This text of Iowa § 249A.24 (Iowa medical assistance drug utilization review commission — created) is published on Counsel Stack Legal Research, covering Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
1.An Iowa medical assistance drug utilization review commission is created within the
department. The commission membership, duties, and related provisions shall comply with
42 C.F.R. pt. 456, subpt. K.
2.In addition to any other duties prescribed, the commission shall make
recommendations to the council on health and human services regarding strategies to reduce
state expenditures for prescription drugs under the medical assistance program excluding
provider reimbursement rates. Following approval of any recommendation by the council on
health and human services, the department shall include the approved recommendation in a
notice of intended action under chapter 17A and shall comply with chapter 17A in adopting
any rules to implement the recommendation. The department shall seek any fe
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1. An Iowa medical assistance drug utilization review commission is created within the
department. The commission membership, duties, and related provisions shall comply with
42 C.F.R. pt. 456, subpt. K.
2. In addition to any other duties prescribed, the commission shall make
recommendations to the council on health and human services regarding strategies to reduce
state expenditures for prescription drugs under the medical assistance program excluding
provider reimbursement rates. Following approval of any recommendation by the council on
health and human services, the department shall include the approved recommendation in a
notice of intended action under chapter 17A and shall comply with chapter 17A in adopting
any rules to implement the recommendation. The department shall seek any federal waiver
necessary to implement any approved recommendation. The strategies to be considered for
recommendation by the commission shall include at a minimum all of the following:
a. Development of a preferred drug formulary pursuant to 42 U.S.C. §1396r-8.
b. Negotiation of supplemental rebates from manufacturers that are in addition to
those required by Tit. XIX of the federal Social Security Act. For the purposes of this
paragraph, “supplemental rebates” may include, at the department’s discretion, cash rebates
and other program benefits that offset a medical assistance expenditure. Pharmaceutical
manufacturers agreeing to provide a supplemental rebate as provided in this paragraph shall
have an opportunity to present evidence supporting inclusion of a product on any preferred
drug formulary developed.
c. Disease management programs.
d. Drug product donation programs.
e. Drug utilization control programs.
f. Prescriber and beneficiary counseling and education.
g. Fraud and abuse initiatives.
h. Pharmaceutical case management.
i. Services or administrative investments with guaranteed savings to the medical
assistance program.
j. Expansion of prior authorization for prescription drugs and pharmaceutical case
management under the medical assistance program.
k. Any other strategy that has been approved by the United States department of health
and human services regarding prescription drugs under the medical assistance program.
3. When making recommendations or determinations regarding beneficiary access to
drugs and biological products for rare diseases, as defined in the federal Orphan Drug Act of
1983, Pub. L. No. 97-414, and drugs and biological products that are genetically targeted, the
commission shall request and consider information from individuals who possess scientific
or medical training with respect to the drug, biological product, or rare disease.