BILL REQ. #:  S-2207.2 

READ FIRST TIME 03/02/09.   

     AN ACT Relating to authorizing state purchased health care programs to maximize appropriate prescription drug use in a cost-effective manner; and amending RCW 69.41.190.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 69.41.190 and 2006 c 233 s 1 are each amended to read as follows:
     (1)(a) Except as provided in subsection (2) of this section, any pharmacist filling a prescription under a state purchased health care program as defined in RCW 41.05.011(2) shall substitute, where identified, a preferred drug for any nonpreferred drug in a given therapeutic class, unless the endorsing practitioner has indicated on the prescription that the nonpreferred drug must be dispensed as written, or the prescription is for a refill of an antipsychotic, antidepressant, chemotherapy, antiretroviral, or immunosuppressive drug, or for the refill of a immunomodulator/antiviral treatment for hepatitis C for which an established, fixed duration of therapy is prescribed for at least twenty-four weeks but no more than forty-eight weeks, in which case the pharmacist shall dispense the prescribed nonpreferred drug.
     (((2))) (b) When a substitution is made under subsection (1) of this section, the dispensing pharmacist shall notify the prescribing practitioner of the specific drug and dose dispensed.
     (2)(a) A state purchased health care program may impose limited restrictions on an endorsing practitioner's authority to dispense as written, as provided for in subsection (1)(a) of this section, only under the following circumstances:
     (i) There is statistical or clear data demonstrating the endorsing practitioner's frequency of prescribing dispensed as written for nonpreferred drugs is in significant noncompliance when compared to the prescribing patterns of his or her peers; and
     (ii) The medical director of a state purchased health program has: (A) Presented the endorsing practitioner with data that indicates the endorsing practitioner's prescribing patterns are significantly not in compliance with his or her peers, (B) provided the endorsing practitioner an opportunity to explain the variation in his or her prescribing patterns to those of his or her peers, and (C) if the variation in prescribing patterns cannot be explained, provided the endorsing practitioner sufficient time to change his or her prescribing patterns to align with those of his or her peers.
     (b) The restrictions imposed under (a) of this subsection (2) must be limited in nature such that the endorsing practitioner may demonstrate a reduction in variation in line with his or her peers.
     (c) A state purchased health care program may immediately designate an available, less expensive generic product in a previously reviewed drug class as preferred, without first submitting the product to review by the pharmacy and therapeutics committee established pursuant to RCW 70.14.050.
     (d) For a patient's first course of treatment within a therapeutic class of drugs, a state purchased health care program may impose limited restrictions on endorsing practitioners' authority to write a prescription to dispense as written, under subsection (1)(a) of this section, only under the following circumstances:
     (i) There is a less expensive therapeutic alternative generic product available to treat the condition;
     (ii) The drug use review board established under WAC 388-530-4000 reviews and provides recommendations as to the appropriateness of the limitation;
     (iii) Prescription, emergency room, diagnosis, and hospitalization history are shared with the endorsing practitioner; and
     (iv) The endorsing practitioner has sufficient time to explain that his or her prescription is medically necessary, consistent with WAC 388-501-0165.
     (e) If, within a therapeutic class, there is a therapeutic alternative over-the-counter drug available, a state purchased health care program may automatically designate the over-the-counter drug as the preferred drug.
     (f) A state purchased health care program may impose limited restrictions on endorsing practitioners' authority to prescribe pharmaceuticals to be dispensed as written, as provided in subsection (1)(a) of this section, for a purpose outside the scope of their approved labels only under the following circumstances:
     (i) There is a less expensive on label product available to treat the condition;
     (ii) There is statistical or clear data demonstrating that the endorsing practitioner's frequency of prescribing certain pharmaceuticals to be dispensed as written for a purpose outside the scope of their approved labels is in significant noncompliance compared to approved label indications or standards as outlined by the drug use review board established under WAC 388-530-4000;
     (iii) The drug use review board established under WAC 388-530-4000 reviews and provides recommendations as to the appropriateness of the limitation;
     (iv) The medical director or his or her agent of the state purchased health program has: (A) Communicated to the endorsing practitioner data that indicates the endorsing practitioner's off-label prescribing is significantly not in compliance with the off-label prescribing patterns offered in the Washington preferred drug list, (B) provided the endorsing practitioner community an opportunity to explain their variation in off-label prescribing patterns, and (C) if the variation in off-label prescribing patterns cannot be explained, provided the endorsing practitioners sufficient time to change their off-label prescribing patterns to align with those of their peers; and
     (v) The endorsing practitioner has sufficient time to explain prescribing a pharmaceutical to be dispensed as written for a purpose outside the scope of its approved label is medically necessary, consistent with WAC 388-501-0165.