H‑0650.2 _____________________________________________
HOUSE BILL 1652
_____________________________________________
State of Washington 57th Legislature 2001 Regular Session
By Representatives Cody, Campbell, Edmonds and Edwards
Read first time 01/31/2001. Referred to Committee on Health Care.
_1 AN ACT Relating to development of a therapeutic and cost-
_2 effective prescription drug education and utilization system;
_3 adding new sections to chapter 41.05 RCW; adding a new section to
_4 chapter 74.09 RCW; creating a new section; making an
_5 appropriation; providing an effective date; and declaring an
_6 emergency.
_7 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
_8 NEW SECTION. Sec. 1. A new section is added to chapter 41.05
_9 RCW to read as follows:
10 (1) The administrator shall develop, in consultation with state
11 and local agencies and private parties, a therapeutic and cost-
12 effective prescription drug education and utilization system
13 designed to promote therapeutic and cost-effective utilization of
14 prescription drugs by residents of the state of Washington.
15 (2) In developing the system, the administrator shall request
16 the participation of the department of social and health services,
17 the department of health, the department of corrections, the
18 department of labor and industries, the office of the insurance
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_1 commissioner, physicians, advanced registered nurse practitioners,
_2 hospitals, pharmacists, the board of pharmacy, and any other
_3 appropriate licensing boards, consumer representatives, health
_4 plans as defined in RCW 48.43.005, pharmacy benefits management
_5 companies, self-insured employer sponsored health benefits plans,
_6 and any other interested party.
_7 (3) The administrator is authorized to solicit, accept, and
_8 spend public and private grants, contributions, and other funds to
_9 match public funds appropriated to carry out the purposes of this
10 section.
11 (4) The system must include, but is not limited to:
12 (a) The development of a uniform formulary of prescription
13 drugs for state purchased health care, except care purchased or
14 reimbursed by the medicaid program under Title XIX of the federal
15 social security act and local school districts not enrolled in the
16 public employees' benefits board system. The formulary developed by
17 the administrator under this subsection must be based upon careful
18 consideration and pharmacoeconomic analysis of the clinical
19 efficacy and cost of prescription drugs that have been approved by
20 the federal food and drug administration. It must contain standards
21 and procedures for consumer access to medically necessary
22 alternatives to the formulary, and for consumer choice of higher
23 cost alternatives to the formulary where a state purchased health
24 care program has the ability to charge higher cost-sharing amounts
25 for nonformulary prescription drugs. Any other public or private
26 entity may choose to adopt the formulary developed under this
27 subsection;
28 (b) A program of academic detailing and consumer counter-
29 detailing that educates physicians and other prescribers and
30 consumers on the therapeutic and cost-effective utilization of
31 prescription drugs. In developing this program, the administrator
32 shall first assess current private and public sector academic
33 detailing and consumer counter-detailing activities in Washington
34 state. The program developed under this subsection should be
35 designed to complement, coordinate, and strengthen these existing
36 activities;
37 (c) Recommendations for continuing medical education
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_1 opportunities and requirements for physicians and other health
_2 care professionals who prescribe, dispense, or administer
_3 prescription drugs;
_4 (d) A program for drug utilization review and drug utilization
_5 management, including prospective, concurrent, and retrospective
_6 review, to improve the quality of pharmaceutical care by ensuring
_7 that prescriptions provided through state-purchased health care
_8 programs are appropriate, medically necessary, and not likely to
_9 produce adverse medical results; and
10 (e) Any other program or activity designed to ensure optimal
11 therapeutic and cost-effective utilization of prescription drugs
12 by consumers.
13 NEW SECTION. Sec. 2. By January 1, 2002, the administrator of
14 the health care authority shall submit to the governor and the
15 legislature a progress report regarding the implementation of the
16 therapeutic and cost-effective prescription drug education and
17 utilization system.
18 NEW SECTION. Sec. 3. A new section is added to chapter 41.05
19 RCW to read as follows:
20 The administrator shall design and implement at least two, but
21 no more than five, pilot disease management programs for persons
22 enrolled in the public employees' benefits board uniform medical
23 plan. The programs shall begin operation on or before July 1, 2002.
24 (1) The administrator shall determine the disease groups most
25 appropriate for disease management after reviewing claims and cost
26 information for uniform medical plan enrollees and reviewing
27 national research on the effectiveness of disease management
28 programs.
29 (2) Each pilot disease management program must include
30 physicians, pharmacists, and other appropriate health care
31 providers in the design and implementation of the program. The
32 programs also must incorporate an evaluation component that will
33 allow the administrator to identify successful programs that are
34 candidates for statewide expansion. The evaluation should consider
35 the impact of the disease management program upon the health
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_1 status of participating uniform medical plan enrollees, the use of
_2 health services by these enrollees, and the overall costs of
_3 treating these enrollees.
_4 (3) In designing and implementing the pilot disease management
_5 programs, the administrator shall coordinate with the department
_6 of social and health services' efforts under section 4 of this
_7 act.
_8 NEW SECTION. Sec. 4. A new section is added to chapter 74.09
_9 RCW to read as follows:
10 The department shall design and implement at least two, but no
11 more than five, pilot disease management programs for aged or
12 disabled persons enrolled in the medical assistance program. The
13 programs shall begin operation on or before July 1, 2002.
14 (1) The following disease groups must be targeted for disease
15 management programs: Asthma, diabetes, heart failure, malignancies,
16 obesity, hemophilia, renal disease, transplants, intervertebral
17 disc disorders, and populations at highest risk of improper use of
18 medication.
19 (2) Each pilot disease management program must include
20 physicians, pharmacists, and other appropriate health care
21 providers in the design and implementation of the program. The
22 programs also must incorporate an evaluation component that will
23 allow the department to identify successful programs that are
24 candidates for statewide expansion. The evaluation should consider
25 the impact of the disease management program upon the health
26 status of the medicaid enrollee, the use of health services by the
27 enrollee, and the overall costs of treating the enrollee.
28 (3) In designing and implementing the pilot disease management
29 programs, the department shall coordinate with the health care
30 authority's efforts under section 3 of this act.
31 NEW SECTION. Sec. 5. The sum of one hundred thousand dollars,
32 or as much thereof as may be necessary, is appropriated for the
33 biennium ending June 30, 2003, from the health services account to
34 the health care authority for the purposes of sections 1 and 2 of
35 this act.
36
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_1 NEW SECTION. Sec. 6. This act is necessary for the immediate
_2 preservation of the public peace, health, or safety, or support of
_3 the state government and its existing public institutions, and
_4 takes effect July 1, 2001.
‑‑‑ END ‑‑‑
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