AB384_R2

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

CHAPTER..........

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.

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

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.

Sec. 2. As used in sections 2 to 12, inclusive, of this act,

unless the context otherwise requires, the words and terms defined

in sections 3 and 4 of this act have the meanings ascribed to them

in those sections.

Sec. 3. “Committee” means the Pharmacy and Therapeutics

Committee established pursuant to section 7 of this act.

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;

(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

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

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;

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.

Sec. 8. 1. The Governor shall appoint the Chairman of the

Committee from among its members.

2. After the initial terms, the term of each member of the

Committee is 2 years. A member may be reappointed.

3. A vacancy occurring in the membership of the Committee

must be filled for the remainder of the unexpired term in the same

manner as the original appointment.

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

at the times and places specified by a call of the Chairman of the

Committee.

5. A majority of the members of the Committee constitutes a

quorum for the transaction of business, and the affirmative vote of

a majority of the members of the Committee is required to take

action.

Sec. 9. 1. Members of the Committee serve without

compensation, except that a member of the Committee is entitled,

while engaged in the business of the Committee, to receive the per

diem allowance and travel expenses provided for state officers and

employees generally.

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

employee of the State of Nevada or a local government must be

relieved from his duties without loss of his regular compensation

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

and perform any work necessary to carry out the duties of the

Committee in the most timely manner practicable. A state agency

or local governmental entity shall not require an officer or

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

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

the Committee or to use annual vacation or compensatory time for

the absence.

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

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

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.

Sec. 11. 1. The Advisory Committee to the Pharmacy and

Therapeutics Committee and the Drug Use Review Board

consisting of three members is hereby created in the Department

to advise the Committee and the Drug Use Review Board

concerning prescription drugs that are used by seniors, persons

who are mentally ill or persons with disabilities.

2. The Director of the Department shall appoint to the

Advisory Committee:

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

the Department by the American Association of Retired Persons or

any successor organization;

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

the Department by the Alliance for the Mentally Ill of Nevada or

any successor organization; and

the Department by the Statewide Independent Living Council

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

3. The Director shall appoint the Chairman of the Advisory

Committee from among its members.

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

Advisory Committee is 2 years. A member may be reappointed. A

vacancy occurring in the membership of the Advisory Committee

must be filled for the remainder of the unexpired term in the same

manner as the original appointment.

5. Members of the Advisory Committee serve without

compensation, except that a member of the Advisory Committee is

entitled, while engaged in the business of the Advisory Committee,

to receive the per diem allowance and travel expenses provided for

state officers and employees generally.

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

or employee of the State of Nevada or a local government must be

relieved from his duties without loss of his regular compensation

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

Committee and perform any work necessary to carry out the duties

of the Advisory Committee in the most timely manner practicable.

A state agency or local governmental entity shall not require an

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

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

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

vacation or compensatory time for the absence.

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.

Sec. 13. NRS 232.320 is hereby amended to read as follows:

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

Director:

(a) Shall appoint, with the consent of the Governor,

administrators of the divisions of the Department, who are

respectively designated as follows:

(1) The Administrator of the Aging Services Division;

(2) The Administrator of the Health Division;

(3) The State Welfare Administrator;

(4) The Administrator of the Division of Child and Family

Services; and

(5) The Administrator of the Division of Health Care

Financing and Policy.

(b) Shall administer, through the divisions of the Department,

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

inclusive, 446 to 450, inclusive, of NRS, NRS 127.220 to 127.310,

inclusive, 422.001 to 422.410, inclusive, and sections 2 to

12, inclusive, of this act, 422.580, 432.010 to 432.139, inclusive,

444.003 to 444.430, inclusive, and 445A.010 to 445A.055,

inclusive, and all other provisions of law relating to the functions of

the divisions of the Department, but is not responsible for the

clinical activities of the Health Division or the professional line

activities of the other divisions.

governments and nonprofit organizations which provide social

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

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

copy of the plan to the Governor and the Legislature at the

beginning of each regular session. The plan must:

(1) Identify and assess the plans and programs of the

Department for the provision of human services, and any

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

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

(3) Provide for communication and the coordination of those

services among nonprofit organizations, agencies of local

government, the State and the Federal Government;

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

the Department and the allocation of that funding;

(5) Set forth sufficient information to assist the Department

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

future provision of those services; and

(6) Contain any other information necessary for the

Department to communicate effectively with the Federal

Government concerning demographic trends, formulas for the

distribution of federal money and any need for the modification of

programs administered by the Department.

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

and local governmental agencies to provide information to him

regarding the programs of those organizations and agencies,

excluding detailed information relating to their budgets and payrolls,

which he deems necessary for his performance of the duties

imposed upon him pursuant to this section.

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

2. The Governor shall appoint the Administrator of the

Division of Mental Health and Developmental Services.

Sec. 14. The Department of Human Resources shall:

1. On or before January 1, 2004, adopt final regulations

required to carry out the provisions of this act.

2. On or before July 1, 2004, apply to the Federal Government

to amend the State Plan for Medicaid as necessary to ensure that the

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

3. Submit a quarterly report concerning its progress toward

preparing, submitting and obtaining federal approval of the

amendment described in subsection 2 to the Interim Finance

Committee and the Legislative Committee on Health Care, until the

date on which the amendment is approved by the Federal

Government.

Sec. 15. 1. As soon as practicable after July 1, 2003, the

Governor shall appoint to the Pharmacy and Therapeutics

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.

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

Department of Human Resources shall appoint to the Advisory

Committee to the Pharmacy and Therapeutics Committee and the

Drug Use Review Board one member to serve an initial term of 1

year and two members to serve initial terms of 2 years.

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.

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