Medicaid Pharmacy Amendments
HB 409 requires Utah's Medicaid program to provide pharmacy benefits through a fee-for-service model, meaning each prescription is paid for individually rather than through a managed care plan. It ensures organ transplant patients receive their prescribed immunosuppressive drugs without being required to try cheaper alternatives (step therapy) and prohibits these drugs from appearing on the Medicaid preferred drug list. The bill also establishes a 24-hour processing deadline for prior authorizations on nonpreferred drugs and sets specific medical criteria for overriding the preferred list for sedative hypnotics, such as documented failed trials of preferred drugs or drug interactions.
Bill status
failed
3 of 4 stages cleared
Introduction
Feb 2025
Committee Review
Feb 2025
Senate Passage
Mar 2025
Governor
Introduced Feb 4, 2025
Last action Mar 8, 2025
Maddy AI version diff · 2 comparisons
What changed between versions
Amended Excerpts 2/26/2025 10:02:745
→
Amended 2/26/2025 10:02:745
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5 edits
MODERATE
This bill amends Utah's Medicaid pharmacy program to require fee-for-service delivery, establish a preferred drug list based on clinical and cost factors, and set specific rules for psychotropic drugs, immunosuppressive drugs, and sedative hypnotics. The changes aim to improve drug utilization review processes, ensure timely access to medications, and protect patients with organ transplants from step therapy requirements.
Scope change
The bill expands Medicaid pharmacy benefit requirements to include specific rules for psychotropic drugs, immunosuppressive drugs, and sedative hypnotics, while maintaining existing provisions for other medications.
REQUIREMENT
Requires Medicaid pharmacy benefits to be provided through the fee-for-service model rather than managed care.
Establishes prior authorization requirements for nonpreferred drugs in the same therapeutic class as preferred drugs, with 24-hour response times for requests during business hours.
Exempts immunosuppressive drugs for organ transplant patients from preferred drug list restrictions and step therapy requirements.
Creates specific criteria for granting prior authorization for sedative hypnotics not on the preferred drug list, including documentation of treatment failures or contraindications.
Removes previous language regarding psychotropic drug savings thresholds and step therapy implementation dates.
Floor votes
How they voted
This bill passed the Senate by voice vote (no roll call recorded).
Full legislative history
Actions timeline
Total actions
26
Key actions
3
Committee
3
Amendments
2
Mar 3, 2025
Introduced
Senate/ 1st reading (Introduced)
upper
Mar 3, 2025
Upper · Passed
House/ passed 3rd reading
upper
Feb 26, 2025
Lower · Passed
House/ comm rpt/ amended
lower
Feb 26, 2025
Lower · Passed
House Comm - Favorable Recommendation
lower
Feb 26, 2025
Introduced
House Comm - Amendment Recommendation
lower
Feb 12, 2025
Committee
House/ to standing committee
lower
Feb 10, 2025
Committee
House/ to standing committee
lower
Feb 4, 2025
Introduced
House/ 1st reading (Introduced)
lower
1 primary · 1 co-sponsor
Sponsors
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