Sec. 17b-274d. Pharmaceutical and Therapeutics Committee. Membership. Duties. Preferred drug lists. Supplemental rebates. Administrative hearings.
Sec. 17b-274d. Pharmaceutical and Therapeutics Committee. Membership.
Duties. Preferred drug lists. Supplemental rebates. Administrative hearings. (a)
Pursuant to 42 USC 1396r-8, there is established a Pharmaceutical and Therapeutics
Committee within the Department of Social Services.
(b) The Pharmaceutical and Therapeutics Committee shall be comprised as specified in 42 USC 1396r-8 and shall consist of fourteen members appointed by the Governor. Five members shall be physicians licensed pursuant to chapter 370, including one
general practitioner, one pediatrician, one geriatrician, one psychiatrist and one specialist in family planning, four members shall be pharmacists licensed pursuant to chapter
400j, two members shall be visiting nurses, one specializing in adult care and one specializing in psychiatric care, one member shall be a clinician designated by the Commissioner of Mental Health and Addiction Services, one member shall be a representative
of pharmaceutical manufacturers and one member shall be a consumer representative.
The committee may, on an ad hoc basis, seek the participation of other state agencies
or other interested parties in its deliberations. The members shall serve for terms of two
years from the date of their appointment. Members may be appointed to more than
one term. The Commissioner of Social Services, or the commissioner's designee, shall
convene the committee following the Governor's designation of appointments. The
administrative staff of the Department of Social Services shall serve as staff for said
committee and assist with all ministerial duties. The Governor shall ensure that the
committee membership includes Medicaid participating physicians and pharmacists,
with experience serving recipients of medical assistance.
(c) Committee members shall select a chairperson and vice-chairperson from the
committee membership on an annual basis.
(d) The committee shall meet at least quarterly, and may meet at other times at the
discretion of the chairperson and committee membership. The committee shall comply
with all regulations adopted by the department, including notice of any meeting of the
committee, pursuant to the requirements of chapter 54.
(e) The Department of Social Services, in consultation with the Pharmaceutical and
Therapeutics Committee, may adopt preferred drug lists for use in the Medicaid, state-administered general assistance and ConnPACE programs. The Department of Social
Services, upon entering into a contract for the provision of prescription drug coverage
to medical assistance recipients receiving services in a managed care setting as provided
by section 17b-266a, shall in consultation with the Pharmaceutical and Therapeutics
Committee, expand the preferred drug list for use in the HUSKY Plan, Part A and Part
B. To the extent feasible, the department shall review all drugs included on the preferred
drug lists at least every twelve months, and may recommend additions to, and deletions
from, the preferred drug lists, to ensure that the preferred drug lists provide for medically
appropriate drug therapies for Medicaid, state-administered general assistance and ConnPACE patients. For the fiscal year ending June 30, 2004, such drug lists shall be limited
to use in the Medicaid and ConnPACE programs and cover three classes of drugs,
including proton pump inhibitors and two other classes of drugs determined by the
Commissioner of Social Services. Not later than June 30, 2005, the Department of Social
Services, in consultation with the Pharmaceutical and Therapeutic Committee shall
expand such drug lists to include other classes of drugs, except as provided in subsection
(f) of this section, in order to achieve savings reflected in the amounts appropriated to
the department, for the various components of the program, in the state budget act.
(f) Nonpreferred drugs in the classes of drugs included on the preferred drug lists
shall be subject to prior authorization. If prior authorization is granted for a drug not
included on a preferred drug list, the authorization shall be valid for one year from the
date the prescription is first filled. Mental-health-related and antiretroviral classes of
drugs shall not be included on the preferred drug lists.
(g) The Department of Social Services shall publish and disseminate the preferred
drug lists to all Medicaid providers in the state.
(h) The department may negotiate supplemental rebate agreements with manufacturers that are in addition to those required under Title XIX of the Social Security Act.
The committee shall ensure that the pharmaceutical manufacturers agreeing to provide
a supplemental rebate pursuant to 42 USC 1396r-8(c) have an opportunity to present
evidence supporting inclusion of a product on the preferred drug lists unless a court of
competent jurisdiction, in a final decision, determines that the Secretary of Health and
Human Services does not have authority to allow such supplemental rebates, provided
the inability to utilize supplemental rebates pursuant to this subsection shall not impair
the committee's authority to maintain preferred drug lists. Upon timely notice, the department shall ensure that any drug that has been approved, or had any of its particular
uses approved, by the United States Food and Drug Administration under a priority
review classification, will be reviewed by the Pharmaceutical and Therapeutics Committee at the next regularly scheduled meeting. To the extent feasible, upon notice by a
pharmaceutical manufacturer, the department shall also schedule a product review for
any new product at the next regularly scheduled meeting of the Pharmaceutical and
Therapeutics Committee.
(i) Factors considered by the department and the Pharmaceutical and Therapeutics
Committee in developing the preferred drug lists shall include, but not be limited to,
clinical efficacy, safety and cost effectiveness of a product.
(j) The Pharmaceutical and Therapeutics Committee may also make recommendations to the department regarding the prior authorization of any prescribed drug.
(k) A recipient who is denied a nonpreferred drug may request an administrative
hearing in accordance with section 17b-60.
(l) The Commissioner of Social Services may contract with a pharmacy benefits
organization or a single entity qualified to negotiate with pharmaceutical manufacturers
for supplemental rebates, available pursuant to 42 USC 1396r-8(c), for the purchase of
drugs listed on the preferred drug lists established pursuant to subsection (e) of this
section.
(May 9 Sp. Sess. P.A. 02-1, S. 121; May 9 Sp. Sess. P.A. 02-7, S. 52; P.A. 03-2, S. 19; 03-278, S. 63; June 30 Sp. Sess.
P.A. 03-3, S. 83; P.A. 04-258, S. 8, 43; May Sp. Sess. P.A. 04-2, S. 41; P.A. 05-280, S. 18; 05-288, S. 71.)
History: May 9 Sp. Sess. P.A. 02-1 effective July 1, 2002; May 9 Sp. Sess. P.A. 02-7 amended Subsec. (h) by adding
provision re implementation of supplemental rebate program subject to determination by a court of competent jurisdiction
re federal authority to allow such rebates, effective August 15, 2002; P.A. 03-2 amended Subsec. (a) to require committee
to convene on or before March 31, 2003, amended Subsec. (e) to require Department of Social Services to adopt preferred
drug list on or before July 1, 2003, to replace provision re department's adoption of preferred drug list upon recommendation
of committee with provision re adoption of preferred drug list in consultation with committee, and to substitute "department"
for "committee" re review of drugs included in the preferred drug list, and amended Subsec. (i) to add "the department
and" re development of the preferred drug list, effective February 28, 2003; P.A. 03-278 made technical changes in Subsec.
(h), effective July 9, 2003; June 30 Sp. Sess. P.A. 03-3 amended Subsec. (b) to increase size of committee from 11 to 14
members, to further specify the professional qualifications required of the committee membership, and to add provisions
re committee may seek participation of other state agencies and interested parties, and re committee to convene after
Governor's designation of appointments, amended Subsec. (e) to add references to the Medicaid and ConnPACE programs
re use of preferred drug list, to provide that for fiscal year ending June 30, 2004, preferred drug list is limited to proton
pump inhibitors and two other classes of drugs to be determined by commissioner and to add provision re notice to legislative
committees, amended Subsec. (j) to add "in accordance with the plan developed and implemented pursuant to section 17b-491a" and added new Subsec. (l) re application of section to state-administered general assistance program, effective
August 20, 2003; P.A. 04-258 amended Subsec. (a) by deleting provision re date by which committee was to convene,
amended Subsecs. (e) through (i), inclusive, by replacing "preferred drug list" with "preferred drug lists" and making
conforming changes, amended Subsec. (e) by providing that use of preferred drug list would be expanded to HUSKY Plan,
Part A and Part B upon the Department of Social Services entering into a contract for the provision of prescription drug
coverage pursuant to Sec. 17b-266a, adding provision re use of preferred drug lists for the fiscal year ending June 30, 2004,
only in the Medicaid and ConnPACE programs, deleting provision re notification by commissioner by January 1, 2004,
of classes of drugs on preferred drug list and adding provision re expansion of drug lists by June 30, 2005, to include other
classes of drugs, amended Subsec. (f) by adding "medications used to treat diabetes, asthma or cancer" to the types of
drugs not subject to prior authorization requirements, moved provision in former Subsec. (l) re application of section to
state-administered general assistance program to Subsec. (e), and added new Subsec. (l) re commissioner's authority to
negotiate with pharmaceutical manufacturers for supplemental rebates for drugs on preferred drug lists, effective July 1,
2004; May Sp. Sess. P.A. 04-2 amended Subsec. (f) by deleting "medications used to treat diabetes, asthma or cancer" re
the types of drugs not subject to prior authorization requirements, effective July 1, 2004; P.A. 05-280 amended Subsecs.
(a), (b), (e) and (h) to (j), inclusive, to delete "Medicaid" from the name of the Pharmaceutical and Therapeutics Committee,
amended Subsec. (b) to substitute "recipients of medical assistance" for "all segments of the Medicaid population", amended
Subsec. (e) by substituting "may" for "shall" re adoption of preferred drug lists, amended Subsec. (f) by providing that
nonpreferred drugs in the classes of drugs included on the preferred drug lists shall be subject to prior authorization,
specifying that the length of prior authorization shall be for one year from the date the prescription is first filled and
exempting mental-health-related and antiretroviral classes of drugs from inclusion on the preferred drug lists, amended
Subsec. (h) by providing that department may negotiate supplemental rebate agreements with manufacturers that supplement those required by Title XIX of the Social Security Act, amended Subsec. (j) by removing provision that limited
committee's recommendation to drugs covered by Medicaid in accordance with the plan developed pursuant to Sec. 17b-491a, and replaced former Subsec. (k) re Medicaid recipients appeal of preferred drug list determinations utilizing Medicaid
fair hearing process with new Subsec. (k) providing that a recipient denied a nonpreferred drug may request an administrative
hearing in accordance with Sec. 17b-60, effective July 1, 2005; P.A. 05-288 made a technical change in Subsec. (f), effective
July 13, 2005.
See Secs. 17b-274, 17b-491a re required prior authorization for brand name prescriptions.