SCS/SB 433 - This act addresses several aspects of the MO HealthNet pharmacy program, including: (1) polypharmacy and antipsychotic medications; (2) prescription drug rebates; and (3) prescription drug co-payments.
POLYPHARMACY AND ANTIPSYCHOTIC MEDICATIONS (Section 208.227)
This act replaces existing language relating to psychotrophic medications with new language relating to the establishment of a polypharmacy program and the prescribing of antipsychotic medications. The MO HealthNet Division shall establish a polypharmacy program for high-risk MO HealthNet participants with numerous or multiple prescribed drugs. The Department shall also establish a behavioral health pharmacy and opioid surveillance program to encourage the use of best medical evidence-supported prescription practices. The Division shall issue provider updates to enumerate specified treatment and utilization principles for MO HealthNet providers, including treatment principles relating to antipsychotic drugs.
If the Division implements any new policy or clinical edit for an antipsychotic drug, the Division shall continue to allow MO HealthNet participants access to any antipsychotic drug that they use and on which they are stable or that they have successfully used in the past. Additionally, the following shall apply to the prescribing of antipsychotics:
(1) If an antipsychotic drug is listed as "non-preferred" by the Division and is considered clinically appropriate for an individual patient, prior authorization shall be simple and flexible;
(2) If an antipsychotic drug is listed as "non-preferred" and is known or found to be safe and effective for a patient, the Division shall not restrict the patient's access to the drug and such drug shall be considered "preferred" for that patient;
(3) A patient shall not be required to change antipsychotic drugs due to changes in medication management policy, prior authorization, or a change in the payor responsible for the benefit; and
(4) Patients transferring from state psychiatric hospitals to community-based settings shall be permitted to continue their medication regimens.
The Division's medication policy and clinical edits shall provide MO HealthNet participants initial access to multiple FDA-approved antipsychotic drugs that have substantially the same clinical differences and adverse effects that are predictable across patients and whose manufacturers have entered into rebate agreements with the federal Department of Health and Human Services. The act specifies the categories of available drugs that shall made available to participants.
PRESCRIPTION DRUG REBATES (Section 208.229)
Under this act, pharmaceutical manufacturers shall pay to the State, in accordance with federal law, rebates on eligible utilization of covered outpatient drugs dispensed to MO HealthNet participants as follows: (1) for single source drugs and innovator multiple source drugs, rebates shall reflect the manufacturer's best price; and (2) for single source drugs and innovator and noninnovator multiple source drugs, any additional rebates as necessary to account for certain price increases in excess of inflation.
PRESCRIPTION DRUG CO-PAYMENTS (Section 208.231)
This act shall require MO HealthNet participants to pay a nominal co-payment for covered outpatient drugs as permitted by federal law. Drugs on the preferred drug list shall be subject to a $4 co-payment and drugs not on the preferred drug list shall be subject to a $8 co-payment. Certain MO HealthNet participants and services, specified in federal law, shall be excluded from the co-payment requirements. The co-payments shall be considered separate from any shared dispensing fee obligation on the part of the participant.
This act is identical to provisions in HCS/HB 986 (2017), substantially similar to provisions in CCS/HCS/SCS/SB 139 (2017), and similar to provisions in HB 1159 (2017).