| | 1-A.__Formulary standards. Any formulary established by the | department must: |
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| A.__Conform to nationally accepted standards for a sound and | adequate drug formulary system that promotes rational, | clinically appropriate and safe access to medically | necessary prescription drugs, ensures that members have | timely and appropriate access to these drugs and does not | discriminate based on disease or condition; |
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| B.__Be structured to maintain at least the same therapeutic | categories and pharmacological classes of drugs provided on | the MaineCare preferred drug list in effect on July 1, 2005; | and |
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| C.__With respect to atypical antipsychotic drugs: |
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| (1)__Ensure that atypical antipsychotic drugs remain | available in the same manner as on July__1, 2005; |
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| (2)__Adopt any clinical edits approved by the | department's psychiatric work group; and |
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| (3)__Conform to national standards for the prescribing | of atypical antipsychotic drugs. |
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| | Sec. X-2. 22 MRSA §3174-M, sub-§2, as enacted by PL 1993, c. 410, Pt. | I, §10, is repealed. |
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| | Sec. X-3. 22 MRSA §3174-M, sub-§2-A is enacted to read: |
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| | 2-A.__Drug formulary committee.__As authorized by Section 1927 | (d) (4) (A) of the federal Social Security Act, 42 United States | Code, Section 1396r-8, the department shall develop a formulary | using the department's MaineCare drug utilization review | committee, except that the membership of the formulary committee | must include pharmacists who are expert in pharmacotherapy for | pediatric, geriatric and psychiatric populations. |
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| A.__A vote of 2/3 of the members of the department's | MaineCare drug utilization review committee present is | required to add or delete a drug from the list of drugs that | are subject to reimbursement and coverage under the | MaineCare program. |
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| B.__A determination under rules adopted pursuant to | subsection 3 that a drug or category of drug is not covered | by the MaineCare program is a final agency action subject to | review under the Maine Administrative Procedure Act. |
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