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HB 540/FN (BR 1932) - J. Jenkins

     AN ACT relating to Medicaid managed care.
     Create a new section of KRS 205.510 to 205.560, relating to the Medicaid program, to define the terms "department," "managed care organization," and "Medicaid managed care contract"; require the Department for Medicaid Services to promulgate an administrative regulation to establish the policies and procedures for administration of prescription drug benefits by a Medicaid managed care organization; require the administrative regulation to include policies for the managed care organization's pharmacy and therapeutics committee regarding committee membership, formulary development process, meeting schedule, drug approval, and appeal process; require a managed care organization to provide coverage for a drug approved by its pharmacy and therapeutics committee, implement drug utilization management tools, and provide coverage in the formulary for all drug categories and classes of disease states; require the department to develop a standardized drug prior authorization request form by June 30, 2012; require coverage for no less than nine months for a drug needed for continuous treatment of a medical condition; require response to a prior authorization request within two days; require managed care organizations to furnish a list of prior authorization requests and responses to the department within 60 days of the effective date of the Act; require a managed care organization to restore authorization for a prescription in effect on October 31, 2011, if the change in prescription was not made by the prescriber; amend KRS 205.564 to require the Pharmacy and Therapeutics Advisory Committee to review and approve the formulary or preferred drug list of any entity contracted with the Department for Medicaid Services to administer pharmacy benefits for the Medicaid program.

     Mar 1-introduced in House
     Mar 5-to Health & Welfare (H)
     Mar 6-posted in committee

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