75th OREGON LEGISLATIVE ASSEMBLY--2009 Regular Session
Enrolled
House Bill 2126
Ordered printed by the Speaker pursuant to House Rule 12.00A (5).
Presession filed (at the request of Governor Theodore R.
Kulongoski for Department of Human Services)
CHAPTER ................
AN ACT
Relating to Department of Human Services program changes caused
by budget reductions; creating new provisions; amending ORS
414.325, 414.334 and 414.735 and section 2, chapter ___, Oregon
Laws 2009 (Enrolled Senate Bill 876); repealing ORS 414.336 and
section 300, chapter ___, Oregon Laws 2009 (Enrolled House Bill
2009); 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) + } '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 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 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. - }
{ + (b) 'Mental health drug' means a type of legend drug
defined by the Department of Human Services by rule that
includes, but is not limited to:
(A) Therapeutic class 7 ataractics-tranquilizers; and
(B) Therapeutic class 11 psychostimulants-antidepressants.
(c) 'Urgent medical condition' means a medical condition that
arises suddenly, is not life-threatening and requires prompt
treatment to avoid the development of more serious medical
problems.
Enrolled House Bill 2126 (HB 2126-A) Page 1
(2) The department shall reimburse the cost of a legend drug
prescribed for a recipient of medical assistance only if the
legend drug:
(a) Is on the drug list of the Practitioner-Managed
Prescription Drug Plan adopted under ORS 414.334;
(b) Is in a therapeutic class of nonsedating antihistamines and
nasal inhalers, as defined by the department by rule, and is
prescribed by an allergist for the treatment of:
(A) Asthma;
(B) Sinusitis;
(C) Rhinitis; or
(D) Allergies; or
(c) Is prescribed and dispensed under this chapter by a
licensed practitioner at a rural health clinic for an urgent
medical condition and:
(A) There is no pharmacy within 15 miles of the clinic;
(B) The prescription is dispensed for a patient outside of the
normal business hours of any pharmacy within 15 miles of the
clinic; or
(C) No pharmacy within 15 miles of the clinic dispenses legend
drugs under this chapter.
(3) The department shall pay only for drugs in the generic form
unless an exception has been granted by the department through
the prior authorization process adopted by the department under
subsection (4) of this section.
(4) Notwithstanding subsection (2) of this section, the
department shall provide reimbursement for a legend drug that
does not meet the criteria in subsection (2) of this section if:
(a) It is a mental health drug.
(b) The department grants approval through a prior
authorization process adopted by the department by rule.
(c) The prescriber contacts the department requesting prior
authorization and the department or its agent fails to respond to
the telephone call or to a prescriber's request made by
electronic mail within 24 hours.
(d) After consultation with the department or its agent, the
prescriber, in the prescriber's professional judgment, determines
that the drug is medically appropriate.
(e) The original prescription was written prior to the
effective date of this 2009 Act or the request is for a refill of
a prescription for:
(A) The treatment of seizures, cancer, HIV or AIDS; or
(B) An immunosuppressant.
(f) It is a drug in a class not evaluated for the
Practitioner-Managed Prescription Drug Plan adopted under ORS
414.334. + }
(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 { - . - } { + ; and
(c) Withhold payment for a legend drug that is not a funded
health service on the prioritized list of health services
established by the Health Services Commission under ORS
414.720. + }
Enrolled House Bill 2126 (HB 2126-A) Page 2
{ - (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)(a) The department shall pay a rural health clinic for
a legend drug prescribed and dispensed under this chapter by a
licensed practitioner at the rural health clinic for an urgent
medical condition if: - }
{ - (A) There is not a pharmacy within 15 miles of the
clinic; - }
{ - (B) The prescription is dispensed for a patient outside
of the normal business hours of any pharmacy within 15 miles of
the clinic; or - }
{ - (C) No pharmacy within 15 miles of the clinic dispenses
legend drugs under this chapter. - }
{ - (b) As used in this subsection, 'urgent medical condition
' means a medical condition that arises suddenly, is not
life-threatening and requires prompt treatment to avoid the
development of more serious medical problems. - }
{ - (7) - } { + (6) + } Notwithstanding ORS 414.334, the
department may conduct prospective drug utilization review prior
to payment for drugs for a patient whose prescription drug use
exceeded 15 drugs in the preceding six-month period.
{ - (8) - } { + (7) + } Notwithstanding subsection (3) of
this section, the department may pay a pharmacy for a particular
brand name drug rather than the generic version of the drug after
notifying the pharmacy that the cost of the particular brand name
drug, after receiving discounted prices and rebates, is equal to
or less than the cost of the generic version of the drug.
{ + (8) The department shall appoint an advisory committee in
accordance with ORS 183.333 for any rulemaking conducted pursuant
to this section. + }
SECTION 2. { + If House Bill 2009, House Bill 2129 and Senate
Bill 876 all become law, section 1 of this 2009 Act (amending ORS
414.325) is repealed and ORS 414.325, as amended by section 1,
chapter ___, Oregon Laws 2009 (Enrolled Senate Bill 876), and
section 35, chapter ___, Oregon Laws 2009 (Enrolled House Bill
2129), is amended to read: + }
414.325. (1) As used in this section { - , - } { + :
(a) + } '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 and pursuant to rules of the
Oregon Health Authority unless the practitioner prescribes
otherwise and an exception is granted by the authority. - }
{ - (3) Except as provided in subsections (4) and (5) of this
section, the authority shall place no limit on the type of legend
drug that may be prescribed by a practitioner, but the authority
shall pay only for drugs in the generic form unless an exception
has been granted by the authority. - }
Enrolled House Bill 2126 (HB 2126-A) Page 3
{ - (4) Notwithstanding subsection (3) of this section, an
exception must be applied for and granted before the authority is
required to pay for minor tranquilizers and amphetamines and
amphetamine derivatives, as defined by rule of the authority. - }
{ + (b) 'Mental health drug' means a type of legend drug
defined by the Oregon Health Authority by rule that includes, but
is not limited to:
(A) Therapeutic class 7 ataractics-tranquilizers; and
(B) Therapeutic class 11 psychostimulants-antidepressants.
(c) 'Urgent medical condition' means a medical condition that
arises suddenly, is not life-threatening and requires prompt
treatment to avoid the development of more serious medical
problems.
(2) The authority shall reimburse the cost of a legend drug
prescribed for a recipient of medical assistance only if the
legend drug:
(a) Is on the drug list of the Practitioner-Managed
Prescription Drug Plan adopted under ORS 414.334;
(b) Is in a therapeutic class of nonsedating antihistamines and
nasal inhalers, as defined by the authority by rule, and is
prescribed by an allergist for the treatment of:
(A) Asthma;
(B) Sinusitis;
(C) Rhinitis; or
(D) Allergies; or
(c) Is prescribed and dispensed under this chapter by a
licensed practitioner at a rural health clinic for an urgent
medical condition and:
(A) There is no pharmacy within 15 miles of the clinic;
(B) The prescription is dispensed for a patient outside of the
normal business hours of any pharmacy within 15 miles of the
clinic; or
(C) No pharmacy within 15 miles of the clinic dispenses legend
drugs under this chapter.
(3) The authority shall pay only for drugs in the generic form
unless an exception has been granted by the authority through the
prior authorization process adopted by the authority under
subsection (4) of this section.
(4) Notwithstanding subsection (2) of this section, the
authority shall provide reimbursement for a legend drug that does
not meet the criteria in subsection (2) of this section if:
(a) It is a mental health drug.
(b) The authority grants approval through a prior authorization
process adopted by the authority by rule.
(c) The prescriber contacts the authority requesting prior
authorization and the authority or its agent fails to respond to
the telephone call or to a prescriber's request made by
electronic mail within 24 hours.
(d) After consultation with the authority or its agent, the
prescriber, in the prescriber's professional judgment, determines
that the drug is medically appropriate.
(e) The original prescription was written prior to the
effective date of this 2009 Act or the request is for a refill of
a prescription for:
(A) The treatment of seizures, cancer, HIV or AIDS; or
(B) An immunosuppressant.
(f) It is a drug in a class not evaluated for the
Practitioner-Managed Prescription Drug Plan adopted under ORS
414.334. + }
Enrolled House Bill 2126 (HB 2126-A) Page 4
(5) { - (a) - } Notwithstanding subsections (1) to (4) of
this section { - and except as provided in paragraph (b) of
this subsection - } , the authority 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 authority has determined should be
limited to those conditions generally recognized as appropriate
by the medical profession { - . - } { + ; and
(c) Withhold payment for a legend drug that is not a funded
health service on the prioritized list of health services
established by the Health Services Commission under ORS
414.720. + }
{ - (b) The authority may not require prior authorization for
therapeutic classes of nonsedating antihistamines and nasal
inhalers, as defined by rule by the authority, 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)(a) The authority shall pay a rural health clinic for
a legend drug prescribed and dispensed under this chapter by a
licensed practitioner at the rural health clinic for an urgent
medical condition if: - }
{ - (A) There is not a pharmacy within 15 miles of the
clinic; - }
{ - (B) The prescription is dispensed for a patient outside
of the normal business hours of any pharmacy within 15 miles of
the clinic; or - }
{ - (C) No pharmacy within 15 miles of the clinic dispenses
legend drugs under this chapter. - }
{ - (b) As used in this subsection, 'urgent medical condition
' means a medical condition that arises suddenly, is not
life-threatening and requires prompt treatment to avoid the
development of more serious medical problems. - }
{ - (7) - } { + (6) + } Notwithstanding ORS 414.334, the
authority may conduct prospective drug utilization review prior
to payment for drugs for a patient whose prescription drug use
exceeded 15 drugs in the preceding six-month period.
{ - (8) - } { + (7) + } Notwithstanding subsection (3) of
this section, the authority may pay a pharmacy for a particular
brand name drug rather than the generic version of the drug after
notifying the pharmacy that the cost of the particular brand name
drug, after receiving discounted prices and rebates, is equal to
or less than the cost of the generic version of the drug.
{ - (9)(a) - } { + (8)(a) + } Within 180 days after the
United States patent expires on an immunosuppressant drug used in
connection with an organ transplant, the authority shall
determine whether the drug is a narrow therapeutic index drug.
(b) As used in this subsection, 'narrow therapeutic index drug'
means a drug that has a narrow range in blood concentrations
between efficacy and toxicity and requires therapeutic drug
concentration or pharmacodynamic monitoring.
{ + (9) The authority shall appoint an advisory committee in
accordance with ORS 183.333 for any rulemaking conducted pursuant
to this section. + }
Enrolled House Bill 2126 (HB 2126-A) Page 5
SECTION 3. ORS 414.334 is amended to read:
414.334. (1) The Department of Human Services shall adopt a
Practitioner-Managed Prescription Drug Plan for the { - Oregon
Health Plan - } { + medical assistance program + }. The purpose
of the plan is to ensure that enrollees of the { - Oregon
Health Plan - } { + medical assistance program + } 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 - } { +
medical assistance program + } 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 drug that the practitioner indicates is medically necessary
for an enrollee as being the most effective available. - }
{ - (5) - } { + (4) + } 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) - } { + (5) + } 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. { + If House Bill 2009 becomes law, section 3 of
this 2009 Act (amending ORS 414.334) is repealed and ORS 414.334,
as amended by section 299, chapter ___, Oregon Laws 2009
(Enrolled House Bill 2009), is amended to read: + }
414.334. (1) The Oregon Health Authority shall adopt a
Practitioner-Managed Prescription Drug Plan for the medical
assistance program. The purpose of the plan is to ensure that
enrollees of the medical assistance program receive the most
effective prescription drug available at the best possible price.
(2) Before adopting the plan, the authority shall conduct
public meetings and consult with the Health Resources Commission.
(3) The authority shall consult with representatives of the
regulatory boards and associations representing practitioners who
are prescribers under the medical assistance program 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 authority, a practitioner may prescribe
any drug that the practitioner indicates is medically necessary
for an enrollee as being the most effective available. - }
{ - (5) - } { + (4) + } An enrollee may appeal to the
authority a decision of a practitioner or the authority to not
provide a prescription drug requested by the enrollee.
{ - (6) - } { + (5) + } 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 5. { + The Department of Human Services shall report
to the health related committees and the Joint Committee on Ways
and Means of the Seventy-sixth Legislative Assembly on the
implementation and effectiveness of the amendments to ORS 414.325
and 414.334 by sections 1 and 3 of this 2009 Act. + }
Enrolled House Bill 2126 (HB 2126-A) Page 6
SECTION 6. If House Bill 2009, House Bill 2129 and Senate Bill
876 all become law, section 5 of this 2009 Act is amended to
read:
{ + Sec. 5. + } The { - Department of Human Services - }
{ + Oregon Health Authority + } shall report to the health
related committees and the Joint Committee on Ways and Means of
the Seventy-sixth Legislative Assembly on the implementation and
effectiveness of the amendments to ORS 414.325 and 414.334 by
sections { - 1 and 3 - } { + 2 and 4 + } of this 2009 Act.
SECTION 7. ORS 414.325, as amended by section 1 of this 2009
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, as defined in ORS 689.005.
{ - (b) 'Mental health drug' means a type of legend drug
defined by the Department of Human Services by rule that
includes, but is not limited to: - }
{ - (A) Therapeutic class 7 ataractics-tranquilizers; and - }
{ - (B) Therapeutic class 11
psychostimulants-antidepressants. - }
{ - (c) - } { + (b) + } 'Urgent medical condition' means a
medical condition that arises suddenly, is not life-threatening
and requires prompt treatment to avoid the development of more
serious medical problems.
{ - (2) The department shall reimburse the cost of a legend
drug prescribed for a recipient of medical assistance only if the
legend drug: - }
{ - (a) Is on the drug list of the Practitioner-Managed
Prescription Drug Plan adopted under ORS 414.334; - }
{ - (b) Is in a therapeutic class of nonsedating
antihistamines and nasal inhalers, as defined by the department
by rule, and is prescribed by an allergist for the treatment of
any of: - }
{ - (A) Asthma; - }
{ - (B) Sinusitis; - }
{ - (C) Rhinitis; or - }
{ - (D) Allergies; or - }
{ - (c) Is prescribed and dispensed under this chapter by a
licensed practitioner at a rural health clinic for an urgent
medical condition and: - }
{ - (A) There is no pharmacy within 15 miles of the
clinic; - }
{ - (B) The prescription is dispensed for a patient outside
of the normal business hours of any pharmacy within 15 miles of
the clinic; or - }
{ - (C) No pharmacy within 15 miles of the clinic dispenses
legend drugs under this chapter. - }
{ - (3) The department shall pay only for drugs in the
generic form unless an exception has been granted by the
department through the prior authorization process adopted by the
department under subsection (4) of this section. - }
{ - (4) Notwithstanding subsection (2) of this section, the
department shall provide reimbursement for a legend drug that
does not meet the criteria in subsection (2) of this section
if: - }
{ - (a) It is a mental health drug. - }
{ - (b) The department grants approval through a prior
authorization process adopted by the department by rule. - }
Enrolled House Bill 2126 (HB 2126-A) Page 7
{ - (c) The prescriber contacts the department requesting
prior authorization and the department or its agent fails to
respond to the telephone call or to a prescriber's request made
by electronic mail within 24 hours. - }
{ - (d) After consultation with the department or its agent,
the prescriber, in the prescriber's professional judgment,
determines that the drug is medically appropriate. - }
{ - (e) The original prescription was written prior to the
effective date of this 2009 Act or the request is for a refill of
a prescription for: - }
{ - (A) The treatment of seizures, cancer, HIV or AIDS;
or - }
{ - (B) An immunosuppressant. - }
{ - (f) It is a drug in a class not evaluated for the
Practitioner-Managed Prescription Drug Plan adopted under ORS
414.334. - }
{ + (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 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 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 { - ; and - } { + . + }
{ - (c) Withhold payment for a legend drug that is not a
funded health service on the prioritized list of health services
established by the Health Services Commission under ORS
414.720. - }
{ + (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) The department shall pay a rural health clinic for a legend
drug prescribed and dispensed under this chapter by a licensed
Enrolled House Bill 2126 (HB 2126-A) Page 8
practitioner at the rural health clinic for an urgent medical
condition if:
(a) There is not a pharmacy within 15 miles of the clinic;
(b) The prescription is dispensed for a patient outside of the
normal business hours of any pharmacy within 15 miles of the
clinic; or
(c) No pharmacy within 15 miles of the clinic dispenses legend
drugs under this chapter. + }
{ - (6) - } { + (7) + } Notwithstanding ORS 414.334, the
department may conduct prospective drug utilization review prior
to payment for drugs for a patient whose prescription drug use
exceeded 15 drugs in the preceding six-month period.
{ - (7) - } { + (8) + } Notwithstanding subsection (3) of
this section, the department may pay a pharmacy for a particular
brand name drug rather than the generic version of the drug after
notifying the pharmacy that the cost of the particular brand name
drug, after receiving discounted prices and rebates, is equal to
or less than the cost of the generic version of the drug.
{ - (8) The department shall appoint an advisory committee in
accordance with ORS 183.333 for any rulemaking conducted pursuant
to this section. - }
SECTION 8. { + If House Bill 2009, House Bill 2129 and Senate
Bill 876 all become law, section 7 of this 2009 Act (amending ORS
414.325) is repealed and ORS 414.325, as amended by section 1,
chapter ___, Oregon Laws 2009 (Enrolled Senate Bill 876), section
35, chapter ___, Oregon Laws 2009 (Enrolled House Bill 2129), and
section 2 of this 2009 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, as defined in ORS 689.005.
{ - (b) 'Mental health drug' means a type of legend drug
defined by the Oregon Health Authority by rule that includes, but
is not limited to: - }
{ - (A) Therapeutic class 7 ataractics-tranquilizers; and - }
{ - (B) Therapeutic class 11
psychostimulants-antidepressants. - }
{ - (c) - } { + (b) + } 'Urgent medical condition' means a
medical condition that arises suddenly, is not life-threatening
and requires prompt treatment to avoid the development of more
serious medical problems.
{ - (2) The authority shall reimburse the cost of a legend
drug prescribed for a recipient of medical assistance only if the
legend drug: - }
{ - (a) Is on the drug list of the Practitioner-Managed
Prescription Drug Plan adopted under ORS 414.334; - }
{ - (b) Is in a therapeutic class of nonsedating
antihistamines and nasal inhalers, as defined by the authority by
rule, and is prescribed by an allergist for the treatment of: - }
{ - (A) Asthma; - }
{ - (B) Sinusitis; - }
{ - (C) Rhinitis; or - }
{ - (D) Allergies; or - }
{ - (c) Is prescribed and dispensed under this chapter by a
licensed practitioner at a rural health clinic for an urgent
medical condition and: - }
{ - (A) There is no pharmacy within 15 miles of the
clinic; - }
Enrolled House Bill 2126 (HB 2126-A) Page 9
{ - (B) The prescription is dispensed for a patient outside
of the normal business hours of any pharmacy within 15 miles of
the clinic; or - }
{ - (C) No pharmacy within 15 miles of the clinic dispenses
legend drugs under this chapter. - }
{ - (3) The authority shall pay only for drugs in the generic
form unless an exception has been granted by the authority
through the prior authorization process adopted by the authority
under subsection (4) of this section. - }
{ - (4) Notwithstanding subsection (2) of this section, the
authority shall provide reimbursement for a legend drug that does
not meet the criteria in subsection (2) of this section if: - }
{ - (a) It is a mental health drug. - }
{ - (b) The authority grants approval through a prior
authorization process adopted by the authority by rule. - }
{ - (c) The prescriber contacts the authority requesting
prior authorization and the authority or its agent fails to
respond to the telephone call or to a prescriber's request made
by electronic mail within 24 hours. - }
{ - (d) After consultation with the authority or its agent,
the prescriber, in the prescriber's professional judgment,
determines that the drug is medically appropriate. - }
{ - (e) The original prescription was written prior to the
effective date of this 2009 Act or the request is for a refill of
a prescription for: - }
{ - (A) The treatment of seizures, cancer, HIV or AIDS;
or - }
{ - (B) An immunosuppressant. - }
{ - (f) It is a drug in a class not evaluated for the
Practitioner-Managed Prescription Drug Plan adopted under ORS
414.334. - }
{ + (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 and pursuant to rules of the
Oregon Health Authority unless the practitioner prescribes
otherwise and an exception is granted by the authority.
(3) Except as provided in subsections (4) and (5) of this
section, the authority shall place no limit on the type of legend
drug that may be prescribed by a practitioner, but the authority
shall pay only for drugs in the generic form unless an exception
has been granted by the authority.
(4) Notwithstanding subsection (3) of this section, an
exception must be applied for and granted before the authority is
required to pay for minor tranquilizers and amphetamines and
amphetamine derivatives, as defined by rule of the authority. + }
(5) { + (a) + } Notwithstanding subsections (1) to (4) of this
section { + and except as provided in paragraph (b) of this
subsection + }, the authority 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 authority has determined should be
limited to those conditions generally recognized as appropriate
by the medical profession { - ; and - } { + . + }
{ - (c) Withhold payment for a legend drug that is not a
funded health service on the prioritized list of health services
Enrolled House Bill 2126 (HB 2126-A) Page 10
established by the Health Services Commission under ORS
414.720. - }
{ + (b) The authority may not require prior authorization for
therapeutic classes of nonsedating antihistamines and nasal
inhalers, as defined by rule by the authority, 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) The authority shall pay a rural health clinic for a legend
drug prescribed and dispensed under this chapter by a licensed
practitioner at the rural health clinic for an urgent medical
condition if:
(a) There is not a pharmacy within 15 miles of the clinic;
(b) The prescription is dispensed for a patient outside of the
normal business hours of any pharmacy within 15 miles of the
clinic; or
(c) No pharmacy within 15 miles of the clinic dispenses legend
drugs under this chapter. + }
{ - (6) - } { + (7) + } Notwithstanding ORS 414.334, the
authority may conduct prospective drug utilization review prior
to payment for drugs for a patient whose prescription drug use
exceeded 15 drugs in the preceding six-month period.
{ - (7) - } { + (8) + } Notwithstanding subsection (3) of
this section, the authority may pay a pharmacy for a particular
brand name drug rather than the generic version of the drug after
notifying the pharmacy that the cost of the particular brand name
drug, after receiving discounted prices and rebates, is equal to
or less than the cost of the generic version of the drug.
( { - 8)(a) - } { + (9)(a) + } Within 180 days after the
United States patent expires on an immunosuppressant drug used in
connection with an organ transplant, the authority shall
determine whether the drug is a narrow therapeutic index drug.
(b) As used in this subsection, 'narrow therapeutic index drug'
means a drug that has a narrow range in blood concentrations
between efficacy and toxicity and requires therapeutic drug
concentration or pharmacodynamic monitoring.
{ - (9) The authority shall appoint an advisory committee in
accordance with ORS 183.333 for any rulemaking conducted pursuant
to this section. - }
SECTION 9. ORS 414.334, as amended by section 3 of this 2009
Act, is amended to read:
414.334. (1) The Department of Human Services shall adopt a
Practitioner-Managed Prescription Drug Plan for the medical
assistance program. The purpose of the plan is to ensure that
enrollees of the medical assistance program 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 medical assistance program 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
Enrolled House Bill 2126 (HB 2126-A) Page 11
any drug that the practitioner indicates is medically necessary
for an enrollee as being the most effective available. + }
{ - (4) - } { + (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.
{ - (5) - } { + (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 10. { + If House Bill 2009 becomes law, section 9 of
this 2009 Act (amending ORS 414.334) is repealed and ORS 414.334,
as amended by section 299, chapter ___, Oregon Laws 2009
(Enrolled House Bill 2009), and section 4 of this 2009 Act, is
amended to read: + }
414.334. (1) The Oregon Health Authority shall adopt a
Practitioner-Managed Prescription Drug Plan for the medical
assistance program. The purpose of the plan is to ensure that
enrollees of the medical assistance program receive the most
effective prescription drug available at the best possible price.
(2) Before adopting the plan, the authority shall conduct
public meetings and consult with the Health Resources Commission.
(3) The authority shall consult with representatives of the
regulatory boards and associations representing practitioners who
are prescribers under the medical assistance program 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 authority, a practitioner may prescribe
any drug that the practitioner indicates is medically necessary
for an enrollee as being the most effective available. + }
{ - (4) - } { + (5) + } An enrollee may appeal to the
authority a decision of a practitioner or the authority to not
provide a prescription drug requested by the enrollee.
{ - (5) - } { + (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 11. { + The Department of Human Services may not adopt
or amend any rule that requires a prescribing practitioner to
contact the department to request an exception for a medically
appropriate or medically necessary drug that is not listed on the
Practitioner-Managed Prescription Drug Plan drug list for that
class of drugs adopted under ORS 414.334, unless otherwise
authorized by enabling legislation setting forth the requirement
for prior authorization. + }
SECTION 12. If House Bill 2009 becomes law, section 11 of this
2009 Act is amended to read:
{ + Sec. 11. + } The { - Department of Human Services - }
{ + Oregon Health Authority + } may not adopt or amend any rule
that requires a prescribing practitioner to contact the
{ - department - } { + authority + } to request an exception
for a medically appropriate or medically necessary drug that is
not listed on the Practitioner-Managed Prescription Drug Plan
drug list for that class of drugs adopted under ORS 414.334,
unless otherwise authorized by enabling legislation setting forth
the requirement for prior authorization.
SECTION 13. { + The amendments to ORS 414.325 and 414.334 by
sections 7 to 10 of this 2009 Act become operative on January 2,
2014. + }
SECTION 14. { + ORS 414.336 is repealed. + }
Enrolled House Bill 2126 (HB 2126-A) Page 12
SECTION 15. { + If House Bill 2009 becomes law, section 300,
chapter ___, Oregon Laws 2009 (Enrolled House Bill 2009)
(amending ORS 414.336), is repealed. + }
SECTION 16. If House Bill 2009, House Bill 2129 and Senate Bill
876 all become law, section 2, chapter ___, Oregon Laws 2009
(Enrolled Senate Bill 876), as amended by section 36, chapter
___, Oregon Laws 2009 (Enrolled House Bill 2129), is amended to
read:
{ + Sec. 2. + } Notwithstanding ORS 414.325 { - (9)(a) - }
{ + (8)(a) + }, if the United States patent on an
immunosuppressant drug used in connection with an organ
transplant expired on or after July 1, 2007, and before the
effective date of chapter ___, Oregon Laws 2009 (Enrolled Senate
Bill 876), the Oregon Health Authority shall determine whether
the drug is a narrow therapeutic index drug as defined in ORS
414.325 { - (9)(b) - } { + (8)(b) + } before January 1, 2010.
SECTION 17. ORS 414.735 is amended to read:
414.735. (1) If insufficient resources are available during a
contract period:
(a) The population of eligible persons determined by law shall
not be reduced.
(b) The reimbursement rate for providers and plans established
under the contractual agreement shall not be reduced.
(2) In the circumstances described in subsection (1) of this
section, reimbursement shall be adjusted by reducing the health
services for the eligible population by eliminating services in
the order of priority recommended by the Health Services
Commission, starting with the least important and progressing
toward the most important.
(3) The Department of Human Services shall obtain the approval
of the Legislative Assembly { + , + } or { + the + } Emergency
Board { - , - } if the Legislative Assembly is not in session,
before instituting the reductions. In addition, providers
contracting to provide health services under ORS 414.705 to
414.750 must be notified at least two weeks prior to any
legislative consideration of such reductions. Any reductions made
under this section shall take effect no sooner than 60 days
following final legislative action approving the reductions.
{ + (4) This section does not apply to reductions made by the
Legislative Assembly in a legislatively adopted or approved
budget. + }
SECTION 18. { + If House Bill 2009 becomes law, section 17 of
this 2009 Act (amending ORS 414.735) is repealed and ORS 414.735,
as amended by 328, chapter ___, Oregon Laws 2009 (Enrolled House
Bill 2009), is amended to read: + }
414.735. (1) If insufficient resources are available during a
contract period:
(a) The population of eligible persons determined by law shall
not be reduced.
(b) The reimbursement rate for providers and plans established
under the contractual agreement shall not be reduced.
(2) In the circumstances described in subsection (1) of this
section, reimbursement shall be adjusted by reducing the health
services for the eligible population by eliminating services in
the order of priority recommended by the Health Services
Commission, starting with the least important and progressing
toward the most important.
(3) The Oregon Health Policy Board shall obtain the approval of
the Legislative Assembly { + , + } or { + the + } Emergency
Board { - , - } if the Legislative Assembly is not in session,
Enrolled House Bill 2126 (HB 2126-A) Page 13
before instituting the reductions. In addition, providers
contracting to provide health services under ORS 414.705 to
414.750 must be notified at least two weeks prior to any
legislative consideration of such reductions. Any reductions made
under this section shall take effect no sooner than 60 days
following final legislative action approving the reductions.
{ + (4) This section does not apply to reductions made by the
Legislative Assembly in a legislatively adopted or approved
budget. + }
SECTION 19. { + Notwithstanding section 24, chapter 736,
Oregon Laws 2003, for the biennium beginning July 1, 2009, the
Department of Human Services may limit the administrative cost
and property expense components of the allowable costs that are
reimbursed pursuant to section 24 (4)(f), chapter 736, Oregon
Laws 2003, in accordance with the legislatively adopted
budget. + }
SECTION 20. { + Section 19 of this 2009 Act is repealed on
June 30, 2011. + }
SECTION 21. { + Notwithstanding ORS 461.549, the amount
allocated from the Administrative Services Economic Development
Fund to the Problem Gambling Treatment Fund under ORS 461.549, in
the fiscal year beginning July 1, 2009, is reduced by
$2,120,912. + }
SECTION 22. { + For the biennium beginning July 1, 2009, the
Department of Human Services is authorized to implement one or
more of the following reductions in temporary assistance for
needy families. The department may, notwithstanding ORS 411.070
and 412.009:
(1) Deny aid to a family in which a caretaker relative is
disqualified from receiving unemployment insurance based upon the
reason for the separation from employment.
(2) Reduce the monthly aid paid to a family under ORS 412.124
to $100 for the period ending September 30, 2010, and to $50 for
the period beginning October 1, 2010.
(3) Establish an income eligibility limit equal to 185 percent
of the federal poverty guidelines for aid to a dependent child
residing with a caretaker relative who is not the child's parent.
(4) Restrict access to activities that promote family stability
and financial independence described in ORS 412.006 (5).
(5) Deny employment-related day care assistance to a parent who
is self-employed.
(6) Eliminate the reduced copayment required for
employment-related day care assistance in the first month of
employment.
(7) Beginning July 1, 2010, restrict employment-related day
care assistance to those families that have received temporary
assistance for needy families in the 24-month period prior to the
date of application for employment-related day care
assistance. + }
SECTION 23. { + This 2009 Act being necessary for the
immediate preservation of the public peace, health and safety, an
emergency is declared to exist, and this 2009 Act takes effect
July 1, 2009. + }
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Enrolled House Bill 2126 (HB 2126-A) Page 14
Passed by House June 26, 2009
...........................................................
Chief Clerk of House
...........................................................
Speaker of House
Passed by Senate June 29, 2009
...........................................................
President of Senate
Enrolled House Bill 2126 (HB 2126-A) Page 15
Received by Governor:
......M.,............., 2009
Approved:
......M.,............., 2009
...........................................................
Governor
Filed in Office of Secretary of State:
......M.,............., 2009
...........................................................
Secretary of State
Enrolled House Bill 2126 (HB 2126-A) Page 16