71st OREGON LEGISLATIVE ASSEMBLY--2001 Regular Session
 
HA to HB 2497
 
LC 2238/HB 2497-3
 
                       HOUSE AMENDMENTS TO
                         HOUSE BILL 2497
 
           By COMMITTEE ON HEALTH AND PUBLIC ADVOCACY
 
                             June 1
 
  On page 1 of the printed bill, line 2, after 'ORS' delete the
rest of the line and insert '414.325.'.
  Delete lines 4 through 31 and delete pages 2 through 5 and
insert:
  '  { +  SECTION 1. + } ORS 414.325 is amended to read:
  ' 414.325. (1) As used in this section  { - , - }   { + and
sections 2 and 3 of this 2001 Act:
  ' (a) + } 'Legend drug' means any drug requiring a prescription
by a practitioner  { - , as defined in ORS 689.005 - } .
  '  { +  (b) 'Pharmacy network' means a group of pharmacies
using a shared database or employing other electronic means to
access prescription information of enrollees from multiple points
of service.
  ' (c) 'Practitioner' has the meaning given that term in ORS
689.005. + }
  ' (2) A licensed practitioner may prescribe such drugs under
this chapter as the practitioner in the exercise of professional
judgment considers appropriate for the diagnosis or treatment of
the patient in the practitioner's care and within the scope of
practice. Prescriptions shall be dispensed in the generic form
pursuant to ORS 689.515, 689.854 and 689.857 and pursuant to
rules of the   { - division - }   { + Department of Human
Services + } unless the practitioner prescribes otherwise and an
exception is granted by the   { - division - }  { +
department + }.
  ' (3) Except as provided in subsections (4) and (5) of this
section, the   { - division - }   { + department + } shall place
no limit on the type of legend drug that may be prescribed by a
practitioner, but shall pay only for drugs in the generic form
unless an exception has been granted by the   { - division - }
 { +  department + }.
  ' (4) Notwithstanding subsection (3) of this section, an
exception must be applied for and granted before the
 { - division - }  { +  department + } is required to pay for
minor tranquilizers and amphetamines and amphetamine derivatives,
as defined by rule of the   { - division - }  { +
department + }.
  ' (5)(a) Notwithstanding subsections (1) to (4) of this section
and except as provided in paragraph (b) of this subsection, the
 { - division - }   { + department + } is authorized to:
  ' (A) Withhold payment for a legend drug when federal financial
participation is not available; and
  ' (B) Require prior authorization of payment for drugs which
the   { - division - }   { + department + } has determined should
be limited to those conditions generally recognized as
appropriate by the medical profession.
  ' (b) The   { - division - }   { + department + } may not
require prior authorization for therapeutic classes of
nonsedating antihistamines and nasal inhalers, as defined by rule
by the
  { - division - }  { +  department + }, when prescribed by an
allergist for treatment of any of the following conditions, as
described by the Health Services Commission on the funded portion
of its prioritized list of services:
  ' (A) Asthma;
  ' (B) Sinusitis;
  ' (C) Rhinitis; or
  ' (D) Allergies.
  '  { +  (6) When a practitioner prescribes a legend drug under
this chapter, the practitioner shall write on the prescription:
  ' (a) The condition, the diagnosis code for the condition and
the line number of the condition on the prioritized list of
services covered for payment for which the legend drug is being
prescribed; and
  ' (b) The practitioner's Office of Medical Assistance Programs
provider number.
  ' (7)(a) At the time of enrollment or reenrollment in a
fee-for-service payment system, an enrollee shall designate a
primary pharmacy or pharmacy network to dispense legend drugs
covered by the medical assistance program.
  ' (b) The department shall adopt rules establishing procedures
that allow an enrollee to:
  ' (A) Obtain a legend drug at a pharmacy other than a
designated primary pharmacy or pharmacy network; and
  ' (B) Change a designation of a primary pharmacy or pharmacy
network.
  ' (8) The department may not establish or designate a pharmacy
or pharmacy network as exclusive providers of prescription or
pharmacy services for enrollees.
  ' (9) The department shall adopt rules that:
  ' (a) Establish procedures to ensure that a primary pharmacy or
pharmacy network will receive notice when an enrollee obtains a
legend drug at another pharmacy; and
  ' (b) Allow payment at the point of sale to a pharmacy other
than a primary pharmacy or pharmacy network for a legend drug
obtained by an enrollee as described in subsection (7)(b)(A) of
this section. + }
  '  { +  SECTION 2. + }  { + (1) By January 1, 2002, the Health
Services Commission shall recommend to the Director of Human
Services a schedule of copayments, not to exceed $5, to be
charged to enrollees of the Oregon Health Plan for the purchase
of legend drugs covered under the Oregon Health Plan.
  ' (2) The Department of Human Services shall apply to the
federal Health Care Financing Administration to obtain the
necessary waiver from federal regulations to implement the
schedule of copayments recommended by the Health Services
Commission.
  ' (3) The department shall report to the President of the
Senate, the Speaker of the House of Representatives and the
Legislative Counsel on whether the waiver required under
subsection (2) of this section was obtained.
  ' (4) Section 3 of this 2001 Act becomes operative on the date
of receipt by the department of the necessary waiver from the
federal Health Care Financing Administration. + }
  '  { +  SECTION 3. + }  { + (1) The Department of Human
Services shall adopt by rule a schedule of copayments recommended
by the Health Services Commission for the purchase of legend
drugs by enrollees of the Oregon Health Plan.
  ' (2) The department may waive the requirement of subsection
(1) of this section upon the request of a fully capitated health
plan or a treating practitioner. + }
  '  { +  SECTION 4. + }  { + The Department of Human Services
shall:
  ' (1) Expedite the resolution of rebate disputes between
pharmaceutical manufacturers that participate in the Medicaid
Drug Rebate Program and the department; and
  ' (2) Make significant efforts to adjudicate and collect the
total amount of outstanding balances owed to the department by
pharmaceutical manufacturers for unpaid drug rebates. + }
  '  { +  SECTION 5. + }  { + The Department of Human Services
shall enter into agreements to require manufacturers of generic
drugs prescribed for enrollees of the Oregon Health Plan to
provide rebates of 15.1 percent of the average manufacturer price
for the manufacturer's generic products. The agreements shall
require that if a generic drug manufacturer pays federal rebates
for Medicaid-reimbursed drugs at a level below 15.1 percent, the
manufacturer must provide a supplemental rebate to the department
in the amount necessary to achieve a 15.1 percent rebate
level. + }
  '  { +  SECTION 6. + }  { + (1) As used in this section,
'capitated services' means those services covered under the
Oregon Health Plan that a contractor agrees to provide for a
capitation payment.
  ' (2) The Department of Human Services shall exclude from
capitated services prescription drugs prescribed for family
planning, mental health and chemical dependency, cancer
treatments, AIDS and HIV-related diseases and transplant
antirejection therapies. + }
  '  { +  SECTION 7. The Department of Human Services shall adopt
by rule a maximum allowable cost for a multiple-source
prescription drug that is available from at least three
manufacturers or labelers. + } ' .
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