ENGROSSED
Senate Bill No. 693
(By Senators Walker, Prezioso, Sharpe, Boley, Hunter, McCabe,

Redd, Ross, Snyder, Sprouse, Unger and Wooton)
____________
[Originating in the Committee on Health and Human Resources;
reported March 2, 1999.]
_____________

A BILL to amend article five, chapter nine of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto a new section, designated section fifteen-a, relating to the Medicaid program; authorizing the state Medicaid agency to promulgate a legislative rule setting forth procedures for requiring prior authorization for any drug or category of drugs; specifying issues to be addressed in the rule; defining terms; authorizing the rule to be promulgated and filed as an emergency rule; and prohibiting the state Medicaid agency from imposing prior authorization requirements on a drug or category of drugs until it promulgates the referenced rule.

Be it enacted by the Legislature of West Virginia:
That article five, chapter nine of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by adding thereto a new section, designated section fifteen-a, to read as follows:

ARTICLE 5. MISCELLANEOUS PROVISIONS.

§9-5-15a. Medicaid program; authorizing rule relating to prior authorization of prescription drugs; specifying scope of rule; requiring filing of emergency rule before additional drugs to be placed on list requiring prior authorization.

(a) On and after the effective date of this section, the state Medicaid agency may not require that any additional prescription drug or category of drugs be subject to prior authorization unless the agency has developed a rule governing requirements for such prior authorization as provided in this section.
(b) Notwithstanding the provisions of section three, article one, chapter twenty-nine-a of this code, the state Medicaid agency shall develop a legislative rule, in accordance with article three, chapter twenty-nine-a of this code, setting forth the procedure for imposing a requirement that a drug or category of drugs be subject to a requirement of prior authorization. This rule shall provide, at a minimum, for the following:
(1) Notice to interested or affected parties that a drug or category of drugs is being considered for imposition of a prior authorization requirement;
(2) Opportunity for interested and affected parties to be heard and present evidence and argument, both written and oral, at a public hearing, before a drug or category of drugs may be subject to a requirement for prior authorization;
(3) Issuance of preliminary written findings of fact by the state Medicaid agency based upon the evidence adduced at the public hearing conducted pursuant to subdivision (2) of this subsection;
(34) Notice of such preliminary findings of fact to interested and affected parties;
(45) Opportunity for interested and affected parties to rebut in writing the preliminary findings of fact issued pursuant to subdivision (3) of this subsection; and
(56) Issuance of final written findings of fact which include the effective date, if any, upon which prior authorization of a drug or category of drugs may be required.
(c) The rule setting forth procedures and governing the imposition of requirements for prior authorization of a drug or category of drugs authorized by this section may be initially promulgated and filed as an emergency rule, in accordance with section fifteen, article three, chapter twenty-nine-a of this code.
(d) As used in this section, the term "interested or affected party" includes, but is not limited to, Medicaid beneficiaries, consumers and patients rights groups and advocates, physicians, pharmacists and pharmaceutical drug manufacturers.

_______

(NOTE: The purpose of this bill is to authorize the state Medicaid agency to promulgate a rule setting forth procedures and requirements for subjecting a drug or category of drugs to requirements for prior authorization. It also prohibits the agency from imposing such requirements until the agency promulgates the rule.

This section is new; therefore, strike-throughs and underscoring have been omitted.)