nursing homes to implement a model
similar to the one used in North Carolina.
The department shall implement the
program by April 1, 2005. Further
provided that the appropriation for
Medical Care Provider Reimbursements,
M00Q01.03, shall be reduced by $200,000
of general funds and $200,000 of federal
funds to recognize savings from the
program.

Further provided that the Medical Care
Programs Administration shall limit adult
Medicaid recipients to four brand name
drugs per month. This restriction will not
apply to antiretroviral agents and atypical
antipsychotic          medications.          The

administration may authorize exceptions
to the brand name drug restriction based
upon the treatment needs of the patients,
when such exceptions arc based on prior
consultation provided by the

administration or an administration
contractor.

Further provided that the administration
must establish procedures to ensure that:
(1) there will be a response to a request for
prior consultation by telephone or other
telecommunication device within 24
hours; (2) a 72-hour supply of the drug
prescribed will be provided in an
emergency or when the agency docs not
provide a response within 24 hours; and
(3) prior authorization for an exception to
the brand name drug restriction is sought
by the prescriber and not by the
pharmacy.

When prior authorization is granted for a
patient in an institutional setting beyond
the brand name drug restriction such
approval is authorized for 12 months and
monthly prior authorization is not
required for that patient.

Further provided that the appropriation
provided for Medical Care Provider
Reimbursements, M00Q01.03, shall be

- 1695 -

ROBERT L. EHRLICH, JR., Governor

Ch. 429