Sec. 202. Medicaid pharmacy and therapeutics committee improvements
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Subparagraph
(A)of section 1927(d)(4) of the Social Security Act ( 42 U.S.C. 1396r–8(d)(4) ) is amended to read as follows: The formulary is developed and reviewed by a pharmacy and therapeutics committee consisting of physicians, pharmacists, and other appropriate individuals appointed by the Governor of the State. Subject to clause (vi), the State establishes and implements a conflict of interest policy for the pharmacy and therapeutics committee that— is publicly accessible; requires all committee members to complete, on at least an annual basis, a disclosure of relationships, associations, and financial dealings that may affect their independence of judgement in committee matters; and contains clear processes, such as recusal from voting or discussion, for those members who report a conflict of interest, along with appropriate processes to address any instance where a member fails to report a conflict of interest. The membership of the pharmacy and therapeutics committee— includes at least 1 actively practicing physician and at least 1 actively practicing pharmacist, each of whom— is independent and free of conflict with respect to manufacturers and Medicaid participating plans or subcontractors, including pharmacy benefit managers; and has expertise in the care of 1 or more Medicaid-specific populations such as elderly or disabled individuals, children with complex medical needs, or low-income individuals with chronic illnesses; and is made publicly available. At the option of the State, the State’s drug use review board established under subsection (g)(3) may serve as the pharmacy and therapeutics committee provided the State ensures that such board meets the requirements of clauses
(ii)and (iii). The State reviews and has final approval of the formulary established by the pharmacy and therapeutics committee. If the Secretary determines it appropriate or necessary based on the findings and recommendations of the Comptroller General of the United States in the report submitted to Congress under section 203 of the Lower Costs, More Cures Act of 2019, the Secretary shall issue guidance that States must follow for establishing conflict of interest policies for the pharmacy and therapeutics committee in accordance with the requirements of clause (ii), including appropriate standards and requirements for identifying, addressing, and reporting on conflicts of interest. . Clause
(xiii)of section 1903(m)(2)(A) of the Social Security Act ( 42 U.S.C. 1396b(m)(2)(A) ) is amended— by striking and
(III)and inserting
(III); by striking the period at the end and inserting , and
(IV)any formulary used by the entity for covered outpatient drugs dispensed to individuals eligible for medical assistance who are enrolled with the entity is developed and reviewed by a pharmacy and therapeutics committee that meets the requirements of clauses
(ii)and
(iii)of section 1927(d)(4)(A). ; and by moving the left margin 2 ems to the left. The amendments made by this section shall take effect on the date that is 1 year after the date of enactment of this Act.
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U.S. Code
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- 42 USC 1396r–8(d)(4)
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Sec. 202
Medicaid pharmacy and therapeutics committee improvements
Cite42 USC 1396r–8(d)(4)
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