemental rebate or other program benefit to the Department

5-40  on the list of preferred prescription drugs developed by the

5-41  Department pursuant to section 12 of this act.

5-42      Sec. 14.  The Department shall use any rebates that it

5-43  receives from pharmaceutical manufacturers for drugs purchased

5-44  pursuant to a program administered by the Department in

5-45  accordance with federal law to:

6-1  1.  Offset the costs incurred in providing prescription drugs

6-2  pursuant to the programs administered by the Department which

6-3  provide prescription drugs; or

6-4  2.  Expand the provision of prescription drugs pursuant to the

6-5  programs administered by the Department which provide

6-6  prescription drugs.

6-7  Sec. 15.  The Department may, to carry out its duties set forth

6-8  in this chapter and to administer the provisions of this chapter:

6-9  1.  Adopt regulations; and

6-10      2.  Enter into contracts for any services.

6-11      Sec. 16.  NRS 232.320 is hereby amended to read as follows:

6-12      232.320 1.  Except as otherwise provided in subsection 2, the

6-13  Director:

6-14      (a) Shall appoint, with the consent of the Governor,

6-15  administrators of the divisions of the Department, who are

6-16  respectively designated as follows:

6-17          (1) The Administrator of the Aging Services Division;

6-18          (2) The Administrator of the Health Division;

6-19          (3) The State Welfare Administrator;

6-20          (4) The Administrator of the Division of Child and Family

6-21  Services; and

6-22          (5) The Administrator of the Division of Health Care

6-23  Financing and Policy.

6-24      (b) Shall administer, through the divisions of the Department,

6-25  the provisions of chapters 210, 423, 424, 425, 427A, 432A to 442,

6-26  inclusive, 446 to 450, inclusive, of NRS, NRS 127.220 to 127.310,

6-27  inclusive, 422.001 to 422.410, inclusive, 422.580, 432.010 to

6-28  432.139, inclusive, 444.003 to 444.430, inclusive, and 445A.010 to

6-29  445A.055, inclusive, sections 2 to 15, inclusive, of this act, and all

6-30  other provisions of law relating to the functions of the divisions of

6-31  the Department, but is not responsible for the clinical activities of

6-32  the Health Division or the professional line activities of the other

6-33  divisions.

6-34      (c) Shall, after considering advice from agencies of local

6-35  governments and nonprofit organizations which provide social

6-36  services, adopt a master plan for the provision of human services in

6-37  this state. The Director shall revise the plan biennially and deliver a

6-38  copy of the plan to the Governor and the Legislature at the

6-39  beginning of each regular session. The plan must:

6-40          (1) Identify and assess the plans and programs of the

6-41  Department for the provision of human services, and any

6-42  duplication of those services by federal, state and local agencies;

6-43          (2) Set forth priorities for the provision of those services;

7-1       (3) Provide for communication and the coordination of those

7-2  services among nonprofit organizations, agencies of local

7-3  government, the State and the Federal Government;

7-4       (4) Identify the sources of funding for services provided by

7-5  the Department and the allocation of that funding;

7-6       (5) Set forth sufficient information to assist the Department

7-7  in providing those services and in the planning and budgeting for the

7-8  future provision of those services; and

7-9       (6) Contain any other information necessary for the

7-10  Department to communicate effectively with the Federal

7-11  Government concerning demographic trends, formulas for the

7-12  distribution of federal money and any need for the modification of

7-13  programs administered by the Department.

7-14      (d) May, by regulation, require nonprofit organizations and state

7-15  and local governmental agencies to provide information to him

7-16  regarding the programs of those organizations and agencies,

7-17  excluding detailed information relating to their budgets and payrolls,

7-18  which he deems necessary for his performance of the duties

7-19  imposed upon him pursuant to this section.

7-20      (e) Has such other powers and duties as are provided by law.

7-21      2.  The Governor shall appoint the Administrator of the

7-22  Division of Mental Health and Developmental Services.

7-23      Sec. 17.  The Department of Human Resources shall:

7-24      1.  On or before July 1, 2004, apply to the Federal Government

7-25  to amend the State Plan for Medicaid as necessary to ensure that the

7-26  State Plan for Medicaid is consistent with the provisions of this act.

7-27      2.  Submit a quarterly report concerning its progress toward

7-28  preparing, submitting and obtaining federal approval of the

7-29  amendment described in subsection 1 to the Interim Finance

7-30  Committee and the Legislative Committee on Health Care, until the

7-31  date on which the amendment is approved by the Federal

7-32  Government.

7-33      Sec. 18.  1.  As soon as practicable after July 1, 2003, the

7-34  Governor shall appoint to the Pharmacy and Therapeutics

7-35  Committee:

7-36      (a) Two physicians licensed to practice medicine in this state

7-37  and two pharmacists registered in this state to serve initial terms of 1

7-38  year; and

7-39      (b) Two physicians licensed to practice medicine in this state

7-40  and two pharmacists registered in this state to serve initial terms of 2

7-41  years.

7-42      2.  As soon as practicable after July 1, 2003, the Director of the

7-43  Department of Human Resources shall appoint to the Advisory

7-44  Committee to the Pharmacy and Therapeutics Committee one

8-1  member to serve an initial term of 1 year and two members to serve

8-2  initial terms of 2 years.

8-3  Sec. 19.  This act becomes effective on July 1, 2003.

 

8-4  H