§ 40-21-3 - Preferred drug list.
SECTION 40-21-3
§ 40-21-3 Preferred drug list. – (a) If a patient's health care provider prescribes a prescription drug that isnot on the preferred drug list, the prescriber shall consult with the programto confirm that in his or her reasonable professional judgment, the patient'sclinical condition is consistent with the criteria for approval of thenonpreferred drug. Such criteria shall include:
(i) The preferred drug has been tried by the patient and hasfailed to produce the desired health outcomes;
(ii) The patient has tried the preferred drug and hasexperienced unacceptable side effects;
(iii) The patient has been stabilized on a nonpreferred drugand transition to the preferred drug would be medically contraindicated; or
(iv) Other clinical indications identified by the committeefor the patients use of the nonpreferred drug, which shall includeconsideration of the medical needs of special populations, including children,elderly, chronically ill, persons with mental health conditions, and personsaffected by HIV/AIDS.
(b) In the event that the patient does not meet the criteriain subsection (a) of this section, the prescriber may provide additionalinformation to the program to justify the use of a prescription drug that isnot on the preferred drug list. The program shall provide a reasonableopportunity for a prescriber to reasonably present his or her justification ofprior authorization. If, after consultation with the program, the prescriber,in his or her reasonable professional judgment, determines that the use of aprescription drug that is not on the preferred drug list is warranted, theprescriber's determination shall be final.