HB 1322 -- HEALTH MAINTENANCE ORGANIZATIONS (Foley)

Current law requires health maintenance organizations to obtain
permission of the enrollee and the enrollee's physician before
changing a maintenance drug, except when the drug is classified
as a narrow therapeutic index drug.  This bill repeals this
exception.

The bill also defines a health maintenance organization to
include any managed care or preferred provider entity.  In
addition, the bill specifies that generic drugs may be dispensed
for prescribed brand name maintenance drugs according to Section
338.056, RSMo.

FISCAL NOTE:  No impact on state funds.

HB 1322, HCA 1 -- HEALTH MAINTENANCE ORGANIZATIONS

SPONSOR:  Foley

COMMITTEE ACTION:  Voted "do pass" by the Committee on Critical
Issues by a vote of 21 to 0.

Current law requires health maintenance organizations to obtain
permission of the enrollee and the enrollee's physician before
changing a maintenance drug, except when the drug is classified
as a narrow therapeutic index drug.  This bill repeals this
exception.

HCA 1:  Prohibits HMOs from mandating that a "physician or other
licensed health care practitioner" change a maintenance drug
without the enrollee's permission.  The prior version included
the term "provider".

FISCAL NOTE:  No impact on state funds.

PROPONENTS:  Supporters say that narrow therapeutic index drugs
should not have been exempted from the requirements that an HMO
receive permission before changing a maintenance drug because
there is a very small difference between the effective and
lethal doses of these medications.  Patients using the drugs
need the most protection from changing medication without the
physician's permission.

Testifying for the bill were Representative Foley; DuPont--
Pharma; Missouri Association of Osteopathic Physicians and
Surgeons; Dana Davis; Conrad Balstrom; Judy Rush; Missouri
Pharmacy Association; and Missouri State Medical Association.

OPPONENTS:  Those who oppose the bill say that the exception in
current law should not be deleted because, without that
exception, the narrow therapeutic index drugs will be subject to
the vague provisions of current requirements.  Those
requirements will make it too difficult for patients to obtain
generic substitutes.

Testifying against the bill were Barr Laboratories; National
Pharmaceutical Association; and Kaiser-Permanente.

Katharine Hickel, Legislative Analyst

HB 1322 -- Health Maintenance Organizations

Sponsor:  Foley

Current law requires health maintenance organizations to obtain
permission of the enrollee and the enrollee's physician before
changing a maintenance drug, except when the drug is classified
as a narrow therapeutic index drug.  This bill repeals this
exception.