Senate Bill No. 617
(By Senator Prezioso)
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[Introduced February 17, 2003; referred to the Committee on
Health and Human Resources; and then to the Committee on
Finance.]
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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 preferred drug list; setting forth
legislative findings; providing for clinical integrity of the
preferred drug list; providing coverage for new prescription
drugs; and providing for patient continuity of care.
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. Clinical integrity of preferred drugs; coverage of new prescription drugs; patient continuity of care.
(a) The Legislature finds that public sector programs, such as
the state's medicaid program, that use economically motivated
preferred drug lists often interfere with the treatment
recommendations of doctors, which ultimately increases the costs to
the medicaid program by delaying the proper treatment of low-income
patients, and jeopardizes the patient's health and well-being.
Switching of therapies based on economic motives: (1) Exposes a
patient whose care is already well managed to the possibility of
new side effects and adverse interactions with coexisting therapies
or diseases; (2) requires the physician to carefully observe, test
and evaluate the patient who is already well managed during the
introduction of a new medication into the treatment protocol or
therapy, often at considerable cost and risk to the patient's well
being; (3) creates confusion and administrative burdens for
patients and families who must accommodate new and different dosing
schedules, routes of administration, and interactions with food and
other medicines; and (4) is an inappropriate interference with the
provider-patient relationship.
(b) A medicaid preferred drug list must adhere to the
following requirements:
(1) Decisions of the pharmaceutical and therapeutics committee
regarding any limitations imposed on any drug or its use for a
specific indication shall be based on sound clinical evidence found in labeling, drug compendia, and peer reviewed clinical literature
pertaining to the use of the drug in a relevant population.
(2) A prescription drug which is newly approved by the federal
food and drug administration is included on the preferred drug list
unless the pharmaceutical and therapeutics committee has met and
determined that the drug should be excluded from the preferred drug
list.
(3) Any patient who is stabilized on a prescription drug
medication previously prescribed by a health care provider, and
used by the patient for the treatment of a particular indication,
is exempted from any requirements related, directly or indirectly,
to the preferred drug list developed and implemented by the
secretary pursuant to section fifteen of this article.
NOTE: The purpose of this bill is to maintain the coverage
and requirements of the medicaid preferred drug list for patients
who are stabilized on a medication.
This section is new; therefore, strike-throughs and
underscoring have been omitted.