Missouri Senate

Introduced

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 or medications. 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 or medications.

If the Division implements any new policy or point-of-sale clinical edit for an antipsychotic drug or medication, the Division shall continue to allow MO HealthNet participants access to any antipsychotic drug or medication 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 or medication is listed as "non-preferred" in the MO HealthNet pharmacy formulary and is considered clinically appropriate for an individual patient, prior authorization shall be simple and flexible;

(2) If an antipsychotic drug or mediation 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 or medication and such drug or medication shall be considered "preferred" for that patient;

(3) A patient shall not be required to change antipsychotic drugs or medications 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 or medications 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 or medications that shall made available to participants.

PRESCRIPTION DRUG PRICE INCREASES (Section 208.228)

Under this act, the Drug Utilization Review Board shall annually identify up to 10 prescription drugs on which the state spends significant health care dollars and for which the wholesale acquisition cost has increased 50% or more over the past 5 years or by 15% or more over the past 12 months. The Board shall provide the list to the Department of Social Services, to be posted on the Department's website, and to the Attorney General. The Attorney General shall require the drugs' manufacturers to provide a justification for the increase in the wholesale acquisition cost of the drug and the Attorney General shall provide a report to the General Assembly and post the report on the Attorney General's website, subject to the confidentiality provisions specified in the act. The Attorney General may bring a civil action to impose a civil penalty of $10,000 per violation against a manufacturer that fails to provide the information required under this act.

The Drug Utilization Review Board shall advise the MO HealthNet Division as to suggested remediations for the drug price increases, including the use of a more restrictive prior authorization process.

PRESCRIPTION DRUG DISPENSATION (Section 208.229)

This act requires any covered outpatient drug that is newly prescribed to a MO HealthNet participant who has not previously been prescribed such drug to be subject to prior authorization and be limited to a 15-day trial supply for the first dispensation.

This act also limits the number of prescriptions of a covered outpatient drug that may be filled or refilled in a month to five, subject to exceptions for certain drugs commonly prescribed for long-term chronic medical conditions and for prior authorized drugs.

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.

SARAH HASKINS