§ 270 — Definitions

§ 270. Definitions. As used in this article, unless the context\nclearly requires otherwise:\n 1. "Administrator" means an entity with which the commissioner\ncontracts for the purpose of administering elements of the preferred\ndrug program, as established under section two hundred seventy-two of\nthis article or the clinical drug review program established under\nsection two hundred seventy-four of this article.\n 2. "Board" shall mean the drug utilization review board.\n 3. "Clinical drug review program" means the clinical drug review\nprogram created by section two hundred seventy-four of this article.\n 4. "Emergency condition" means a medical or behavioral condition as\ndetermined by the prescriber or pharmacists, the onset of which is\nsudden, that manifests itself by symptoms of sufficient severity,\nincluding severe pain, and for which delay in beginning treatment\nprescribed by the patient's health care practitioner would result in:\n (a) placing the health or safety of the person afflicted with such\ncondition or other person or persons in serious jeopardy;\n (b) serious impairment to such person's bodily functions;\n (c) serious dysfunction of any bodily organ or part of such person;\n (d) serious disfigurement of such person; or\n (e) severe discomfort.\n 5. "Non preferred drug" means a prescription drug that is included in\nthe preferred drug program and is not one of the drugs on the preferred\ndrug list because it is either: (a) in a therapeutic class that is\nincluded in the preferred drug program and is not one of the drugs on\nthe preferred drug list in that class or (b) manufactured by a\npharmaceutical manufacturer with whom the commissioner is negotiating or\nhas negotiated a manufacturer agreement and is not a preferred drug\nunder a manufacturer agreement.\n 6. "Panel" means the elderly pharmaceutical insurance coverage panel\nestablished pursuant to section two hundred forty-four of the elder law.\n 7. "Preferred drug" means a prescription drug that is either (a) in a\ntherapeutic class that is included in the preferred drug program and is\none of the drugs on the preferred drug list in that class or (b) a\npreferred drug under a manufacturer agreement.\n 8. "Preferred drug program" means the preferred drug program\nestablished under section two hundred seventy-two of this article.\n 9. "Prescription drug" or "drug" means a drug defined in subdivision\nseven of section sixty-eight hundred two of the education law, for which\na prescription is required under the federal food, drug and cosmetic\nact. Any drug that does not require a prescription under such act, but\nwhich would otherwise meet the criteria under this article for inclusion\non the preferred drug list may be added to the preferred drug list under\nthis article; and, if so included, shall be considered to be a\nprescription drug for purposes of this article; provided that it shall\nbe eligible for reimbursement under a state public health plan when\nordered by a prescriber authorized to prescribe under the state public\nhealth plan and the prescription is subject to the applicable provisions\nof this article and paragraph (a) of subdivision four of section three\nhundred sixty-five-a of the social services law.\n 10. "Prior authorization" means a process requiring the prescriber or\nthe dispenser to verify with the applicable state public health plan or\nits authorized agent that the drug is appropriate for the needs of the\nspecific patient.\n 11. "State public health plan" means the medical assistance program\nestablished by title eleven of article five of the social services law\n(referred to in this article as "Medicaid"), the elderly pharmaceutical\ninsurance coverage program established by title three of article two of\nthe elder law (referred to in this article as "EPIC"), and the family\nhealth plus program established by section three hundred sixty-nine-ee\nof the social services law to the extent that section provides that the\nprogram shall be subject to this article.\n 12. "Supplemental rebate" means a supplemental rebate under\nsubdivision eleven of section two hundred seventy-two of this article.\n 13. "Therapeutic class" means a group of prescription drugs that\nproduce a particular intended clinical outcome and are grouped together\nas a therapeutic class by the pharmacy and therapeutics committee.\n 14. "Manufacturer agreement" means an agreement between the\ncommissioner and a pharmaceutical manufacturer under paragraph (b) of\nsubdivision eleven of section two hundred seventy-two of this article.\n