CHAPTER 113

S.P. 493 - L.D. 1404

Resolve, To Increase the Quality of Care and Reduce

Administrative Burdens in the Pharmacy Prior Approval

Process

Sec. 1. Preferred drug lists and prior authorization. Resolved: That the Department of Health and Human Services shall take the following actions to promote the quality of care and reduce administrative burdens in the pharmacy prior approval process.

1. The department shall specify on the preferred drug list and on the prior authorization form the number, titration if required and classes of preferred drugs that must be determined to be clinically inappropriate or ineffective before the department will permit the use of a nonpreferred drug.

2. In the next changes to the MaineCare Benefits Manual, but no later than January 15, 2006, the department shall adopt a provision to articulate the current standards for off-label drug use of prescription drugs for children.

3. The department shall change the prior authorization forms to provide examples of clinical conditions and functional limitations that could support a waiver of prior authorization.

4. By January 2006, the department shall amend its rules regarding prior authorization to include the criteria for approving special exception overrides. The department shall arrange to modify the message screen to include a reminder that