422.403 - Establishment and management of use by Medicaid program of step therapy and prior authorization; duties of Drug Use Review Board; acceptance of recommendations from Board.
422.403 Establishment and management of use by Medicaid program of step therapy and prior authorization; duties of Drug Use Review Board; acceptance of recommendations from Board.
1. The Department shall, by regulation, establish and manage the use by the Medicaid program of step therapy and prior authorization for prescription drugs.
2. The Drug Use Review Board shall:
(a) Advise the Department concerning the use by the Medicaid program of step therapy and prior authorization for prescription drugs;
(b) Develop step therapy protocols and prior authorization policies and procedures for use by the Medicaid program for prescription drugs; and
(c) Review and approve, based on clinical evidence and best clinical practice guidelines and without consideration of the cost of the prescription drugs being considered, step therapy protocols used by the Medicaid program for prescription drugs.
3. The Department shall not require the Drug Use Review Board to develop, review or approve prior authorization policies or procedures necessary for the operation of the list of preferred prescription drugs developed for the Medicaid program pursuant to NRS 422.4025.
4. The Department shall accept recommendations from the Drug Use Review Board as the basis for developing or revising step therapy protocols and prior authorization policies and procedures used by the Medicaid program for prescription drugs.
(Added to NRS by 2003, 1318)