[Part XVI.]  MEDICAID PREAUTHORIZATION
EXEMPTION



 



[§346-351]  Findings.  The legislature finds
that:



(1)  Patients who are medicaid recipients and who
suffer from the human immunodeficiency virus, acquired immune deficiency
syndrome, hepatitis C, or who are in need of immunosuppressives as a result of
organ transplants, have the least means available to obtain proper medications
required to control their illnesses;



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



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



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



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



(6)  The imposition of a "first fail" plan
before a physician can adjust or change a medication not on the approved list
of medications is medically unsound.  The condition of a seriously ill patient
suffering from the human immunodeficiency virus, acquired immune deficiency syndrome,
or hepatitis C, or who is in need of transplant immunosuppressives, will
generally not remain stable for long without prompt treatment.  If these
persons are not more promptly and effectively treated, a significant
probability exists that there will be a substantial increase in health care
costs and hospitalizations, thereby increasing medical costs to the State. [L
2005, c 241, pt of §1]