Sec. 17b-491a. Prior authorization requirements for prescription drugs. Designation of specific suppliers. Schedule for dispensing of maximum quantities of oral dosage units. Submission of plans and r - Connecticut Statutes

      Sec. 17b-491a. Prior authorization requirements for prescription drugs. Designation of specific suppliers. Schedule for dispensing of maximum quantities of oral dosage units. Submission of plans and revisions thereto to General Assembly. (a) The Commissioner of Social Services may require prior authorization of any prescription for a drug covered under the Medicaid, state-administered general assistance, or ConnPACE program, including (1) any early refill of a prescription drug covered under any of said programs; and (2) brand name drug products when a chemically equivalent generic drug product substitution is available. The authorization for a brand name drug product shall be valid for one year from the date the prescription is first filled. The Commissioner of Social Services shall establish a procedure by which prior authorization under this subsection shall be obtained from an independent pharmacy consultant acting on behalf of the Department of Social Services, under an administrative services only contract. If prior authorization is not granted or denied within two hours of receipt by the commissioner of the request for prior authorization, it shall be deemed granted.

      (b) The Commissioner of Social Services, to increase cost-efficiency or enhance access to a particular prescription drug, may designate specific suppliers of a prescription drug from which a dispensing pharmacy shall order the prescription to be delivered to the pharmacy and billed by the supplier to the department. For each prescription dispensed through designated suppliers, the department shall pay the dispensing pharmacy a handling fee not to exceed four hundred per cent of the dispensing fee established pursuant to section 17b-280. In no event shall the provisions of this subsection be construed to allow the commissioner to purchase all prescription drugs covered under the Medicaid, state-administered general assistance, and ConnPACE programs under one contract.

      (c) Notwithstanding the provisions of section 17b-262 and any regulation adopted thereunder, on or after July 1, 2000, the Commissioner of Social Services may establish a schedule of maximum quantities of oral dosage units permitted to be dispensed at one time for prescriptions covered under the Medicaid and state-administered general assistance programs based on a review of utilization patterns.

      (d) A plan or schedule established pursuant to subsection (a), (b) or (c) of this section and on and after July 1, 2005, any revisions thereto shall be submitted to the joint standing committees of the General Assembly having cognizance of matters relating to public health, human services and appropriations and the budgets of state agencies. Within sixty days of receipt of such a plan or schedule or revisions thereto, said joint standing committees of the General Assembly shall approve or deny the plan or schedule or any revisions thereto and advise the commissioner of their approval or denial of the plan or schedule or any revisions thereto. The plan or schedule or any revisions thereto shall be deemed approved unless all committees vote to reject such plan or schedule or revisions thereto within sixty days of receipt of such plan or schedule or revisions thereto.

      (June Sp. Sess. P.A. 00-2, S. 36, 53; P.A. 04-76, S. 21; P.A. 05-280, S. 17.)

      History: June Sp. Sess. P.A. 00-2 effective July 1, 2000; P.A. 04-76 amended Subsecs. (a) to (c), inclusive, by deleting references to "general assistance"; P.A. 05-280 amended Subsec. (a) by replacing "establish a plan for the" with "require" re prior authorization, removing former Subdiv. (1) designator, "initial" and "that costs five hundred dollars or more for a thirty day supply or", redesignating existing Subdiv. (2) as Subdiv. (1), adding new Subdiv. (2) re prior authorization requirement for brand name drugs when a chemically equivalent generic drug product substitution is available, and providing that authorization for brand name drug shall be valid for one year from the date the initial prescription is first filled, amended Subsec. (b) by deleting provision that required commissioner to establish a plan for designating certain suppliers of prescription drugs to be used by pharmacies when ordering prescription drugs and amended Subsec. (d) by adding "on and after July 1, 2005," re submission of plan revisions to General Assembly, effective July 13, 2005.