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HCS/SCS/SB 139 - This act establishes a Controlled Substance Abuse Prevention Fund that is funded using fees collected by the Department of Health and Senior Services when issuing registrations to manufacture, distribute, or dispense controlled substances. Any money appropriated or made available for the purpose of funding the Bureau of Narcotics and Dangerous Drugs within the Department shall be deposited into the fund. The Bureau shall employ investigators as needed. (Sections 195.430 and 195.435) These provisions shall become effective on August 28, 2019. These provisions are substantially similar to HB 103 (2017). This act repeals existing language relating to psychotrophic medications and adds 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 Division 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. (Section 208.227) 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.(Section 208.229) These provisions are identical to provisions in HCS/HB 986 (2017), substantially similar to provisions in SCS/SB 433 (2017), and similar to provisions in HB 1159 (2017). The act modifies provisions relating to the Missouri Rx Prescription Drug Program by requiring applicants' household income limits for eligibility to only apply to Medicaid dual eligible individuals. (Section 208.790) The provisions of the Missouri Rx Program shall sunset on August 28, 2022. (Section 208.798) These provisions are identical to provisions in HCS/HB 986 (2017). This act also creates the Rx Cares for Missouri Program to be administered by the Board of Pharmacy in consultation with the Department of Health and Senior Services. The goals of the program are to promote medication safety and prevent prescription drug abuse. The Board may expend funds appropriated to the Board to private and public entities for the development of programs and education in order to meet these goals. Funds shall not be used for any state prescription drug monitoring program. The Board of Pharmacy may enter into interagency agreements with the Department of Health and Senior Services so that the Department may assist in the operation of the program. The program shall expire on August 28, 2019. (Section 338.710). These provisions are substantially similar to SB 1136 (2016). JAMIE ANDREWS
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