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TO AMEND CHAPTER 6 OF TITLE 44, CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING ARTICLE 8 SO AS TO ESTABLISH THE PHARMACY AND THERAPEUTICS COMMITTEE WITHIN THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, TO PROVIDE FOR THE MEMBERSHIP, ORGANIZATION, AND DUTIES OF THE COMMITTEE, AND TO PROVIDE THAT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES SHALL ADHERE TO CERTAIN PROVISIONS WHEN IMPLEMENTING THE PREFERRED DRUG LIST.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Chapter 6, Title 44 of the 1976 Code is amended by adding:
Section 44-6-1000. For purposes of this chapter:
(1) 'Chairman' means Chairman of the Pharmacy and Therapeutics Committee.
(2) 'Committee' means the Pharmacy and Therapeutics Committee.
(3) 'Department' means the Department of Health and Human Services.
(4) 'Director' means the Director of the Department of Health and Human Services.
Section 44-6-1010. (A) There is established within the department the Pharmacy and Therapeutics Committee. The committee shall consist of fifteen members appointed by the director and serving at his pleasure. The members shall include eleven physicians and four pharmacists licensed to practice in South Carolina and actively engaged in providing services to the South Carolina Medicaid population. The physicians may include, but are not limited to, doctors who have experience in treating diabetes, cancer, HIV/AIDS, mental illness, and hemophilia and who practice in internal medicine, primary care, and pediatrics. (B) The committee shall adopt by-laws that include, at a minimum, the length of term of a membership. A chairman and vice-chairman shall be elected on an annual basis from the committee membership. Committee members must not be compensated for service on the committee. However, committee members may be reimbursed for actual and necessary expenses incurred pursuant to discharging committee duties in an amount not to exceed the mileage and subsistence amounts allowed by law for members of boards, commissions, and committees.
(C) The committee shall meet at least quarterly and may meet at other times at the discretion of the chairman or the director. Committee meetings are subject to the provisions of the Freedom of Information Act. The department shall publish notice of regular business meetings of the committee at least thirty days before the meeting. However, the director or chairman may call special meetings of the committee and provide such public notice as may be practical.
(D) The committee shall provide for public comment, including comment on clinical and patient care data from Medicaid providers, representatives of the pharmaceutical industry, and patient advocacy groups. Trade secrets as defined in Section 30-4-40(a)(1) and relevant federal law must not be publicly disclosed.
(E) The committee shall recommend to the department therapeutic classes of drugs that should be included on a Preferred Drug List. For those recommended classes, the committee shall recommend the drug or drugs considered preferred within that class based on safety and efficacy. In determining safety and efficacy, the committee may consider all submitted public comment or clinical information including, but not limited to, scientific evidence, standards of practice, peer-reviewed medical literature, randomized clinical trials, pharmacoeconomic studies, and outcomes research data. The committee also shall recommend prior authorization criteria for nonpreferred drugs in the recommended therapeutic classes.
Section 44-6-1020. Any Preferred Drug List program implemented by the department must include:
(1) procedures to ensure that a request for prior authorization that has no material defect or impropriety can be processed within twenty-four hours of receipt;
(2) procedures to allow the prescribing physician to request and receive notification of any delay or negative decision in regard to a prior authorization request;
(3) procedures to allow the prescribing physician to request and receive a second review of any denial of a prior authorization request; and
(4) procedures to allow a pharmacist to dispense an emergency, seventy-two-hour supply of a drug requiring prior authorization without such prior authorization if the -pharmacist:
(a) has made a reasonable attempt to contact the prescribing physician and request that the prescribing physician secure prior authorization; and
(b) reasonably believes that refusing to dispense a seventy-two-hour supply would unduly burden the Medicaid recipient and produce undesirable health consequences.
Section 44-6-1030. A grant of prior authorization for a drug is specific to the drug, rather than the actual prescription, and extends to all refills allowed pursuant to the original prescription and to subsequent prescriptions for the same drug at the same dosage provided the time allowed by the prior authorization has not expired.
Section 44-6-1040. A Medicaid recipient who has been denied prior authorization for a prescribed drug is entitled to appeal this decision through the department's appeals process."
SECTION 2. This act takes effect upon approval by the Governor.
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