71st OREGON LEGISLATIVE ASSEMBLY--2001 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 4104
House Bill 3300
Sponsored by Representative BATES; Representatives BARNHART,
HASS, JOHNSON, KAFOURY, MERKLEY, MONNES ANDERSON, MORRISETTE,
NOLAN, RINGO, ROSENBAUM, TOMEI, WIRTH, Senators CLARNO,
CORCORAN
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
Directs Health Resources Commission to develop limited
prescription drug formulary for medical assistance program.
Modifies requirements for prescription and payment of
prescription drugs for medical assistance program.
Declares emergency, effective on passage.
A BILL FOR AN ACT
Relating to prescription drugs for individuals receiving medical
assistance; creating new provisions; amending ORS 414.325 and
442.580; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 414.325 is amended to read:
414.325. (1) As used in this section { - , - } { + : + }
{ + (a) 'Practitioner' has the meaning given that term in ORS
689.005.
(b) + } { - ' legend drug' means any drug requiring a
prescription by a practitioner, as defined in ORS 689.005. - }
{ + ' Prescription drug' has the meaning given that term in ORS
689.005. + }
(2) A { - licensed - } practitioner may prescribe
{ - such - } { + prescription + } 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 unless the practitioner
prescribes otherwise and an exception is granted by the
division - } { + Department of Human Services + }.
{ - (3) Except as provided in subsections (4) and (5) of this
section, the division 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. - }
{ - (4) - } { + (3) + } { - 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) - } { + (4) + } { - Notwithstanding
subsections (1) to (4) of this section and except as provided in
paragraph (b) of this subsection, the division is authorized
to - } { + The department may + }:
{ - (A) - } { + (a) + } Withhold payment for a
{ - legend - } { + prescription + } drug when federal
financial participation is not available; and
{ - (B) - } { + (b) Notwithstanding section 4 of this 2001
Act, + } require prior authorization of payment for { +
prescription + } drugs { - which - } { + that + } the
{ - division - } { + department + } has determined should be
limited to those conditions generally recognized as appropriate
by the medical profession.
{ - (b) The division may not require prior authorization for
therapeutic classes of nonsedating antihistamines and nasal
inhalers, as defined by rule by the division, 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. - }
SECTION 2. ORS 442.580 is amended to read:
442.580. (1) There is created the Health Resources Commission,
consisting of nine members { + appointed by the Governor as
follows: + } { - . - }
{ - (2) The Health Resources Commission shall be appointed by
the Governor and shall consist of the following: - }
{ + (a) Seven members who have experience in the evaluation
of medical technologies and clinical outcomes, including: + }
{ - (a) - } { + (A) + } Four physicians, one of whom
{ - engages in family practice - } { + is trained in public
health services + }, and each of whom
{ - shall be - } { + is + } licensed to practice in this
state { - and experienced in health research and the evaluation
of medical technologies and clinical outcomes - } ;
{ - (b) - } { + (B) + } One representative of hospitals;
{ - (c) - } { + (C) + } One { - insurance industry
representative; - } { + health services researcher; and + }
{ - (d) - } { + (D) + } One { - business
representative; - } { + pharmacist who is licensed to practice
in this state; and
(b) Two members who are knowledgeable in health care and
research issues, including: + }
{ - (e) - } { + (A) + } One representative of labor
organizations; and
{ - (f) - } { + (B) + } One consumer representative.
{ + (2) In making appointments to the commission, the
Governor shall consult with professional and other interested
organizations. + }
(3) The term of office of each member is three years. Each
member serves at the pleasure of the Governor. Before the
expiration of the term of a member, the Governor shall appoint a
successor whose term begins on July 1 next following. A member is
eligible for reappointment. If there is a vacancy for any cause,
the Governor shall make an appointment to become immediately
effective for the unexpired term.
(4) { - The consumer representative on - } { + Members of
+ }the commission shall be entitled to compensation and expenses
as provided in ORS 292.495. { - The other members shall not be
entitled to compensation or expenses. - }
SECTION 3. { + Notwithstanding the term of office of a Health
Resources Commission member specified in ORS 442.580, of the nine
commission members appointed after July 1, 2001:
(1) Four members shall serve for terms ending July 1, 2003; and
(2) Five members shall serve for terms ending July 1, 2004. + }
SECTION 4. { + (1) By January 1, 2002, and every six months
thereafter, the Health Resources Commission shall recommend to
the Department of Human Services and the Governor:
(a) A prescription drug formulary for certain specific groups
of drugs; and
(b) A procedure for obtaining an exception to the formulary as
described in subsection (3) of this section.
(2)(a) The commission shall recommend a prescription drug
formulary based on the selection of a reference drug for a
selected group of drugs. The formulary shall include all drugs in
the same group that the commission determines are effective for
initial treatment and that may be purchased for the same or a
lower price than the reference drug.
(b) As used in this subsection:
(A) 'Peer-reviewed medical literature' has the meaning given
that term in ORS 743.695.
(B) 'Peer-reviewed pharmacy literature' means scientific
studies printed in journals or other publications that publish
original manuscripts only after the manuscripts have been
critically reviewed by unbiased independent experts for
scientific accuracy, validity and reliability. 'Peer-reviewed
pharmacy literature' does not include internal publications of
pharmaceutical manufacturers.
(C) 'Reference drug' means the drug in a group of drugs that,
after a review of peer-reviewed medical literature or
peer-reviewed pharmacy literature, the commission determines is
as effective as other drugs for initial treatment and is as
cost-effective as other drugs in the group.
(3) The commission shall recommend a procedure for obtaining an
exception to the prescription drug formulary recommended under
subsection (1) of this section. The procedure recommended by the
commission must contain a provision that an exception shall be
granted and preauthorization or other conditions may not be
imposed if a treating physician or a pharmacist, with the
concurrence of the treating physician, requests an exception to
the formulary for one of the following reasons:
(a) A formulary drug is contraindicated because of experienced
or anticipated interaction with another medication a patient is
taking;
(b) A formulary drug is contraindicated because of a health
condition of a patient;
(c) A formulary drug has been tried and has failed to produce
the desired outcome;
(d) A formulary drug has been tried and has had unacceptable
side effects;
(e) A patient has been stabilized on a medication and a
transition to a formulary drug would be unacceptably disruptive
or risky; or
(f) A patient cannot manage the method or frequency of
administration of a formulary drug.
(4) The Drug Use Review Board shall advise the commission in
the development of the prescription drug formulary. + }
SECTION 5. { + (1) The Department of Human Services shall
adopt by rule the prescription drug formulary recommended by the
Health Resources Commission under section 4 of this 2001 Act for
certain groups of drugs prescribed for individuals receiving
medical assistance under ORS chapter 414 not later than 90 days
after receipt of each recommendation of the commission.
(2) The rules adopted by the department under subsection (1) of
this section must include the procedures recommended by the
commission and circumstances under which a practitioner, as
defined in ORS 689.005, may make an exception to the list of
prescription drugs covered by the formulary.
(3) Notwithstanding section 4 of this 2001 Act, the
prescription drug formulary does not apply to inpatient hospital
services or fully capitated health plans. + }
SECTION 6. { + (1) The Department of Human Services shall
apply to the federal Health Care Financing Administration to
obtain the necessary waiver from federal regulations in order to
require a copayment for the purchase of a prescription drug for
which an exception to the prescription drug formulary has not
been granted.
(2) The Department of Human Services shall report to the
Seventy-second Legislative Assembly on whether the waiver
requested under subsection (1) of this section was obtained.
(3) Upon receipt of the waiver, the Department of Human
Services shall adopt by rule a copayment that is equal to the
difference in cost between the reference drug as defined in
section 4 of this 2001 Act and the nonformulary drug for which an
exception has not been granted. + }
SECTION 7. { + The amendments to ORS 414.325 by section 1 of
this 2001 Act become operative on April 1, 2002. + }
SECTION 8. { + Section 6 of this 2001 Act becomes operative
upon receipt by the Department of Human Services of the necessary
waiver from the federal Health Care Financing Administration. + }
SECTION 9. { + The Health Resources Commission may seek public
and private funds to assist the work of the commission. + }
SECTION 10. { + The Health Resources Commission shall report
to the Seventy-third Legislative Assembly in the manner provided
by ORS 192.245 on the development and implementation of a
prescription drug formulary for the medical assistance program
under ORS chapter 414. + }
SECTION 11. { + This 2001 Act being necessary for the
immediate preservation of the public peace, health and safety, an
emergency is declared to exist, and this 2001 Act takes effect on
its passage. + }
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