[Part XVI.]  MEDICAID PREAUTHORIZATIONEXEMPTION

 

[§346-351]  Findings.  The legislature findsthat:

(1)  Patients who are medicaid recipients and whosuffer from the human immunodeficiency virus, acquired immune deficiencysyndrome, hepatitis C, or who are in need of immunosuppressives as a result oforgan transplants, have the least means available to obtain proper medicationsrequired to control their illnesses;

(2)  These medicaid recipients, if not promptlytreated and maintained on effective medications, will, by the very nature oftheir illnesses, suffer greatly and may require increased medical care,including prolonged hospitalization, resulting in increased costs to thesepatients and society as a whole;

(3)  Failure to promptly treat a patient with thehuman immunodeficiency virus, acquired immune deficiency syndrome, or hepatitisC, and failure to use effective immunosuppressives during and after organtransplants, may result in increased suffering by the patients, the early orunnecessary loss of the patients' lives, increased cost of medical care, andincreased emotional, physical, financial, and societal costs;

(4)  It is ethically imperative that the physicianswho treat medicaid recipient patients with human immunodeficiency virus,acquired immune deficiency syndrome, or hepatitis C, or patients who are inneed of immunosuppressives before, during, and after transplant operations,have the unfettered ability to promptly medically intervene in treating thesepatients and to continue proven medications for those patients;

(5)  The procedure of requiring preauthorization ofmedicaid recipients before dispensing medications for the treatment of humanimmunodeficiency virus, acquired immune deficiency syndrome, hepatitis C, andimmunosuppressives needed for transplant patients, is unduly arduous,difficult, and too time-consuming for practitioners with large numbers of thesepatients who require immediate treatment to avoid permanent injury and otherundesirable consequences; and

(6)  The imposition of a "first fail" planbefore a physician can adjust or change a medication not on the approved listof medications is medically unsound.  The condition of a seriously ill patientsuffering from the human immunodeficiency virus, acquired immune deficiency syndrome,or hepatitis C, or who is in need of transplant immunosuppressives, willgenerally not remain stable for long without prompt treatment.  If thesepersons are not more promptly and effectively treated, a significantprobability exists that there will be a substantial increase in health carecosts and hospitalizations, thereby increasing medical costs to the State. [L2005, c 241, pt of §1]