Resolve, To Increase the Quality of Care and Reduce Administrative Burdens in the Pharmacy Prior Approval Process Further amend the bill by striking out everything after the title and inserting in its place the following: Sec. 1. Preferred drug lists and prior authorization. Resolved: That the Department of Health and Human Services shall take the following actions to promote the quality of care and reduce administrative burdens in the pharmacy prior approval process. 1. The department shall specify on the preferred drug list and on the prior authorization form the number, titration if required and classes of preferred drugs that must be determined to be clinically inappropriate or ineffective before the department will permit the use of a nonpreferred drug. 2. In the next changes to the MaineCare Benef i ts Manual, but no later than January 15, 2006, the department shall adopt a provision to articulate the current standards for off-label drug use of prescription drugs for children. Page l-LR1953(2) COMMITTEE AMENDMENT
Maine Legislature, Session 122, LD 1404
Committee Amendment CA_A_S332 (Senate)

COMMITTEE AMENDMENT "A, to S.P. 493, L.D. 1404, Bill, "An 
Act To Increase the Quality of Care and Reduce Administrative 
Burdens in the Pharmacy Prior Approval Process" 
Amend the bill by striking out the title and substituting 
the following: 
'Resolve, 
To 
Increase 
the 
Quality 
of 
Care 
and 
Reduce 
Administrative Burdens in the Pharmacy Prior Approval Process' 
Further amend the bill by striking out everything after the 
title and inserting in its place the following: 
'Sec. 1. Preferred drug lists and prior authorization. Resolved: 
That the Department of Health and Human Services shall take the 
following actions to promote the quality of care and reduce 
administrative burdens in the pharmacy prior approval process. 
1. 
The department shall specify on the preferred drug list 
and on the prior authorization form the number, titration if 
required and classes of preferred drugs that must be determined 
to 
be 
clinically 
inappropriate 
or 
ineffective 
before 
the 
department will permit the use of a nonpreferred drug. 
2. 
In the next changes to the MaineCare Benef i ts Manual, 
but no later than January 15, 2006, the department shall adopt a 
provision to articulate the current standards for off-label drug 
use of prescription drugs for children. 
Page l-LR1953(2) 
COMMITTEE AMENDMENT 
~ r!.\-
,'" 
COMMITTEE AMENDMENT .J'\. to S.P. 493, L.D. 1404 
3. 
The department shall change 
the prior authorization 
forms to provide examples of clinical conditions and functional 
limitations that could support a waiver of prior authorization. 
4. 
By January 2006, the department shall amend its rules 
regarding 
prior 
authorization 
to 
include 
the 
criteria 
for 
approving special 
exception overrides. 
The 
department 
shall 
arrange to modify the message screen to include a reminder that 
overrides may be available. 
The message format must comply with 
National Council for Prescription Drug Programs standards. 
5. 
By October 1, 2005, the department shall minimize the 
burden on providers of submitting duplicative medical records on 
behalf of a MaineCare member. 
In order to reduce the submission 
of duplicate information, the department shall work to provide 
notice to providers of the types of documentation required and to 
create a prior authorization file for each member. 
6. 
The department shall provide prompt notice of changes to 
the preferred drug list through posting on its website, its group 
electronic mailings 
regarding pharmacy issues 
and notices to 
provider organizations. 
7. 
The department shall arrange to allow submission of the 
prior authorization form and other required documentation as an 
e-mail attachment when such submissions are feasible. 
8. 
By January 15, 
2006, 
the department shall amend its 
rules regarding the drug utilization review committee under the 
MaineCare 
Benefits 
Manual, 
chapter 
II, 
section 
80.01-13 
to 
establish conflict-of-interest 
standards 
for 
members 
of 
the 
committee. 
9. 
The department shall consult with the MaineCare Advisory 
Committee on the design of future studies related to pharmacy 
prior authorization, including a 
survey of MaineCare members. 
The department shall report to the Joint Standing Committee on 
Health and Human Services by February 1, 2006 on its progress in 
implementing this subsection.' 
SUMMARY 
This amendment replaces the bill with a resolve that directs 
the Department of Health and Human Services to undertake a number 
of 
initiatives, 
including 
rulemaking 
regarding 
prior 
authorization, preferred drug lists and procedures for providers 
to follow for members of the MaineCare program. 
FISCAL :\OTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 06/02/05 ~ac:.. 
LD 1404 
LR 1953(02) 
An Act To Increase the Quality of Care and Reduce Administrative Burdens in the Pharmacy Prior 
Approval Process 
Fiscal Detail and Notes 
Fiscal Note for Bill as Amended by Committee Amendment ,A, 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Additional costs to the Department of Health and Humans Services are expected to be minor and can be absorbed 
utilizing existing budgetary resources. 
LR1953(2) - Fiscal Note - Page 1 of 1