AN ACT to amend the Indiana Code concerning Medicaid and to make an appropriation.
Be it enacted by the General Assembly of the State of Indiana:
SECTION 1. IC 4-12-8-2, AS AMENDED BY P.L.291-2001,
SECTION 70, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 2. (a) The Indiana prescription drug account
is established within the Indiana tobacco master settlement agreement
fund for the purpose of providing access to needed prescription drugs
to ensure the health and welfare of Indiana's low-income senior
citizens. The account consists of:
(1) amounts to be distributed to the account from the Indiana
tobacco master settlement agreement fund;
(2) appropriations to the account from other sources; and
(3) rebates:
(A) required under 42 U.S.C. 1396r-8(a) for a Medicaid
waiver under which a prescription drug program is
established or implemented; or
(B) voluntarily negotiated under a prescription drug
program that is established or implemented;
to provide access to prescription drugs for low income senior
citizens; and
(4) grants, gifts, and donations intended for deposit in the
account.
(b) The account shall be administered by the budget agency.
Expenses for administration and benefits under the Indiana prescription
drug program established under IC 12-10-16 shall be paid from the
account. Money in the account at the end of the state fiscal year does
not revert to the state general fund or the Indiana tobacco master
settlement agreement fund but is annually appropriated and
remains available for expenditure for a prescription drug program
established or implemented to provide access to prescription drugs
for low income senior citizens.
(c) Money in the account may be used to match federal funds
available under a Medicaid waiver under which a prescription
drug program is established or implemented to provide access to
prescription drugs for low income senior citizens.
SECTION 2. IC 4-23-27-7, AS ADDED BY P.L.273-1999,
SECTION 162, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2002]: Sec. 7. The board shall direct policy
coordination of children's health programs by doing the following:
(1) Developing a comprehensive policy in the following areas:
(A) Appropriate delivery systems of care.
(B) Enhanced access to care.
(C) The use of various program funding for maximum
efficiency.
(D) The optimal provider participation in various programs.
(E) The potential for expanding health insurance coverage to
other populations.
(F) Technology needs, including development of an electronic
claim administration, payment, and data collection system that
allows providers to have the following:
(I) (i) Point of service claims payments.
(ii) Instant claims adjudication.
(iii) Point of service health status information.
(iv) Claims related data for analysis.
(G) Appropriate organizational structure to implement health
policy in the state.
(2) Coordinating aspects of existing children's health programs,
including the children's health insurance program, Medicaid
managed care for children, first steps, and children's special
health care services, in order to achieve a more seamless system
easily accessible by participants and providers, specifically in the
following areas:
(A) Identification of potential enrollees.
(B) Outreach.
(C) Eligibility criteria.
(D) Enrollment.
deficit disorder or attention deficit hyperactivity disorder.
SECTION 4. IC 12-7-2-40.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 40.5. "Compendia",
for purposes of IC 12-15-35 and IC 12-15-35.5, has the meaning set
forth in IC 12-15-35-3.
SECTION 5. IC 12-7-2-48.5 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 48.5. "Covered outpatient drug", for
purposes of IC 12-15-35, has the meaning set forth in
IC 12-15-35-4.5.
SECTION 6. IC 12-7-2-51.8 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 51.8. "Cross-indicated drug", for purposes
of IC 12-15-35.5, has the meaning set forth in IC 12-15-35.5-2.
SECTION 7. IC 12-7-2-178.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 178.5. "Single
source drug" for purposes of IC 12-15-35-35, has the meaning set forth
in IC 12-15-35-35(a). means an outpatient drug that is produced or
distributed under an original new drug application approved by
the federal Food and Drug Administration, including a drug
product marketed by any cross-licensed producers or distributors
operating under the new drug application.
SECTION 8. IC 12-7-2-190.6 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 190.6. "Therapeutic
classification" or "therapeutic category", for purposes of
IC 12-15-35, has the meaning set forth in IC 12-15-35-17.5.
SECTION 9. IC 12-7-2-196.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 196.5. "Unrestricted access",
for purposes of IC 12-15-35.5, has the meaning set forth in
IC 12-15-35.5-2.5.
SECTION 10. IC 12-15-5-6 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 6. The office may not limit the number of
brand name prescription drugs a recipient may receive under the
program.
SECTION 11. IC 12-15-12-14, AS ADDED BY P.L.291-2001,
SECTION 160, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2002]: Sec. 14. (a) This section applies to a
Medicaid recipient: who:
(1) who is determined by the office to be eligible for enrollment
in a Medicaid managed care program; and
(2) whose Medicaid eligibility is not based on the individual's
aged, blind, or disabled status; and
(3) who resides in a county having a population of:
(A) more than one hundred fifty thousand (150,000) but less
than one hundred sixty thousand (160,000). one hundred
eighty-two thousand seven hundred ninety (182,790) but
less than two hundred thousand (200,000);
(B) more than one hundred sixty thousand (160,000) but less
than two hundred thousand (200,000). one hundred seventy
thousand (170,000) but less than one hundred eighty
thousand (180,000);
(C) more than two hundred thousand (200,000) but less than
three hundred thousand (300,000);
(D) more than three hundred thousand (300,000) but less than
four hundred thousand (400,000); or
(E) more than four hundred thousand (400,000) but less than
seven hundred thousand (700,000).
(b) Not later than January 1, 2003, the office shall require a
recipient described in subsection (a) to enroll in the risk-based
managed care program.
(c) The office:
(1) shall apply to the United States Department of Health and
Human Services for any approval necessary; and
(2) may adopt rules under IC 4-22-2;
to implement this section.
SECTION 12. IC 12-15-35-4.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 4.5. As used in this chapter,
"covered outpatient drug" has the meaning set forth in 42 U.S.C.
1396r-8(k)(2).
SECTION 13. IC 12-15-35-17.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 17.5. As used in this chapter,
"therapeutic classification" or "therapeutic category" means a
group of pharmacologic agents primarily characterized by a
significant similarity of the biochemical or physiological
mechanism by which these agents result in the intended clinical
outcome.
SECTION 14. IC 12-15-35-20.1, AS ADDED BY P.L.231-1999,
SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 20.1. (a) Each board member and each
therapeutics committee member shall fully disclose any potential
conflicts of interest, financial or otherwise, relating to an issue that
comes before the board or committee for recommendation or other
action.
(b) A board member or therapeutics committee member may not
vote on a recommendation or other action if the member or the
member's employer has a conflict of interest, financial or otherwise, in
the outcome of the vote.
(c) A board member or therapeutics committee member who may
not vote on a recommendation or other action under subsection (b) may
still participate in any discussions regarding the recommendation or
other action.
SECTION 15. IC 12-15-35-20.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 20.5. (a) The therapeutics
committee is established as a subcommittee of the board.
(b) The chairperson of the board elected under section 25 of this
chapter shall, with the approval of a majority of a quorum of the
board, appoint the members of the therapeutics committee.
(c) The therapeutics committee is composed of the following
members:
(1) Five (5) physicians licensed under IC 25-22.5, including:
(A) one (1) physician with expertise in the area of family
practice;
(B) one (1) physician with expertise in the area of
pediatrics;
(C) one (1) physician with expertise in the area of
geriatrics;
(D) one (1) physician with expertise in psychiatric
medicine; and
(E) one (1) physician with expertise in the area of internal
medicine and who specializes in the treatment of diabetes.
(2) Two (2) pharmacists who are licensed under IC 25-26 and
who have a doctor of pharmacy degree or an equivalent
degree.
(d) Not more than three (3) of the individuals appointed by the
chairperson under subsection (b) to the therapeutics committee
may also be members of the board.
(e) At least three (3) of the members described in subsection
(c)(1) and appointed under subsection (b) must have at least three
(3) years of recent experience in prescription drug formulary
management, including therapeutic category review.
(f) A member of the therapeutics committee may not:
(1) be employed by; or
(2) contract with;
the state or a pharmaceutical manufacturer or labeler. However,
this subsection does not apply to a physician or a pharmacist whose
only contract with the state is a Medicaid provider agreement
under IC 12-15-11 or a provider agreement under the children's
health insurance program under IC 12-17.6.
(g) The term of a member of the therapeutics committee is three
(3) years. A member may be reappointed to the committee upon
the completion of the member's term.
(h) The expenses of the therapeutics committee shall be paid by
the office.
(i) Each member of the therapeutics committee is entitled to the
minimum salary per diem provided by IC 4-10-11-2.1(b). The
member is also entitled to reimbursement for traveling expenses as
provided under IC 4-13-1-4 and other expenses actually incurred
in connection with the member's duties as provided in the state
policies and procedures established by the Indiana department of
administration and approved by the budget agency.
(j) The affirmative votes of a majority of a quorum of the
therapeutics committee are required for the committee to take
action on any measure. A quorum of the therapeutics committee
consists of four (4) members.
(k) The therapeutics committee shall meet:
(1) upon the call of the chairperson of the therapeutics
committee; and
(2) at least quarterly.
(l) The chairperson and the vice chairperson of the therapeutics
committee:
(1) each serve for a term of one (1) year; and
(2) must be elected from the therapeutics committee's
membership at the therapeutics committee's first meeting
each calendar year.
(m) A meeting held by the therapeutics committee must be open
to the public in accordance with IC 5-14-1.5. However, the
therapeutics committee may meet in executive session only for the
purpose of reviewing confidential or proprietary information.
SECTION 16. IC 12-15-35-26, AS AMENDED BY P.L.291-2001,
SECTION 162, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 26. (a) The secretary shall
provide additional staff to the board.
fraud, abuse, gross overuse, or inappropriate or medically
unnecessary care among physicians, pharmacists, and
recipients.
(B) Potential or actual severe or adverse reactions to drugs.
(C) Therapeutic appropriateness.
(D) Overutilization or underutilization.
(E) Appropriate use of generic drugs.
(F) Therapeutic duplication.
(G) Drug-disease contraindications.
(H) Drug-drug interactions.
(I) Incorrect drug dosage and duration of drug treatment.
(J) Drug allergy interactions.
(K) Clinical abuse and misuse.
(9) The adoption and implementation of procedures designed to
ensure the confidentiality of any information collected, stored,
retrieved, assessed, or analyzed by the board, staff to the board, or
contractors to the DUR program that identifies individual
physicians, pharmacists, or recipients.
(10) The implementation of additional drug utilization review
with respect to drugs dispensed to residents of nursing facilities
shall not be required if the nursing facility is in compliance with
the drug regimen procedures under 410 IAC 16.2-3-8 and 42 CFR
483.60.
(11) The research, development, and approval of a preferred
drug list for:
(A) Medicaid's fee for service program;
(B) Medicaid's primary care case management program;
and
(C) the primary care case management component of the
children's health insurance program under IC 12-17.6;
in consultation with the therapeutics committee.
(12) The approval of the review and maintenance of the
preferred drug list at least two (2) times per year.
(13) The preparation and submission of a report concerning
the preferred drug list at least two (2) times per year to the
select joint commission on Medicaid oversight established by
IC 2-5-26-3.
(14) The collection of data reflecting prescribing patterns
related to treatment of children diagnosed with attention
deficit disorder or attention deficit hyperactivity disorder.
(b) The board shall use the clinical expertise of the therapeutics
committee in developing a preferred drug list. The board shall also
consider expert testimony in the development of a preferred drug
list.
(c) In researching and developing a preferred drug list under
subsection (a)(11), the board shall do the following:
(1) Use literature abstracting technology.
(2) Use commonly accepted guidance principles of disease
management.
(3) Develop therapeutic classifications for the preferred drug
list.
(4) Give primary consideration to the clinical efficacy or
appropriateness of a particular drug in treating a specific
medical condition.
(5) Include in any cost effectiveness considerations the cost
implications of other components of the state's Medicaid
program and other state funded programs.
(d) Prior authorization is required for coverage under a
program described in subsection (a)(11) of a drug that is not
included on the preferred drug list.
(e) The board shall determine whether to include a single source
covered outpatient drug that is newly approved by the federal
Food and Drug Administration on the preferred drug list not later
than sixty (60) days after the date of the drug's approval. However,
if the board determines that there is inadequate information about
the drug available to the board to make a determination, the board
may have an additional sixty (60) days to make a determination
from the date that the board receives adequate information to
perform the board's review. Prior authorization may not be
automatically required for a single source drug that is newly
approved by the federal Food and Drug Administration and that
is:
(1) in a therapeutic classification:
(A) that has not been reviewed by the board; and
(B) for which prior authorization is not required; or
(2) the sole drug in a new therapeutic classification that has
not been reviewed by the board.
(f) The board may not exclude a drug from the preferred drug
list based solely on price.
(g) The following requirements apply to a preferred drug list
developed under subsection (a)(11):
(1) The office or the board may require prior authorization
for a drug that is included on the preferred drug list under the
following circumstances:
under section 28 of this chapter.
(2) Submit to the board a proposed preferred drug list that
has been approved by a majority of a quorum of the
therapeutics committee.
(3) Advise and make recommendations to the board in the
board's review and maintenance of a preferred drug list.
SECTION 19. IC 12-15-35-28.7 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 28.7. (a) The board shall
submit the initial approved preferred drug list to the office not
later than August 1, 2002.
(b) Except as permitted under subsection (g), the office may not
further restrict the status of a drug in the Medicaid program or the
children's health insurance program until the board reviews a
therapeutic classification and the office implements the therapeutic
classification on the preferred drug list.
(c) The office shall provide advance notice to providers of the
contents of the preferred drug list submitted by the board under
subsection (a).
(d) Notwithstanding IC 12-15-13-6, the office shall implement
any change in the preferred drug list not later than thirty (30) days
after the date the board submits the amended list to the office.
(e) The office may not implement a preferred drug list or an
amendment to the preferred drug list that has not been approved
by the board.
(f) The office may not require prior authorization for a drug
that is excluded from the preferred drug list unless the board has
made the determinations required under section 35 of this chapter.
(g) The office may adopt rules under IC 4-22-2 necessary to
carry out this chapter.
SECTION 20. IC 12-15-35-35, AS AMENDED BY P.L.231-1999,
SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 35. (a) As used in this section, "single source
drug" means a covered outpatient drug that is produced or distributed
under an original new drug application approved by the federal Food
and Drug Administration, including a drug product marketed by any
cross-licensed producers or distributors operating under the new drug
application.
(b) (a) Before the board develops a program to place a single source
drug on prior approval, restrict the drug in its use, or establish a drug
monitoring process or program to measure or restrict utilization of
single source drugs other than in the SURS program, the board must
meet the following conditions:
(1) Make a determination, after considering evidence and credible
information provided to the board by the office and the public,
that placing a single source drug on prior approval or restricting
the drug's use will not:
(A) impede the quality of patient care in the Medicaid
program; or
(B) increase costs in other parts of the Medicaid program,
including hospital costs and physician costs.
(2) Meet to review a formulary or a restriction on a single source
drug after the office provides at least thirty (30) fifteen (15) days
notification to the public that the board will review the formulary
or restriction on a single source drug at a particular board
meeting. The notification shall contain the following information:
(A) A statement of the date, time, and place at which the board
meeting will be convened.
(B) A general description of the subject matter of the board
meeting.
(C) An explanation of how a copy of the formulary to be
discussed at the meeting may be obtained.
The board shall meet to review the formulary or the restriction on
a single source drug at least thirty (30) fifteen (15) days but not
more than sixty (60) days after the notification.
(3) Ensure that:
(A) there is access to at least two (2) alternative drugs within
each therapeutic classification, if available, on the formulary;
and
(B) a process is in place through which a Medicaid recipient
has access to medically necessary drugs.
(4) Reconsider the drug's removal from its restricted status or
from prior approval not later than six (6) months after the single
source drug is placed on prior approval or restricted in its use.
(5) Ensure that the program provides either telephone or FAX
approval or denial Monday through Friday, twenty-four (24) hours
a day. The office must provide the approval or denial within
twenty-four (24) hours after receipt of a prior approval request.
The program must provide for the dispensing of at least a
seventy-two (72) hour supply of the drug in an emergency
situation or on weekends.
(6) Ensure that any prior approval program or restriction on the
use of a single source drug is not applied to prevent acceptable
medical use for appropriate off-label indications.
board to conduct its review under subsection (a).
(c) The board shall report to the select joint commission on
Medicaid oversight established by IC 2-5-26-3 at least one (1) time
per year on the board's review under subsection (a).
SECTION 23. IC 12-15-35.5-2.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 2.5. As used in this chapter,
"unrestricted access" means the ability of a recipient to obtain a
prescribed drug without being subject to limits or preferences
imposed by the office or the board for the purpose of cost savings
except as provided under IC 12-15-35-8 and section 7 of this
chapter.
SECTION 24. IC 12-15-35.5-4, AS ADDED BY HEA 1233-2002,
SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]:
Sec. 4. Prior authorization requirements developed under this
chapter must:
(1) comply with all applicable state and federal laws, including
the provisions of 405 IAC 5-3 and 42 U.S.C. 1396r-8(d)(5); and
(2) provide that the prior authorization number assigned to an
approved request be included on the prescription or drug order:
(A) issued by the prescribing physician; practitioner; or
(B) if the prescription is transmitted orally, relayed to the
dispensing pharmacist by the prescribing physician.
practitioner.
SECTION 25. IC 12-17.6-3-3, AS ADDED BY P.L.273-1999,
SECTION 177, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2002]: Sec. 3. (a) Subject to subsection (b), a
child who is eligible for the program shall receive services from the
program until the earlier of the following:
(1) The end of a period of twelve (12) consecutive months
following the determination of the child's eligibility for the
program. The child becomes financially ineligible.
(2) The child becomes nineteen (19) years of age.
(b) Subsection (a) applies only if the child and the child's family
comply with enrollment requirements.
SECTION 26. IC 12-17.6-4-8, AS ADDED BY P.L.291-2001,
SECTION 158, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 8. (a) The office shall require
the use of generic drugs in the program.
(b) The office shall use the preferred drug list implemented
under IC 12-15-35-28.7.
notice is given to the board, the board shall recommend similar control
of the substance under this article in the board's report to the general
assembly, unless the board objects to inclusion or rescheduling. In that
case, the board shall publish the reasons for objection and afford all
interested parties an opportunity to be heard. At the conclusion of the
hearing, the board shall publish its findings.
(e) If a substance is rescheduled to a less restrictive schedule or
deleted as a controlled substance under federal law, the substance is
rescheduled or deleted under this article. If the board objects to
inclusion, rescheduling, or deletion of the substance, the board shall
notify the chairman of the legislative council not more than thirty (30)
days after the federal law is changed and the substance may not be
rescheduled or deleted until the conclusion of the next complete
session of the general assembly. The notice from the board to the
chairman of the legislative council must be published.
(f) There is established a fifteen (15) sixteen (16) member
controlled substances advisory committee to serve as a consultative and
advising body to the board in all matters relating to the classification,
reclassification, addition to, or deletion from of all substances
classified as controlled substances in schedules I to IV or substances
not controlled or yet to come into being. In addition, the advisory
committee shall conduct hearings and make recommendations to the
board regarding revocations, suspensions, and restrictions of
registrations as provided in IC 35-48-3-4. All hearings shall be
conducted in accordance with IC 4-21.5-3. The advisory committee
shall be made up of:
(1) two (2) physicians licensed under IC 25-22.5, one (1) to be
elected by the medical licensing board of Indiana from among its
members and one (1) to be appointed by the governor;
(2) two (2) pharmacists, one (1) to be elected by the state board
of pharmacy from among its members and one (1) to be appointed
by the governor;
(3) two (2) dentists, one (1) to be elected by the state board of
dentistry from among its members and one (1) to be appointed by
the governor;
(4) the state toxicologist or the designee of the state toxicologist;
(5) two (2) veterinarians, one (1) to be elected by the state board
of veterinary medical examiners from among its members and one
(1) to be appointed by the governor;
(6) one (1) podiatrist to be elected by the board of podiatric
medicine from among its members;
(7) one (1) advanced practice nurse with authority to prescribe
legend drugs as provided by IC 25-23-1-19.5 who is:
(A) elected by the state board of nursing from among the
board's members; or
(B) if a board member does not meet the requirements under
IC 25-23-1-19.5 at the time of the vacancy on the advisory
committee, appointed by the governor;
(8) the superintendent of the state police department or the
superintendent's designee; and
(9) three (3) members appointed by the governor who have
demonstrated expertise concerning controlled substances; and
(10) one (1) member appointed by the governor who is a
psychiatrist with expertise in child and adolescent psychiatry.
(g) All members of the advisory committee elected by a board shall
serve a term of one (1) year and all members of the advisory committee
appointed by the governor shall serve a term of four (4) years. Any
elected or appointed member of the advisory committee, may be
removed for cause by the authority electing or appointing the member.
If a vacancy occurs on the advisory committee, the authority electing
or appointing the vacating member shall elect or appoint a successor to
serve the unexpired term of the vacating member. The board shall
acquire the recommendations of the advisory committee pursuant to
administration over the controlled substances to be or not to be
included in schedules I to V, especially in the implementation of
scheduled substances changes as provided in subsection (d).
(h) Authority to control under this section does not extend to
distilled spirits, wine, or malt beverages, as those terms are defined or
used in IC 7.1, or to tobacco.
(i) The board shall exclude any nonnarcotic substance from a
schedule if that substance may, under the Federal Food, Drug, and
Cosmetic Act or state law, be sold over the counter without a
prescription.
SECTION 32. IC 12-15-2-15.7 IS REPEALED [EFFECTIVE JULY
1, 2002].
SECTION 33. [EFFECTIVE JULY 1, 2002] (a) As used in this
SECTION, "advisory committee" refers to the controlled
substances advisory committee established by IC 35-48-2-1(f), as
amended by this act.
(b) The advisory committee shall review the records maintained
for the previous year by the central repository for controlled
substances designated by the state police department under
IC 35-48-7-10 regarding the prescribing of stimulant medications
approved by the federal Food and Drug Administration for the
treatment of attention deficit disorder or attention deficit
hyperactivity for children less than eighteen (18) years of age.
(c) Not later than October 1, 2002, the advisory committee shall
submit a report containing information obtained under subsection
(b) to the drug utilization review board established by
IC 12-15-35-19.
(d) The report required under subsection (c) may not contain
any information that:
(1) may be used to identify a child for whom a stimulant
medication was prescribed; or
(2) indicates that a particular physician's prescribing of
stimulant medications to a child was inappropriate.
(e) Any meeting held by the advisory committee to comply with
this SECTION is not open to the public.
(f) Unless otherwise provided by law, records reviewed by the
advisory committee to comply with this SECTION are not public
records.
(g) The drug utilization review board shall review:
(1) the report submitted under subsection (c);
(2) information submitted under:
(A) IC 5-10-8-12, as added by this act;
(B) IC 27-8-30, as added by this act; and
(C) IC 27-13-42, as added by this act;
(3) information submitted by the office of Medicaid policy and
planning regarding the prescribing of stimulant medications
approved by the federal Food and Drug Administration for
the treatment of attention deficit disorder and attention
deficit hyperactivity disorder for children less than eighteen
(18) years of age who participate in:
(A) Medicaid under IC 12-15; or
(B) the children's health insurance program under
IC 12-17.6; and
(4) any other relevant information concerning the prescribing
of stimulant medications approved by the federal Food and
Drug Administration for the treatment of attention deficit
disorder or attention deficit hyperactivity for children less
than eighteen (18) years of age.
(h) Before December 31, 2002, the drug utilization review board
shall submit a report analyzing the information reviewed under
subsection (g) to the following:
(1) The select joint commission on Medicaid oversight
established by IC 2-5-26-3.
program should include a requirement for copayments or
premium payments.
(4) Marketing and outreach strategies.
(5) Administrative structure and delivery systems.
(6) Evaluation.
(e) The recommendations shall address the following:
(1) Cost-effectiveness of program design.
(2) Coordination with existing pharmaceutical assistance
programs.
(3) Strategies to minimize crowd-out of private insurance.
(4) Reasonable balance between maximum eligibility levels
and maximum benefit levels.
(5) Feasibility of a health care subsidy program where the
amount of the subsidy is based on income.
(6) Advisability of entering into contracts with health
insurance companies to administer the program.
(f) The committee may not recommend the use of funds from the
Indiana prescription drug account for a state prescription drug
benefit for low-income senior citizens if there is a federal statute or
program, other than a federal Medicaid waiver, providing a
similar prescription drug benefit for the benefit of low-income
senior citizens.
(g) This SECTION expires December 31, 2005.
SECTION 36. [EFFECTIVE UPON PASSAGE] (a) As used in this
SECTION, "office" refers to the office of Medicaid policy and
planning.
(b) The office shall develop a federal Medicaid waiver
application under which a prescription drug program may be
established or implemented to provide access to prescription drugs
for low-income senior citizens.
(c) Before the office may submit an application for a federal
Medicaid waiver that will have an effect on the Indiana
prescription drug program established under IC 12-10-16, the
following must occur:
(1) The office shall submit the proposed Medicaid waiver to
the prescription drug advisory committee established under
this act.
(2) The prescription drug advisory committee must review,
allow public comment, and approve the proposed Medicaid
waiver.
(d) A prescription drug program established or implemented by
the office or a contractor of the office under this SECTION may
only limit access to prescription drugs for prescription drug
program recipients to the extent that restrictions are in place in the
Medicaid program on the date of enactment of this act.
(e) Changes to a prescription drug program that:
(1) is established or implemented by the office or a contractor
of the office under this SECTION; and
(2) uses money from the Indiana prescription drug account
established under IC 4-12-8-2;
must be approved by the prescription drug advisory committee
established under this act.
(f) Before July 1, 2002, the office shall apply to the United States
Department of Health and Human Services for approval of any
waiver necessary under the federal Medicaid program to provide
access to prescription drugs for low income senior citizens.
(g) A Medicaid waiver developed under this SECTION must
limit a prescription drug program's state expenditures to funding
appropriated to the Indiana prescription drug account established
under IC 4-12-8-2 from the Indiana tobacco master settlement
agreement fund.
(h) The office may not implement a waiver under this SECTION
until the office files an affidavit with the governor attesting that the
federal waiver applied for under this SECTION is in effect. The
office shall file the affidavit under this subsection not later than
five (5) days after the office is notified that the waiver is approved.
(i) If the office receives a waiver under this SECTION from the
United States Department of Health and Human Services and the
governor receives the affidavit filed under subsection (f), the office
shall implement the waiver not more than sixty (60) days after the
governor receives the affidavit.
SECTION 37. [EFFECTIVE UPON PASSAGE] (a) There is
appropriated from the Indiana tobacco master settlement
agreement fund (IC 4-12-1-14.3) fifteen million five hundred
sixteen thousand six hundred eighteen dollars ($15,516,618) to the
Indiana prescription drug account established under IC 4-12-8-2.
The budget agency shall allot the money appropriated under this
subsection for the Indiana prescription drug account.
(b) Notwithstanding IC 4-12-1-14.3, the amount appropriated
under subsection (a) is the remainder of the amount appropriated
under P.L.21-2000, SECTION 12 for the Indiana prescription drug
program that was not placed in the Indiana prescription drug
account and does not count against the maximum amount of
expenditures, transfers, or distributions that may be made from
the Indiana tobacco master settlement agreement fund during the
state fiscal year.
(c) This SECTION expires July 1, 2004.
SECTION 38. [EFFECTIVE UPON PASSAGE] (a) As used in this
SECTION, "office" refers to the office of the secretary of family
and social services.
(b) As used in this SECTION, "point of sale system" means a
system that uses an electronic hardware device that is:
(1) operated by a pharmacist on behalf of the office; and
(2) capable of:
(A) reading information on a card that is issued by the
office; and
(B) providing an immediate prescription drug benefit to
the eligible recipient.
(c) Before July 1, 2002, the office shall establish and implement
a point of sale system for the Indiana prescription drug program
established under IC 12-10-16.
(d) This SECTION expires July 1, 2002.
SECTION 39. [EFFECTIVE JULY 1, 2002] (a) As used in this
SECTION, "office" refers to the office of Medicaid policy and
planning established under IC 12-8-6-1.
(b) Before September 1, 2002, the office shall apply to the United
States Department of Health and Human Services to do the
following:
(1) Amend the state's waiver under 42 U.S.C. 1396n(b)(1) to
include the aged, blind, and disabled in the managed care
program under IC 12-15-12.
(2) Amend the state Medicaid plan in accordance with this
act.
(c) The office may not implement the amendments under
subsection (b) until the office files an affidavit with the governor
attesting that the amendments applied for under this SECTION
have been approved. The office shall file the affidavit under this
subsection not later than five (5) days after the office is notified
that the amendments are approved.
(d) If the United States Department of Health and Human
Services approves the amendments applied for under this
SECTION and the governor receives the affidavit filed under
subsection (c), the office shall implement the amendments not more
than sixty (60) days after the governor receives the affidavit.
(e) The office may adopt rules under IC 4-22-2 to implement this
SECTION.
(f) This SECTION expires December 31, 2008.
SECTION 40. [EFFECTIVE UPON PASSAGE] The chairperson
shall make the appointments required under IC 12-15-35-20.5, as
added by this act, not more than thirty (30) days after the effective
date of this act.
SECTION 41. [EFFECTIVE UPON PASSAGE] (a) As used in this
SECTION, "committee" refers to the therapeutics committee
established by IC 12-15-35-20.5, as added by this act.
(b) The initial terms of office for the members of the committee
are as follows:
(1) Of the members appointed under IC 12-15-35-20.5(c)(1),
as added by this act:
(A) one (1) member shall be appointed for a term of one (1)
year;
(B) two (2) members shall be appointed for a term of two
(2) years; and
(C) two (2) members shall be appointed for a term of three
(3) years.
(2) Of the members appointed under IC 12-15-35-20.5(c)(2),
as added by this act:
(A) one (1) member shall be appointed for a term of two (2)
years; and
(B) one (1) member shall be appointed for a term of three
(3) years.
(c) This SECTION expires December 31, 2003.
SECTION 42. An emergency is declared for this act.