An Act To Increase Public Access to the Prior Authorization Process
Maine Legislature, Session 121, LD 1288
Committee: Health and Human Services
Sponsors: TURNER, BRENNAN, MARTIN, WESTON, KANE
Amends: 22 MRSA §3174-D

Legislative Document 
No. 1288 
S.P.419 
In Senate, March 11, 2003 
An Act To Increase Public Access to the Prior Authorization Process 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Senator TURNER of Cumberland. 
Cosponsored by Representative DUG A Y of Cherryfield and 
JOY J. O'BRIEN 
Secretary of the Senate 
Senators: BRENNAN of Cumberland, MARTIN of Aroostook, WESTON of Waldo, 
Representati ves: CURLEY of Scarborough, KANE of Saco. 
Printed 011 recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 22 MRSA §3174-DD is enacted to read: 
§3174-DD. 
Drug Utilization Review Committee 
1. 
Authority. 
The 
department 
has 
the 
authority 
to 
determine 
which 
prescription 
and 
over-the-counter 
drugs 
are 
subject to prior authorization and coverage under the MaineCare 
program. 
2. 
Drug Utilization Review Committee. 
In order to make 
determinations regarding which prescription and over-the-counter 
drugs are subject to prior authorization, the Drug Utilization 
Review Committee, referred to in this section as "the committee," 
is established. 
A. 
The committee is composed of an equal number of actively 
practicing physicians and actively practicing pharmacists, 
totaling not fewer than 6 individuals. 
The department shall 
appoint the members of the committee and establish their 
terms. 
B. 
Public notice of the date, time and location of all 
meetings of the committee must be made in accordance with 
Title 1, section 406 at least 7 days in advance of the 
meeting. 
This notice must also include a list of all drugs 
to be considered for prior authorization at that meeting. 
The 
meetings 
must be 
considered public proceedings, 
for 
purposes of Title L 
chapter 13. 
Members of the public, 
including health care providers and drug manufacturers, who 
are physically present at committee meetings must be granted 
reasonable opportunity to address the committee prior to any 
vote. 
C. 
At the conclusion of a meeting pursuant to paragraph B, 
committee members shall record their vote for each drug on a 
form 
to 
be 
supplied at each meeting. 
After 
adding or 
deleting a drug from the list of drugs that require prior 
authorization, the committee shall issue written findings 
setting forth the evidentiary basis for its decision. 
These 
findings 
must 
address, 
without 
limitation, 
all 
relevant 
clinical data, as well as the likelihood that subjecting a 
drug 
to prior 
authorization will 
cause 
adverse 
medical 
results 
or 
affect 
patients' 
access 
to 
all 
medically 
necessary outpatient drugs. 
A vote of at least 2/3 of the 
committee members present is required to add or delete a 
drug from the list of drugs that require prior authorization. 
Page l-LR1737(1) 
D. 
All documents generated by the committee are public 
records for purposes of Title 1, chapter 13 and must be 
maintained on file at the Bureau of Medical Services. 
3. 
Appeals. 
A determination that a particular drug is 
subject to prior authorization constitutes final agency action 
within the meaning of the Maine Administrative Procedure Act and 
is subject to judicial review under the Maine Administrative 
Procedure Act. 
Persons entitled to appeal a decision of the 
committee to subject a particular drug to prior authorization are 
limited to: 
A. 
MaineCare recipients who were being prescribed the drug 
at the time of the committee's decision; 
B. 
Health care providers who had prescribed the drug at the 
time of the committee's decision; and 
C. 
The manufacturer of the drug. 
4. 
Rules. 
The department shall adopt rules to implement 
this section. 
Rules 
adopted pursuant to this subsection are 
routine technical rules 
as defined in Title 5, 
chapter 
375, 
subchapter 2-A. 
SUMMARY 
This 
bill 
establishes 
the 
Drug 
Utilization 
Review 
Committee. 
The committee makes determinations regarding which 
prescription and over-the-counter drugs 
are 
subject to prior 
authorization under the MaineCare program. 
The bill requires 
public notice of committee meetings to be given, 
and provides 
that committee meetings 
are public proceedings 
and 
committee 
documents are public records for purposes of the laws governing 
freedom of access. 
It provides that members of the public must 
be granted a reasonable opportunity to address the committee and 
requires the committee to issue written findings that describe 
the basis for its decisions. 
It also provides that a 2/3 vote of 
the committee is required to add or delete a drug from the list 
of drugs that require prior authorization and that the decisions 
of the committee are final agency action for purposes of the 
Maine Administrative Procedure Act.