ASSEMBLY ACTION Initial and Date |SENATE ACTION Initial and Date
Adopted Lost | Adopted Lost
Concurred In Not
|Concurred In Not
Receded Not | Receded Not
Amend section 1, page 1, by deleting lines 1 through 3 and inserting:
“Section 1. Chapter 422 of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 12, inclusive, of this act.”.
Amend sec. 2, page 1, line 4, by deleting “this chapter,” and inserting:
“sections 2 to 12, inclusive, of this act,”.
Amend the bill as a whole by deleting sec. 3 and renumbering sec. 4 as sec. 3.
Amend sec. 4, page 1, line 10, by deleting “6” and inserting “7”.
Amend the bill as a whole by deleting sections 5 and 6, renumbering sections 7 and 8 as sections 8 and 9, and adding new sections designated sections 4 through 7, following sec. 4, to read as follows:
“Sec. 4. “Drug Use Review Board” means the Board established pursuant to 42 U.S.C. § 1396r-8(g)(3).
Sec. 5. 1. The Department shall, by regulation, develop a list of preferred prescription drugs to be used for the Medicaid program.
2. The Department shall, by regulation, establish a list of prescription drugs which must be excluded from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs established pursuant to subsection 1. The list established pursuant to this subsection must include, without limitation:
(a) Atypical and typical antipsychotic medications that are prescribed for the treatment of a mental illness of a patient who is receiving services pursuant to Medicaid;
(b) Prescription drugs that are prescribed for the treatment of the human immunodeficiency virus or acquired immunodeficiency syndrome, including, without limitation, protease inhibitors and antiretroviral medications;
(c) Anticonvulsant medications;
(d) Antirejection medications for organ transplants;
(e) Antidiabetic medications;
(f) Antihemophilic medications; and
(g) Any prescription drug which the Committee identifies as appropriate for exclusion from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs.
3. The regulations must provide that the Committee makes the final determination of:
(a) Whether a class of therapeutic prescription drugs is included on the list of preferred prescription drugs and is excluded from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs;
(b) Which therapeutically equivalent prescription drugs will be reviewed for inclusion on the list of preferred prescription drugs and for exclusion from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs; and
(c) Which prescription drugs should be excluded from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs based on continuity of care concerning a specific diagnosis, condition, class of therapeutic prescription drugs or medical specialty.
4. The regulations must provide that each new pharmaceutical product and each existing pharmaceutical product for which there is new clinical evidence supporting its inclusion on the list of preferred prescription drugs must be made available pursuant to the Medicaid program with prior authorization until the Committee reviews the product or the evidence.
Sec. 6. 1. The Department shall, by regulation, establish and manage the use by the Medicaid program of step therapy and prior authorization for prescription drugs.
2. The Drug Use Review Board shall:
(a) Advise the Department concerning the use by the Medicaid program of step therapy and prior authorization for prescription drugs;
(b) Develop step therapy protocols and prior authorization policies and procedures for use by the Medicaid program for prescription drugs; and
(c) Review and approve, based on clinical evidence and best clinical practice guidelines and without consideration of the cost of the prescription drugs being considered, step therapy protocols used by the Medicaid program for prescription drugs.
3. The Department shall not require the Drug Use Review Board to develop, review or approve prior authorization policies or procedures necessary for the operation of the list of preferred prescription drugs developed for the Medicaid program pursuant to section 5 of this act.
4. The Department shall accept recommendations from the Drug Use Review Board as the basis for developing or revising step therapy protocols and prior authorization policies and procedures used by the Medicaid program for prescription drugs.
Sec. 7. 1. The Director shall create a Pharmacy and Therapeutics Committee within the Department. The Committee must consist of at least 9 members and not more than 11 members appointed by the Governor based on recommendations from the Director.
2. The Governor shall appoint to the Committee health care professionals who have knowledge and expertise in one or more of the following:
(a) The clinically appropriate prescribing of outpatient prescription drugs that are covered by Medicaid;
(b) The clinically appropriate dispensing and monitoring of outpatient prescription drugs that are covered by Medicaid;
(c) The review of, evaluation of and intervention in the use of prescription drugs; and
(d) Medical quality assurance.
3. At least one-third of the members of the Committee and not more than 51 percent of the members of the Committee must be active physicians licensed to practice medicine in this state, at least one of whom must be an active psychiatrist licensed to practice medicine in this state. At least one-third of the members of the Committee and not more than 51 percent of the members of the Committee must be either active pharmacists registered in this state or persons in this state with doctoral degrees in pharmacy.
4. A person must not be appointed to the Committee if he is employed by, compensated by in any manner, has a financial interest in, or is otherwise affiliated with a business or corporation that manufactures prescription drugs.”.
Amend the bill as a whole by deleting sections 9 and 10 and adding a new section designated sec. 10, following sec. 8, to read as follows:
“Sec. 10. 1. The Department shall, by regulation, set forth the duties of the Committee which must include, without limitation:
(a) Identifying the prescription drugs which should be included on the list of preferred prescription drugs developed by the Department for the Medicaid program pursuant to section 5 of this act and the prescription drugs which should be excluded from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs;
(b) Identifying classes of therapeutic prescription drugs for its review and performing a clinical analysis of each drug included in each class that is identified for review; and
(c) Reviewing at least annually all classes of therapeutic prescription drugs on the list of preferred prescription drugs developed by the Department for the Medicaid program pursuant to section 5 of this act.
2. The Department shall, by regulation, require the Committee to:
(a) Base its decisions on evidence of clinical efficacy and safety without consideration of the cost of the prescription drugs being considered by the Committee;
(b) Review new pharmaceutical products in as expeditious a manner as possible; and
(c) Consider new clinical evidence supporting the inclusion of an existing pharmaceutical product on the list of preferred prescription drugs developed by the Department for the Medicaid program and new clinical evidence supporting the exclusion of an existing pharmaceutical product from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs in as expeditious a manner as possible.
3. The Department shall, by regulation, authorize the Committee to:
(a) In carrying out its duties, exercise clinical judgment and analyze peer review articles, published studies, and other medical and scientific information; and
(b) Establish subcommittees to analyze specific issues that arise as the Committee carries out its duties.”.
Amend sec. 11, page 4, lines 21 and 22, after “Committee” by inserting:
“and the Drug Use Review Board”.
Amend the bill as a whole by deleting sections 12 through 14 and renumbering sections 15 through 19 as sections 12 through 16.
Amend sec. 15, page 6, by deleting lines 7 through 10 and inserting:
“Sec. 12. 1. The Department may, to carry out its duties set forth in sections 2 to 12, inclusive, of this act and to administer the provisions of sections 2 to 12, inclusive, of this act:
(a) Adopt regulations; and
(b) Enter into contracts for any services.
2. Any regulations adopted by the Department pursuant to sections 2 to 12, inclusive, of this act must be adopted in accordance with the provisions of chapter 241 of NRS.”.
Amend sec. 16, page 6, by deleting line 27 and inserting:
“inclusive, 422.001 to 422.410, inclusive, and sections 2 to 12, inclusive, of this act, 422.580, 432.010 to”.
Amend sec. 16, page 6, by deleting line 29 and inserting:
“445A.055, inclusive, and all”.
Amend sec. 17, page 7, line 24, after “1.” by inserting:
“On or before January 1, 2004, adopt final regulations required to carry out the provisions of this act.
2.”.
Amend sec. 17, page 7, line 27, by deleting “2.” and inserting “3.”.
Amend sec. 17, page 7, line 29, by deleting “1” and inserting “2”.
Amend sec. 18, page 7, by deleting lines 35 through 41 and inserting:
“Committee, so that the terms of the members are staggered, half of the members to serve initial terms of 1 year and the other half of the members to serve initial terms of 2 years.”.
Amend sec. 18, page 7, line 44, after “Therapeutics Committee” by inserting:
“and the Drug Use Review Board”.
Amend sec. 19, page 8, by deleting line 3 and inserting:
“Sec. 16. This act becomes effective upon passage and approval for the purpose of adopting regulations by the Department of Human Resources and on July 1, 2003, for all other purposes.”.
Amend the title of the bill to read as follows:
“AN ACT relating to public welfare; requiring the Department of Human Resources to develop a list of preferred prescription drugs to be used for the Medicaid program; requiring the Department to manage the use by the Medicaid program of step therapy and prior authorization for prescription drugs; creating the Pharmacy and Therapeutics Committee within the Department; and providing other matters properly relating thereto.”.
Amend the summary of the bill to read as follows: