26-18-105 - Drug prior approval program.
26-18-105. Drug prior approval program.
(1) A drug prior approval program approved or implemented by the board shall meet thefollowing conditions:
(a) except as provided in Subsection (2), a drug may not be placed on prior approval forother than medical reasons;
(b) the board shall hold a public hearing at least 30 days prior to placing a drug on priorapproval;
(c) notwithstanding the provisions of Section 52-4-202, the board shall provide not lessthan 14 days' notice to the public before holding a public hearing under Subsection (1)(b);
(d) the board shall consider written and oral comments submitted by interested partiesprior to or during the hearing held in accordance with Subsection (1)(b);
(e) the board shall provide evidence that placing a drug class on prior approval:
(i) will not impede quality of recipient care; and
(ii) that the drug class is subject to clinical abuse or misuse;
(f) the board shall reconsider its decision to place a drug on prior approval:
(i) no later than nine months after any drug class is placed on prior approval; and
(ii) at a public hearing with notice as provided in Subsection (1)(b);
(g) the program shall provide an approval or denial of a request for prior approval:
(i) by either:
(A) fax;
(B) telephone; or
(C) electronic transmission;
(ii) at least Monday through Friday, except for state holidays; and
(iii) within 24 hours after receipt of the prior approval request;
(h) the program shall provide for the dispensing of at least a 72-hour supply of the drugon the prior approval program:
(i) in an emergency situation; or
(ii) on weekends or state holidays;
(i) the program may be applied to allow acceptable medical use of a drug on priorapproval for appropriate off-label indications; and
(j) before placing a drug class on the prior approval program, the board shall:
(i) determine that the requirements of Subsections (1)(a) through (i) have been met; and
(ii) by majority vote, place the drug class on prior approval.
(2) The board may, only after complying with Subsections (1)(b) through (j), consider thecost:
(a) of a drug when placing a drug on the prior approval program; and
(b) associated with including, or excluding a drug from the prior approval process,including:
(i) potential side effects associated with a drug; or
(ii) potential hospitalizations or other complications that may occur as a result of a drug'sinclusion on the prior approval process.
Amended by Chapter 205, 2010 General Session