ARTICLE 33 SUBSTITUTE A

RELATING TO MEDICAL ASSISTANCE -- PRESCRIPTION DRUGS

SECTION 1. The department of human services is hereby authorized and directed to amend its practices, procedures, regulations and the Rhode Island state plan for medical assistance (Medicaid) pursuant to title XIX of the federal Social Security Act [42 U.S.C. § 1396 et seq.] to modify the prescription drug program:

(1) to establish a preferred drug list (PDL);

(2) to enter into supplemental rebate, discount or other agreements with pharmaceutical companies; and

(3) to negotiate either state-specific supplemental rebates or to participate in a multi-state pooling supplemental rebate program.

Determinations of drugs included on the PDL will be made by the State Department of Human Services, and a listing of such drugs shall be maintained on a public website. In making these determinations, the department shall consider the recommendations of the Medicaid Pharmaceutical and Therapeutics Committee, whose membership shall include practicing pharmacists and physicians, faculty members of the University of Rhode Island's College of Pharmacy, and consumers or consumer representatives. Drugs exempt from the PDL shall include: (1) antipsychotics; (2) anti-retrovirals; and (3) organ transplant medications. Physicians will be informed about prior authorization procedures for medications not on the PDL, and seventy-two (72) hour emergency supplies may be dispensed if authorizations cannot be obtained.

SECTION 2. The Department of Human Services is hereby authorized and directed to amend its regulations and the Rhode Island State Plan for Medical Assistance (Medicaid) pursuant to title XIX of the federal Social Security Act to modify the fee-for-service program prescription drug reimbursement formula to establish a ceiling equivalent to the combination of the manufacturer's wholesale acquisition cost and a dispensing fee of $3.40 for outpatient prescriptions and $2.85 for long-term care prescriptions.

SECTION 3. This article shall take effect upon passage.