249A.24 - IOWA MEDICAL ASSISTANCE DRUG UTILIZATION REVIEW COMMISSION -- CREATED.
249A.24 IOWA MEDICAL ASSISTANCE DRUG UTILIZATION
REVIEW COMMISSION -- CREATED.
1. An Iowa medical assistance drug utilization review commission
is created within the department. The commission membership, duties,
and related provisions shall comply with 42 C.F.R. pt. 456, subpt. K.
2. In addition to any other duties prescribed, the commission
shall make recommendations to the council on human services regarding
strategies to reduce state expenditures for prescription drugs under
the medical assistance program excluding provider reimbursement
rates. The commission shall make initial recommendations to the
council by October 1, 2002. Following approval of any recommendation
by the council on human services, the department shall include the
approved recommendation in a notice of intended action under chapter
17A and shall comply with chapter 17A in adopting any rules to
implement the recommendation. The department shall seek any federal
waiver necessary to implement any approved recommendation. The
strategies to be considered for recommendation by the commission
shall include at a minimum all of the following:
a. Development of a preferred drug formulary pursuant to 42
U.S.C. § 1396r-8.
b. Negotiation of supplemental rebates from manufacturers
that are in addition to those required by Title XIX of the federal
Social Security Act. For the purposes of this paragraph,
"supplemental rebates" may include, at the department's
discretion, cash rebates and other program benefits that offset a
medical assistance expenditure. Pharmaceutical manufacturers
agreeing to provide a supplemental rebate as provided in this
paragraph shall have an opportunity to present evidence supporting
inclusion of a product on any preferred drug formulary developed.
c. Disease management programs.
d. Drug product donation programs.
e. Drug utilization control programs.
f. Prescriber and beneficiary counseling and education.
g. Fraud and abuse initiatives.
h. Pharmaceutical case management.
i. Services or administrative investments with guaranteed
savings to the medical assistance program.
j. Expansion of prior authorization for prescription drugs
and pharmaceutical case management under the medical assistance
program.
k. Any other strategy that has been approved by the United
States department of health and human services regarding prescription
drugs under the medical assistance program.
3. The commission shall submit an annual review, including facts
and findings, of the drugs on the department's prior authorization
list to the department and to the members of the general assembly's
joint appropriations subcommittee on health and human services. Section History: Recent Form
2002 Acts, 2nd Ex, ch 1003, §263, 266; 2005 Acts, ch 175, §112
Referred to in § 249J.18