‘ E. "Stable on a prescription drug" means, with respect to an enrollee, receiving a positive therapeutic outcome on a prescription drug selected by the enrollee's health care provider for the enrollee's medical condition.’
| HP0751 LD 1009 |
Session - 129th Maine Legislature C "A", Filing Number H-432, Sponsored by
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LR 1137 Item 2 |
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| Bill Tracking, Additional Documents | Chamber Status | ||
Amend the bill in section 1 in the first line (page 1, line 2 in L.D.) by striking out the following: "§4320-L" and inserting the following: '§4320-M'
Amend the bill in section 1 in §4320-L in the first line (page 1, line 3 in L.D.) by striking out the following: " §4320-L" and inserting the following: ' §4320-M'
Amend the bill in section 1 in §4320-L in subsection 1 by inserting after paragraph D the following:
Amend the bill in section 1 in §4320-L in subsection 1 by relettering the paragraphs to read alphabetically.
Amend the bill in section 1 in §4320-L in subsection 6 by striking out all of paragraph D (page 3, lines 15 to 21 in L.D.) and inserting the following:
Amend the bill in section 1 in §4320-L in subsection 6 by striking out all of paragraph F (page 3, lines 23 to 28 in L.D.) and inserting the following:
(1) A carrier or utilization review organization from requiring an enrollee to try a generic drug, as defined in Title 32, section 13702-A, subsection 14, or an interchangeable biological product, as defined in Title 32, section 13702-A, subsection 14-A, prior to providing coverage for the equivalent brand-name prescription drug; or
(2) A health care provider from prescribing a prescription drug that is determined to be medically necessary.
Amend the bill in section 1 in §4320-L by striking out all of subsection 7 (page 3, lines 29 to 33 in L.D.) and inserting the following:
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section number to read consecutively.
summary
This amendment conforms the timeline for responding to a request for a step therapy override exception determination with the existing timeline for prior authorization requests. The amendment clarifies the meaning of exigent circumstances and makes clear that a carrier is required to continue to provide access to the prescription drug subject to step therapy protocol during the consideration of a request for a step therapy override exception determination. The amendment also adds a definition of "stable on a prescription drug" and clarifies that the provisions do not prevent a carrier from requiring an enrollee to try an interchangeable biological product. The amendment also changes the allocation of a new section of the statutory provision to avoid a numbering problem.