§ 25.5-5-506 — Prescribed drugs - utilization review

(1) The state department
shall develop and implement a drug utilization review process to assure the
appropriate utilization of drugs by patients receiving medical assistance in the fee-for-service and primary care physician programs. The review process shall include
the monitoring of prescription information and shall address at a minimum
underutilization and overutilization of benefit drugs. Periodic reports of findings and
recommendations shall be forwarded to the state department.

(2) It is the general assembly's intent that the implementation of a drug
utilization review process for the fee-for-service and primary care physician
programs will produce savings within the state's medicaid program. The state
department, therefore, is authorized to use savings in the medical services
premiums appropriations to fund the development and implementation of a drug
utilization review process for these programs, as required by subsection (1) of this
section. The state department may contract on a contingency basis for the
development or implementation of the review process required by subsection (1) of
this section.

(3) (a) The state department shall implement drug utilization mechanisms,
including, but not limited to, prior authorization, to control costs in the medical
assistance program associated with prescribed drugs. The state board shall
promulgate a rule that outlines a process in which any interested party may be
notified of and comment on the implementation of any prior authorization for a
class of prescribed drugs before the class is prior authorized.

(b) Repealed.

Legislative History

Source: L. 2006: Entire article added with relocations, p. 1906, � 7, effective July 1. L. 2016: (3)(b) repealed, (HB 16-1081), ch. 22, p. 51, � 4, effective August 10.