Sec. 5. Prior authorization study and survey. The Department of Health and Human Services shall contract with an independent entity to study the efficacy and impact of the prior authorization process on program benefits and costs and conduct a survey of MaineCare members.

1. Study. The study shall examine at a minimum the following issues:

A. The number of prescriptions not being filled by recipients of prescription drug benefits under the MaineCare program as a result of the prior authorization process;

B. The percentage of denied requests from providers who do not later file an additional request for prior authorization;

C. The percentage of denied requests for which a generic drug was substituted;

D. The percentage of denied requests for which no drug was substituted; and

E. The extent to which adverse health effects or the use of additional MaineCare services resulted from not receiving a nonpreferred drug.

2. Random sample survey. By October 1, 2005, the department shall conduct a random sample survey of MaineCare members to examine the impact of the prior authorization process on members. The survey must be designed to determine whether members are receiving clinically appropriate, medically necessary drugs with reasonable promptness and must explore the extent to which, as a result of the prior authorization process, members may have encountered barriers to care or adverse health effects or may have incurred additional health care costs for the MaineCare program.

3. Report. By March 1, 2006, the department shall report to the Joint Standing Committee on Health and Human Services on the results of the study and the survey under this section.

SUMMARY

This bill establishes prior authorization pharmacy benefit procedures for the MaineCare and elderly low-cost drug programs. The bill establishes a drug utilization review committee within