Michigan Medical Assistance requires prior authorization for designated prescription drugs. In March and April 2020, respectively, Michigan began allowing for suspension of prior authorization requirements and some early drug refills.
Minnesota:
Minnesota Medical Assistance requires prior authorization for prescription drugs designated as noncovered and generally covers a 34-day supply of covered drugs. On April 2, 2020, Minnesota temporarily increased the prescription drug coverage limit for certain therapeutic non-controlled drug classes to a 90-day supply for all Medical Assistance Members. On April 27, 2020, Minnesota allowed for suspension of prior authorization requirements.
Summary of factual data and analytical methodologies
The Department relied upon requirements under s. 227.24, Stats., and information provided to the Department by the Legislative Reference Bureau. Analysis and supporting documents used to determine effect on small business
The emergency rule is not anticipated to have an effect on small business. See the associated Fiscal Estimate & Economic Impact Analysis.
Effect on small business
The emergency rule is not anticipated to have an effect on small business.
Agency contact person
Statement on quality of agency data
See “summary of factual data and analytical methodologies” section above.
Place where comments are to be submitted and deadline for submission
Comments may be submitted to the agency contact person that is listed above until the deadline given in the upcoming notice of public hearing. The notice of public hearing and deadline for submitting comments will be published in the Wisconsin Administrative Register and to the department’s website, at https://www.dhs.wisconsin.gov/rules/permanent.htm. Comments may also be submitted through the Wisconsin Administrative Rules Website, at: https://docs.legis.wisconsin.gov/code/chr/active. RULE TEXT
SECTION 1. DHS 107.10 (2) (e), (3) (a), (d), (e) and (h) are amended to read:
DHS 107.10 (2) (e) Any drug Drugs as identified by the Medical Assistance program that are produced by a manufacturer who has not entered into a rebate agreement with the federal secretary of health and human services, as required by 42 USC 1396r−8, if the prescribing provider under sub. (1) demonstrates to the department’s satisfaction that no other drug sold by a manufacturer who complies with 42 USC 1396r−8 is medically appropriate and cost−effective in treating the recipient’s condition; DHS 107.10 (3) (a) Dispensing of schedule III, IV and V drugs shall be limited to the original dispensing plus 5 refills, or 6 months from the date of the original prescription, whichever comes first in accordance with 21 CFR 1306.22. DHS 107.10 (3) (d) Except as provided in par. (e), legend Legend drugs shall be dispensed in the full amounts prescribed, not to exceed a 34−day supply.
DHS 107.10 (3) (e) The following drugs may be dispensed in amounts up to but not to exceed a 100−day supply, as prescribed by a physician:
1. Digoxin, digitoxin, digitalis;
2. Hydrochlorothiazide and chlorothiazide;
3. Prenatal vitamins;
4. Fluoride;
5. Levothyroxine, liothyronine and thyroid extract;
6. Phenobarbital;
7. Phenytoin; and
8. Oral contraceptives Medical Assistance program will maintain a list of drugs which may be dispensed in amounts up to but not to exceed a 100-day supply as described in MA provider handbooks.
DHS 107.10 (3) (h) To be included as a covered service, a non−legend drug shall be used in the treatment of a diagnosable medical condition and be a rational part of an accepted medical treatment plan. The following general categories of non−legend drugs are covered:
1. Antacids;
2. Analgesics;
3. Insulins;
4. Contraceptives;
5. Cough preparations;
6. Ophthalmic lubricants; and
7. Iron supplements for pregnant women.The Medical Assistance program shall identify non-legend drugs covered as described in MA provider handbooks.
SECTION 2. EFFECTIVE DATE: This rule shall take effect upon publication in the official state newspaper, as provided in s. 227.24 (1) (c), Stats. The rule shall remain in effect until the end of the time period provided in ss. 227.24 (1) (c) and (2), Stats. Wisconsin Department of Health Services
Dated: __________________________________
Andrea Palm, Secretary-designee
SEAL:
