26B-3-305. Drug prior approval program.
| (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
| (a) |
except as provided in Subsection (2), a drug may not be placed on prior approval for other than medical reasons; |
| (b) |
the board shall hold a public hearing at least 30 days prior to placing a drug on prior approval; |
| (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); |
| (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); |
| (e) |
the board shall provide evidence that placing a drug class on prior approval:
| (i) |
will not impede quality of recipient care; and |
| (ii) |
that the drug class is subject to clinical abuse or misuse; |
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| (f) |
the board shall reconsider its decision to place a drug on prior approval:
| (i) |
no later than nine months after any drug class is placed on prior approval; and |
| (ii) |
at a public hearing with notice as provided in Subsection (1)(b); |
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| (g) |
the program shall provide an approval or denial of a request for prior approval:
| (i) |
by either:
| (C) |
electronic transmission; |
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| (ii) |
at least Monday through Friday, except for state holidays; and |
| (iii) |
within 24 hours after receipt of the prior approval request; |
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| (h) |
the program shall provide for the dispensing of at least a 72-hour supply of the drug on the prior approval program:
| (i) |
in an emergency situation; or |
| (ii) |
on weekends or state holidays; |
|
| (i) |
the program may be applied to allow acceptable medical use of a drug on prior approval for appropriate off-label indications; and |
| (j) |
before placing a drug class on the prior approval program, the board shall:
| (i) |
determine that the requirements of Subsections (1)(a) through (i) have been met; and |
| (ii) |
by majority vote, place the drug class on prior approval. |
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| (2) |
The board may, only after complying with Subsections (1)(b) through (j), consider the cost:
| (a) |
of a drug when placing a drug on the prior approval program; and |
| (b) |
associated with including, or excluding a drug from the prior approval process, including:
| (i) |
potential side effects associated with a drug; or |
| (ii) |
potential hospitalizations or other complications that may occur as a result of a drug’s inclusion on the prior approval process. |
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Renumbered and Amended by Chapter 306, 2023 General Session
