HCS HB 1332 -- PHARMACIES AND PHARMACY BENEFITS (Sater)

COMMITTEE OF ORIGIN:  Special Committee on Healthcare
Transformation

This substitute changes the laws regarding pharmacies and
pharmacy benefits.

PHARMACY AUDITS

The substitute establishes guidelines that entities must follow
when auditing a pharmacy.  Any entity conducting an audit must
develop an appeal process under which a pharmacy can appeal an
unfavorable audit report.  The substitute does not apply to any
investigative audits involving fraud, willful misrepresentation,
or abuse.

RECOMMENDATIONS FOR SWITCHING MEDICATIONS

All switch communications must clearly identify the originally
prescribed medication and disclose any financial interest that
the health care insurer, pharmacy benefits manager, or
prescribing physician has in the patient's decision to switch
medications.  Any person who issues or delivers or causes to be
issued or delivered a switch communication that has not been
approved, provides a misrepresentation or false statement in a
switch communication, or commits any other material violation of
the provisions of the substitute will be subject to a fine of up
to $25,000.

PHYSICIAN OVERRIDE OF DRUG RESTRICTIONS

A prescribing physician can override any step therapy or fail
first protocol when the treatment has been ineffective in
treating the patient's disease or medical condition, is expected
to be ineffective, or is likely to cause an adverse reaction.
The duration of any step therapy or fail first protocol cannot
last longer than 14 days.  For medications with no generic
equivalent and for which the prescribing physician feels there is
no appropriate therapeutic alternative, the health carrier or
pharmacy benefit manager is required to provide access to United
States Food and Drug Administration labeled medications without
restriction.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of Unknown
but Greater than $36,810 in FY 2009, FY 2010, and FY 2011.
Estimated Cost on Other State Funds of $25,650 in FY 2009,
FY 2010, and FY 2011.

Missouri House of Representatives
94th General Assembly, 2nd Regular Session
Last Updated October 15, 2008 at 3:10 pm