Utah Code 26B-3-305. Drug prior approval program
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(1) A drug prior approval program approved or implemented by the board shall meet the following conditions:
Terms Used In Utah Code 26B-3-305
- Board: means the Drug Utilization Review Board created in Section 26B-3-302. See Utah Code 26B-3-301
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Process: means a writ or summons issued in the course of a judicial proceeding. See Utah Code 68-3-12.5
- Recipient: means a person who has received medical assistance under the Medicaid program. See Utah Code 26B-3-101
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
(1)(a) except as provided in Subsection (2), a drug may not be placed on prior approval for other than medical reasons;
(1)(b) the board shall hold a public hearing at least 30 days prior to placing a drug on prior approval;
(1)(c) notwithstanding the provisions of Section 52-4-202, the board shall provide not less than 14 days’ notice to the public before holding a public hearing under Subsection (1)(b);
(1)(d) the board shall consider written and oral comments submitted by interested parties prior to or during the hearing held in accordance with Subsection (1)(b);
(1)(e) the board shall provide evidence that placing a drug class on prior approval:
(1)(e)(i) will not impede quality of recipient care; and
(1)(e)(ii) that the drug class is subject to clinical abuse or misuse;
(1)(f) the board shall reconsider its decision to place a drug on prior approval:
(1)(f)(i) no later than nine months after any drug class is placed on prior approval; and
(1)(f)(ii) at a public hearing with notice as provided in Subsection (1)(b);
(1)(g) the program shall provide an approval or denial of a request for prior approval:
(1)(g)(i) by either:
(1)(g)(i)(A) fax;
(1)(g)(i)(B) telephone; or
(1)(g)(i)(C) electronic transmission;
(1)(g)(ii) at least Monday through Friday, except for state holidays; and
(1)(g)(iii) within 24 hours after receipt of the prior approval request;
(1)(h) the program shall provide for the dispensing of at least a 72-hour supply of the drug on the prior approval program:
(1)(h)(i) in an emergency situation; or
(1)(h)(ii) on weekends or state holidays;
(1)(i) the program may be applied to allow acceptable medical use of a drug on prior approval for appropriate off-label indications; and
(1)(j) before placing a drug class on the prior approval program, the board shall:
(1)(j)(i) determine that the requirements of Subsections (1)(a) through (i) have been met; and
(1)(j)(ii) by majority vote, place the drug class on prior approval.
(2) The board may, only after complying with Subsections (1)(b) through (j), consider the cost:
(2)(a) of a drug when placing a drug on the prior approval program; and
(2)(b) associated with including, or excluding a drug from the prior approval process, including:
(2)(b)(i) potential side effects associated with a drug; or
(2)(b)(ii) potential hospitalizations or other complications that may occur as a result of a drug’s inclusion on the prior approval process.