Bill Text: OR SB334 | 2013 | Regular Session | Introduced
Bill Title: Relating to payments for prescription drugs.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2013-07-08 - In committee upon adjournment. [SB334 Detail]
Download: Oregon-2013-SB334-Introduced.html
77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 2176
Senate Bill 334
Sponsored by Senator WINTERS (Presession filed.)
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
Requires, until June 30, 2016, medical assistance coverage of
prescription drugs that are immunosuppressant drugs or drugs for
treatment of seizures, cancer, HIV or AIDS.
A BILL FOR AN ACT
Relating to payments for prescription drugs; creating new
provisions; and amending ORS 414.325 and section 13, chapter
827, Oregon Laws 2009.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 414.325, as amended by section 8, chapter 827,
Oregon Laws 2009, is amended to read:
414.325. (1) As used in this section:
(a) 'Legend drug' means any drug requiring a prescription by a
practitioner, as defined in ORS 689.005.
(b) 'Urgent medical condition' means a medical condition that
arises suddenly, is not life-threatening and requires prompt
treatment to avoid the development of more serious medical
problems.
(2) A licensed practitioner may prescribe such drugs under this
chapter as the practitioner in the exercise of professional
judgment considers appropriate for the diagnosis or treatment of
the patient in the practitioner's care and within the scope of
practice. Prescriptions shall be dispensed in the generic form
pursuant to ORS 689.515 and pursuant to rules of the Oregon
Health Authority unless the practitioner prescribes otherwise and
an exception is granted by the authority.
(3) Except as provided in subsections (4) and (5) of this
section, the authority shall place no limit on the type of legend
drug that may be prescribed by a practitioner, but the authority
shall pay only for drugs in the generic form unless an exception
has been granted by the authority.
(4) Notwithstanding subsection (3) of this section, an
exception must be applied for and granted before the authority is
required to pay for minor tranquilizers and amphetamines and
amphetamine derivatives, as defined by rule of the authority.
(5)(a) Notwithstanding subsections (1) to (4) of this section
and except as provided in paragraph (b) of this subsection, the
authority is authorized to:
(A) Withhold payment for a legend drug when federal financial
participation is not available; and
(B) Require prior authorization of payment for drugs that the
authority has determined should be limited to those conditions
generally recognized as appropriate by the medical profession.
(b) The authority may not require prior authorization
for { + : + } { +
(A) + } Therapeutic classes of nonsedating antihistamines and
nasal inhalers, as defined by rule by the authority, when
prescribed by an allergist for treatment of any of the following
conditions, as described by the Health Evidence Review Commission
on the funded portion of its prioritized list of services:
{ - (A) - } { + (i) + } Asthma;
{ - (B) - } { + (ii) + } Sinusitis;
{ - (C) - } { + (iii) + } Rhinitis; or
{ - (D) - } { + (iv) + } Allergies { - . - } { + ; or
(B) A drug indicated for the treatment of seizures, cancer, HIV
or AIDS or an immunosuppressant drug. + }
(6) The authority shall pay a rural health clinic for a legend
drug prescribed and dispensed under this chapter by a licensed
practitioner at the rural health clinic for an urgent medical
condition if:
(a) There is not a pharmacy within 15 miles of the clinic;
(b) The prescription is dispensed for a patient outside of the
normal business hours of any pharmacy within 15 miles of the
clinic; or
(c) No pharmacy within 15 miles of the clinic dispenses legend
drugs under this chapter.
(7) Notwithstanding ORS 414.334, the authority may conduct
prospective drug utilization review prior to payment for drugs
for a patient whose prescription drug use exceeded 15 drugs in
the preceding six-month period.
(8) Notwithstanding subsection (3) of this section, the
authority may pay a pharmacy for a particular brand name drug
rather than the generic version of the drug after notifying the
pharmacy that the cost of the particular brand name drug, after
receiving discounted prices and rebates, is equal to or less than
the cost of the generic version of the drug.
(9)(a) Within 180 days after the United States patent expires
on an immunosuppressant drug used in connection with an organ
transplant, the authority shall determine whether the drug is a
narrow therapeutic index drug.
(b) As used in this subsection, 'narrow therapeutic index drug'
means a drug that has a narrow range in blood concentrations
between efficacy and toxicity and requires therapeutic drug
concentration or pharmacodynamic monitoring.
SECTION 2. ORS 414.325, as amended by section 8, chapter 827,
Oregon Laws 2009, and section 2 of this 2013 Act, is amended to
read:
414.325. (1) As used in this section:
(a) 'Legend drug' means any drug requiring a prescription by a
practitioner, as defined in ORS 689.005.
(b) 'Urgent medical condition' means a medical condition that
arises suddenly, is not life-threatening and requires prompt
treatment to avoid the development of more serious medical
problems.
(2) A licensed practitioner may prescribe such drugs under this
chapter as the practitioner in the exercise of professional
judgment considers appropriate for the diagnosis or treatment of
the patient in the practitioner's care and within the scope of
practice. Prescriptions shall be dispensed in the generic form
pursuant to ORS 689.515 and pursuant to rules of the Oregon
Health Authority unless the practitioner prescribes otherwise and
an exception is granted by the authority.
(3) Except as provided in subsections (4) and (5) of this
section, the authority shall place no limit on the type of legend
drug that may be prescribed by a practitioner, but the authority
shall pay only for drugs in the generic form unless an exception
has been granted by the authority.
(4) Notwithstanding subsection (3) of this section, an
exception must be applied for and granted before the authority is
required to pay for minor tranquilizers and amphetamines and
amphetamine derivatives, as defined by rule of the authority.
(5)(a) Notwithstanding subsections (1) to (4) of this section
and except as provided in paragraph (b) of this subsection, the
authority is authorized to:
(A) Withhold payment for a legend drug when federal financial
participation is not available; and
(B) Require prior authorization of payment for drugs that the
authority has determined should be limited to those conditions
generally recognized as appropriate by the medical profession.
(b) The authority may not require prior authorization for
{ - : - }
{ - (A) - } therapeutic classes of nonsedating
antihistamines and nasal inhalers, as defined by rule by the
authority, when prescribed by an allergist for treatment of any
of the following conditions, as described by the Health Evidence
Review Commission on the funded portion of its prioritized list
of services:
{ - (i) - } { + (A) + } Asthma;
{ - (ii) - } { + (B) + } Sinusitis;
{ - (iii) - } { + (C) + } Rhinitis; or
{ - (iv) - } { + (D) + } Allergies { - ; or - } { + . + }
{ - (B) A drug indicated for the treatment of seizures,
cancer, HIV or AIDS or an immunosuppressant drug. - }
(6) The authority shall pay a rural health clinic for a legend
drug prescribed and dispensed under this chapter by a licensed
practitioner at the rural health clinic for an urgent medical
condition if:
(a) There is not a pharmacy within 15 miles of the clinic;
(b) The prescription is dispensed for a patient outside of the
normal business hours of any pharmacy within 15 miles of the
clinic; or
(c) No pharmacy within 15 miles of the clinic dispenses legend
drugs under this chapter.
(7) Notwithstanding ORS 414.334, the authority may conduct
prospective drug utilization review prior to payment for drugs
for a patient whose prescription drug use exceeded 15 drugs in
the preceding six-month period.
(8) Notwithstanding subsection (3) of this section, the
authority may pay a pharmacy for a particular brand name drug
rather than the generic version of the drug after notifying the
pharmacy that the cost of the particular brand name drug, after
receiving discounted prices and rebates, is equal to or less than
the cost of the generic version of the drug.
(9)(a) Within 180 days after the United States patent expires
on an immunosuppressant drug used in connection with an organ
transplant, the authority shall determine whether the drug is a
narrow therapeutic index drug.
(b) As used in this subsection, 'narrow therapeutic index drug'
means a drug that has a narrow range in blood concentrations
between efficacy and toxicity and requires therapeutic drug
concentration or pharmacodynamic monitoring.
SECTION 3. Section 13, chapter 827, Oregon Laws 2009, is
amended to read:
{ + Sec. 13. + } { + (1) + } The amendments to ORS
{ - 414.325 and - } 414.334 by
{ - sections 7 to - } { + section + } 10 { + , + } { - of
this 2009 Act - } { + chapter 827, Oregon Laws 2009, + } become
operative on January 2, 2014.
{ + (2) The amendments to ORS 414.325 by section 8, chapter
827, Oregon Laws 2009, become operative on January 1, 2014. + }
SECTION 4. { + The amendments to ORS 414.325 by section 2 of
this 2013 Act become operative June 30, 2016. + }
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