249A.20A - PREFERRED DRUG LIST PROGRAM.
249A.20A PREFERRED DRUG LIST PROGRAM.
1. The department shall establish and implement a preferred drug
list program under the medical assistance program. The department
shall submit a medical assistance state plan amendment to the centers
for Medicare and Medicaid services of the United States department of
health and human services, no later than May 1, 2003, to implement
the program.
2. a. A medical assistance pharmaceutical and therapeutics
committee shall be established within the department by July 1, 2003,
for the purpose of developing and providing ongoing review of the
preferred drug list.
b. (1) The members of the committee shall be appointed by the
governor and shall include health care professionals who possess
recognized knowledge and expertise in one or more of the following:
(a) The clinically appropriate prescribing of covered outpatient
drugs.
(b) The clinically appropriate dispensing and monitoring of
covered outpatient drugs.
(c) Drug use review, evaluation, and intervention.
(d) Medical quality assurance.
(2) The membership of the committee shall be comprised of at
least one third but not more than fifty-one percent licensed and
actively practicing physicians and at least one third licensed and
actively practicing pharmacists.
c. The members shall be appointed to terms of two years.
Members may be appointed to more than one term. The department shall
provide staff support to the committee. Committee members shall
select a chairperson and vice chairperson annually from the committee
membership.
3. The pharmaceutical and therapeutics committee shall recommend
a preferred drug list to the department. The committee shall develop
the preferred drug list by considering each drug's clinically
meaningful therapeutic advantages in terms of safety, effectiveness,
and clinical outcome. The committee shall use evidence-based
research methods in selecting the drugs to be included on the
preferred drug list. The committee shall periodically review all
drug classes included on the preferred drug list and may amend the
list to ensure that the list provides for medically appropriate drug
therapies for medical assistance recipients and achieves cost savings
to the medical assistance program. The department may procure a sole
source contract with an outside entity or contractor to provide
professional administrative support to the pharmaceutical and
therapeutics committee in researching and recommending drugs to be
placed on the preferred drug list.
4. With the exception of drugs prescribed for the treatment of
human immunodeficiency virus or acquired immune deficiency syndrome,
transplantation, or cancer and drugs prescribed for mental illness
with the exception of drugs and drug compounds that do not have a
significant variation in a therapeutic profile or side effect profile
within a therapeutic class, prescribing and dispensing of
prescription drugs not included on the preferred drug list shall be
subject to prior authorization.
5. The department may negotiate supplemental rebates from
manufacturers that are in addition to those required by Title XIX of
the federal Social Security Act. The committee shall consider a
product for inclusion on the preferred drug list if the manufacturer
provides a supplemental rebate. The department may procure a sole
source contract with an outside entity or contractor to conduct
negotiations for supplemental rebates.
6. The department shall adopt rules to provide a procedure under
which the department and the pharmaceutical and therapeutics
committee may disclose information relating to the prices
manufacturers or wholesalers charge for pharmaceuticals. The
procedures established shall comply with 42 U.S.C. § 1396r-8 and with
chapter 550.
7. The department shall publish and disseminate the preferred
drug list to all medical assistance providers in this state.
8. Until such time as the pharmaceutical and therapeutics
committee is operational, the department shall adopt and utilize a
preferred drug list developed by a midwestern state that has received
approval for its medical assistance state plan amendment from the
centers for Medicare and Medicaid services of the United States
department of health and human services.
9. The department may procure a sole source contract with an
outside entity or contractor to participate in a pharmaceutical
pooling program with midwestern or other states to provide for an
enlarged pool of individuals for the purchase of pharmaceutical
products and services for medical assistance recipients.
10. The department may adopt administrative rules under section
17A.4, subsection 3, and section 17A.5, subsection 2, paragraph
"b", to implement this section.
11. Any savings realized under this section may be used to the
extent necessary to pay the costs associated with implementation of
this section prior to reversion to the medical assistance program.
The department shall report the amount of any savings realized and
the amount of any costs paid to the legislative fiscal committee on a
quarterly basis. Section History: Recent Form
2003 Acts, ch 112, §3, 14; 2003 Acts, ch 179, § 161; 2005 Acts, ch
3, §53; 2008 Acts, ch 1031, §108
Referred to in § 249J.18 Footnotes
Cost requirements for a newly released generic drug product to be
considered to be a preferred drug; method for determining the medical
assistance program cost of a drug product; 2004 Acts, ch 1175, § 119