422.4025 - List of preferred prescription drugs used for Medicaid program; list of drugs excluded from restrictions; role of Pharmacy and Therapeutics Committee; availability of new pharmaceutical pro
422.4025 List of preferred prescription drugs used for Medicaid program; list of drugs excluded from restrictions; role of Pharmacy and Therapeutics Committee; availability of new pharmaceutical products and products for which there is new evidence.
1. The Department shall, by regulation, develop a list of preferred prescription drugs to be used for the Medicaid program.
2. The Department shall, by regulation, establish a list of prescription drugs which must be excluded from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs established pursuant to subsection 1. The list established pursuant to this subsection must include, without limitation:
(a) Atypical and typical antipsychotic medications that are prescribed for the treatment of a mental illness of a patient who is receiving services pursuant to Medicaid;
(b) Prescription drugs that are prescribed for the treatment of the human immunodeficiency virus or acquired immunodeficiency syndrome, including, without limitation, protease inhibitors and antiretroviral medications;
(c) Anticonvulsant medications;
(d) Antirejection medications for organ transplants;
(e) Antidiabetic medications;
(f) Antihemophilic medications; and
(g) Any prescription drug which the Committee identifies as appropriate for exclusion from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs.
3. The regulations must provide that the Committee makes the final determination of:
(a) Whether a class of therapeutic prescription drugs is included on the list of preferred prescription drugs and is excluded from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs;
(b) Which therapeutically equivalent prescription drugs will be reviewed for inclusion on the list of preferred prescription drugs and for exclusion from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs; and
(c) Which prescription drugs should be excluded from any restrictions that are imposed on drugs that are on the list of preferred prescription drugs based on continuity of care concerning a specific diagnosis, condition, class of therapeutic prescription drugs or medical specialty.
4. The regulations must provide that each new pharmaceutical product and each existing pharmaceutical product for which there is new clinical evidence supporting its inclusion on the list of preferred prescription drugs must be made available pursuant to the Medicaid program with prior authorization until the Committee reviews the product or the evidence.
(Added to NRS by 2003, 1317)