2006 Utah Code - 31A-29-113.5 — Pilot Program for Chronic Disease and Pharmaceutical Management of Bleeding Disorders.

     31A-29-113.5.   Pilot Program for Chronic Disease and Pharmaceutical Management of Bleeding Disorders.
     (1) Beginning July 1, 2005, and ending on July 1, 2010, the pool policy shall include a pilot program for hemophilia and bleeding disorders in accordance with this section.
     (2) In accordance with this Subsection (2), the pool's pilot program shall:
     (a) permit enrollees in the pool who have hemophilia or a bleeding disorder to participate in a pharmaceutical program for people with hemophilia and bleeding disorders administered by an entity that is qualified as a federal 340B Drug Pricing Program of the Public Health Service Act, enacted in Public Law 102-585, the Veterans Health Care Act of 1992;
     (b) pay the eligible medical expenses for the enrollee's participation in the pilot program subject to all applicable plan benefits and limitations; and
     (c) may not impose cost containment measures on an enrollee who participates in the pilot program greater than the cost containment measures imposed on other enrollees under the provisions of Subsection 31A-29-113(6).
     (3) (a) The pool may establish the pilot program through the best means available for obtaining the lowest drug discount pricing, including administering the pilot program through the Department of Health's 340B Medicaid drug discount program or the Ryan White HIV drug discount program.
     (b) The Department of Health shall assist the pool with administering the pilot program, including assistance in processing claims for the drug discount and chronic disease management services.
     (4) (a) The board shall report to the commissioner and to the Health and Human Services Interim Committee prior to October 30, 2010 regarding the claims experience and pharmaceutical costs under the pilot program.
     (b) The board may discontinue the pilot program created in this section prior to July 1, 2010, if prior to discontinuing the pilot program:
     (i) the board reports on the need to discontinue the pilot program to the Health and Human Services Interim Committee and the Commerce and Revenue Appropriations Subcommittee; and
     (ii) either:
     (A) the commissioner and the board determine that the requirements of the pilot program jeopardize the actuarial soundness of the pool; or
     (B) the entity that is qualified as a 340B Drug Pricing Program is disqualified by federal law from providing 340B drug pricing discounts to enrollees in the pool.

Enacted by Chapter 273, 2005 General Session