71st OREGON LEGISLATIVE ASSEMBLY--2001 Regular Session
Enrolled
Senate Bill 819
Sponsored by Senator CLARNO; Senators L BEYER, BROWN, BURDICK,
CASTILLO, CORCORAN, DUNCAN, HARTUNG, MESSERLE, METSGER, MINNIS,
Representatives NELSON, NOLAN, C WALKER
CHAPTER ................
AN ACT
Relating to Oregon Health Plan; creating new provisions; amending
ORS 414.325; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + The Legislative Assembly finds that:
(1) The cost of prescription drugs in the Oregon Health Plan is
growing and will soon be unsustainable;
(2) The benefit of prescription drugs when appropriately used
decreases the need for other expensive treatments and improves
the health of Oregonians; and
(3) Providing the most effective drugs in the most
cost-effective manner will benefit both patients and
taxpayers. + }
SECTION 2. { + It is the policy of the State of Oregon that a
Practitioner-managed Prescription Drug Plan will ensure that:
(1) Oregonians have access to the most effective prescription
drugs appropriate for their clinical conditions;
(2) Decisions concerning the clinical effectiveness of
prescription drugs are made by licensed health practitioners, are
informed by the latest peer-reviewed research and consider the
health condition of a patient or characteristics of a patient,
including the patient's gender, race or ethnicity; and
(3) The cost of prescription drugs in the Oregon Health Plan is
managed through market competition among pharmaceutical
manufacturers by publicly considering, first, the effectiveness
of a given drug and, second, its relative cost. + }
SECTION 3. { + (1) The Department of Human Services shall
adopt a Practitioner-managed Prescription Drug Plan for the
Oregon Health Plan. The purpose of the plan is to ensure that
enrollees of the Oregon Health Plan receive the most effective
prescription drug available at the best possible price.
(2) Before adopting the plan, the department shall conduct
public meetings and consult with the Health Resources Commission.
(3) The department shall consult with representatives of the
regulatory boards and associations representing practitioners who
are prescribers under the Oregon Health Plan and ensure that
practitioners receive educational materials and have access to
training on the Practitioner-managed Prescription Drug Plan.
(4) Notwithstanding the Practitioner-managed Prescription Drug
Plan adopted by the department, a practitioner may prescribe any
Enrolled Senate Bill 819 (SB 819-B) Page 1
drug that the practitioner indicates is medically necessary for
an enrollee as being the most effective available.
(5) An enrollee may appeal to the department a decision of a
practitioner or the department to not provide a prescription drug
requested by the enrollee.
(6) This section does not limit the decision of a practitioner
as to the scope and duration of treatment of chronic conditions,
including but not limited to arthritis, diabetes and asthma. + }
SECTION 4. { + The President of the Senate and the Speaker of
the House of Representatives shall designate an appropriate
interim legislative committee or legislative commission to:
(1) Receive regular reports on the development and
implementation of the Practitioner-managed Prescription Drug
Plan;
(2) Review the impact of the implementation of the
Practitioner-managed Prescription Drug Plan, including but not
limited to a review of whether the program realizes any savings,
whether there is an increase in physician and hospital costs for
individuals receiving medical assistance, and whether there is an
impact on the ability of an individual receiving medical
assistance to obtain prescribed drugs; and
(3) Report its findings and recommendations periodically to the
Emergency Board and to the Seventy-second Legislative
Assembly. + }
SECTION 5. ORS 414.325 is amended to read:
414.325. (1) As used in this section, 'legend drug' means any
drug requiring a prescription by a practitioner, as defined 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 shall place no limit on the type of legend
drug that may be prescribed by a practitioner, but - } { + The
department + } shall pay only for drugs in the generic form { +
if the federal Food and Drug Administration has approved a
generic version of a particular brand name drug that is
chemically identical to the brand name drug according to federal
Food and Drug Administration rating standards, + } 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 - } { + the department + }
is authorized to:
{ - (A) - } { + (a) + } Withhold payment for a legend drug
when federal financial participation is not available; and
Enrolled Senate Bill 819 (SB 819-B) Page 2
{ - (B) - } { + (b) + } Require prior authorization of
payment for 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. - }
{ + (6) Notwithstanding subsection (3) of this section, the
department may not limit legend drugs when used as approved by
the federal Food and Drug Administration to treat mental illness,
HIV and AIDS, and cancer. + }
SECTION 5a. { + If House Bill 2497 becomes law, section 5 of
this 2001 Act (amending ORS 414.325) is repealed and ORS 414.325,
as amended by section 1, chapter ___, Oregon Laws 2001 (Enrolled
House Bill 2497), is amended to read: + }
414.325. (1) As used in this section:
(a) 'Legend drug' means any drug requiring a prescription by a
practitioner.
(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 Department of Human Services unless the practitioner
prescribes otherwise and an exception is granted by the
department.
(3) { - Except as provided in subsections (4) and (5) of this
section, the department shall place no limit on the type of
legend drug that may be prescribed by a practitioner, but - }
{ + The department + } shall pay only for drugs in the generic
form { + if the federal Food and Drug Administration has
approved a generic version of a particular brand name drug that
is chemically identical to the brand name drug according to
federal Food and Drug Administration rating standards, + } unless
an exception has been granted by the department.
(4) { - Notwithstanding subsection (3) of this section, - }
An exception must be applied for and granted before the
department is required to pay for minor tranquilizers and
amphetamines and amphetamine derivatives, as defined by rule of
the department.
(5)(a) Notwithstanding subsections (1) to (4) of this section
{ - and except as provided in paragraph (b) of this
subsection - } , the department is authorized to:
Enrolled Senate Bill 819 (SB 819-B) Page 3
(A) Withhold payment for a legend drug when federal financial
participation is not available; and
(B) Require prior authorization of payment for drugs
{ - which - } { + that + } the department has determined
should be limited to those conditions generally recognized as
appropriate by the medical profession.
{ - (b) The department may not require prior authorization
for therapeutic classes of nonsedating antihistamines and nasal
inhalers, as defined by rule by the 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. - }
{ - (c) - } { + (b) + } Notwithstanding subsections (1) to
(4) of this section and { - paragraphs (a) and (b) - } { +
paragraph (a) + } of this subsection, the department may require
prior authorization of payment for drugs for individuals whose
prescription drug use exceeded 15 drugs in the preceding
six-month period.
{ + (6) Notwithstanding subsection (3) of this section, the
department may not limit legend drugs when used as approved by
the federal Food and Drug Administration to treat mental illness,
HIV and AIDS, and cancer. + }
{ - (6) - } { + (7) + } When a practitioner prescribes a
legend drug under this chapter, the practitioner shall write on
the prescription:
(a) The diagnosis code for 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) - } { + (8)(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) - } { + (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) - }
{ + (8)(b)(A) + } of this section.
SECTION 6. ORS 414.325, as amended by section 5 of this 2001
Act, is amended to read:
414.325. (1) As used in this section, 'legend drug' means any
drug requiring a prescription by a practitioner, as defined in
ORS 689.005.
(2) A licensed practitioner may prescribe such drugs under this
chapter as the practitioner in the exercise of professional
Enrolled Senate Bill 819 (SB 819-B) Page 4
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 Department of Human Services unless the practitioner
prescribes otherwise and an exception is granted by the
department.
(3) { + Except as provided in subsections (4) and (5) of this
section, the department shall place no limit on the type of
legend drug that may be prescribed by a practitioner, but + } the
department shall pay only for drugs in the generic form { - if
the federal Food and Drug Administration has approved a generic
version of a particular brand name drug that is chemically
identical to the brand name drug according to federal Food and
Drug Administration rating standards, - } unless an exception
has been granted by the department.
(4) { + Notwithstanding subsection (3) of this section, + } an
exception must be applied for and granted before the department
is required to pay for minor tranquilizers and amphetamines and
amphetamine derivatives, as defined by rule of the department.
(5) { + (a) + } Notwithstanding subsections (1) to (4) of this
section { + and except as provided in paragraph (b) of this
subsection + }, the department is authorized to:
{ - (a) - } { + (A) + } Withhold payment for a legend drug
when federal financial participation is not available; and
{ - (b) - } { + (B) + } Require prior authorization of
payment for drugs that the department has determined should be
limited to those conditions generally recognized as appropriate
by the medical profession.
{ + (b) The department may not require prior authorization
for therapeutic classes of nonsedating antihistamines and nasal
inhalers, as defined by rule by the 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) Notwithstanding subsection (3) of this section, the
department may not limit legend drugs when used as approved by
the federal Food and Drug Administration as the primary treatment
for mental illness, HIV and AIDS and cancer. - }
SECTION 6a. { + If House Bill 2497 becomes law, section 6 of
this 2001 Act (amending ORS 414.325) is repealed and ORS 414.325,
as amended by section 5a of this 2001 Act, is amended to
read: + }
414.325. (1) As used in this section:
(a) 'Legend drug' means any drug requiring a prescription by a
practitioner.
(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
Enrolled Senate Bill 819 (SB 819-B) Page 5
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 Department of Human Services unless the practitioner
prescribes otherwise and an exception is granted by the
department.
(3) { + Except as provided in subsections (4) and (5) of this
section, the department shall place no limit on the type of
legend drug that may be prescribed by a practitioner, but + } the
department shall pay only for drugs in the generic form { - if
the federal Food and Drug Administration has approved a generic
version of a particular brand name drug that is chemically
identical to the brand name drug according to federal Food and
Drug Administration rating standards, - } unless an exception
has been granted by the department.
(4) { + Notwithstanding subsection (3) of this section, + } an
exception must be applied for and granted before the department
is required to pay for minor tranquilizers and amphetamines and
amphetamine derivatives, as defined by rule of the department.
(5)(a) Notwithstanding subsections (1) to (4) of this section
{ + and except as provided in paragraph (b) of this
subsection + }, the 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 that the
department has determined should be limited to those conditions
generally recognized as appropriate by the medical profession.
{ + (b) The department may not require prior authorization
for therapeutic classes of nonsedating antihistamines and nasal
inhalers, as defined by rule by the 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. + }
{ - (b) - } { + (c) + } Notwithstanding subsections (1) to
(4) of this section and { - paragraph (a) - } { + paragraphs
(a) and (b) + } of this subsection, the department may require
prior authorization of payment for drugs for individuals whose
prescription drug use exceeded 15 drugs in the preceding
six-month period.
{ - (6) Notwithstanding subsection (3) of this section, the
department may not limit legend drugs when used as approved by
the federal Food and Drug Administration to treat mental illness,
HIV and AIDS, and cancer. - }
{ - (7) - } { + (6) + } When a practitioner prescribes a
legend drug under this chapter, the practitioner shall write on
the prescription:
(a) The diagnosis code for 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.
{ - (8)(a) - } { + (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:
Enrolled Senate Bill 819 (SB 819-B) Page 6
(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.
{ - (9) - } { + (8) + } 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 { - (8)(b)(A) - }
{ + (7)(b)(A) + } of this section.
SECTION 7. { + The amendments to ORS 414.325 by section 6 of
this 2001 Act become operative on January 2, 2007. + }
SECTION 7a. If House Bill 2497 becomes law, section 7 of this
2001 Act is amended to read:
{ + Sec. 7. + } The amendments to ORS 414.325 by section
{ - 6 - } { + 6a + } of this 2001 Act become operative on
January 2, 2007.
SECTION 8. { + 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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Passed by Senate July 6, 2001
...........................................................
Secretary of Senate
...........................................................
President of Senate
Passed by House July 7, 2001
...........................................................
Speaker of House
Enrolled Senate Bill 819 (SB 819-B) Page 7
Received by Governor:
......M.,............., 2001
Approved:
......M.,............., 2001
...........................................................
Governor
Filed in Office of Secretary of State:
......M.,............., 2001
...........................................................
Secretary of State
Enrolled Senate Bill 819 (SB 819-B) Page 8