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22-6-122
Section 22-6-122 Medicaid Pharmacy and Therapeutics Committee - Classification and recommendation
of drugs; assurance of quality patient care; review of pharmaceutical products. (a) The Medicaid
Pharmacy and Therapeutics Committee shall review and recommend classes of drugs to the Medicaid
Commissioner for inclusion in the Medicaid Preferred Drug Plan. Class means a therapeutic
group of pharmaceutical agents approved by the FDA as defined by the American Hospital Formulary
Service. The classes of anti-retroviral and anti-psychotic drugs shall not be included in
the Medicaid Preferred Drug Plan. (b) The Medicaid Pharmacy and Therapeutics Committee shall
develop its preferred drug list recommendations by considering the clinical efficacy, safety,
and cost effectiveness of a product. Within each covered class, the committee shall review
and recommend drugs to the Medicaid Commissioner for inclusion on a preferred drug list. Generics
and over the counter drugs covered by Medicaid may be...
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22-6-121
Section 22-6-121 Medicaid Pharmacy and Therapeutics Committee - Composition; meetings. (a)
The Alabama Medicaid Agency shall utilize a Medicaid Pharmacy and Therapeutics Committee within
the agency for the purpose of advising and assisting Medicaid in the development of a preferred
drug plan pursuant to 42 U.S.C. ยง1396r-8. (b) The Medicaid Pharmacy and Therapeutics Committee
shall be comprised and consist of three clinical pharmacists licensed to practice in the State
of Alabama and at least five physicians licensed to practice medicine in the State of Alabama.
Physician members will be appointed by the Medicaid Commissioner from a list of at least two
nominees for each position submitted by the Medical Association of the State of Alabama. Clinical
pharmacist members will be nominated by the Alabama Pharmacy Association and appointed by
the Medicaid Commissioner. Members of the Medicaid Pharmacy and Therapeutics Committee should
be enrolled Medicaid providers and have experience...
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22-6-123
Section 22-6-123 Considerations for inclusions on preferred drug list; review; adoption of
list. (a) Drugs will be considered for the Medicaid preferred drug list based on clinical
efficacy, side effect profiles, appropriate usage, and cost effectiveness. (b) The Medicaid
Pharmacy and Therapeutics Committee shall perform a thorough review of relevant clinical and
medical considerations, including, but not limited to: Medicaid Drug Utilization Review (DUR)
data; Surveillance Utilization Review (SUR) data; potential abuse, misuse, or inappropriate
use in prescribing and/or dispensing patterns; inconsistency with FDA approved labeling, inconsistency
with uses recognized in the American Hospital Formulary Service Drug Information, and the
American Medical Association Drug Evaluations, or the U.S. Pharmacopoeia Dispensing Information.
(c) The Medicaid Pharmacy and Therapeutics Committee shall recommend and the Medicaid Agency
shall adopt an initial Medicaid preferred drug list not later...
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22-6-120
Section 22-6-120 Legislative findings. The Legislature finds the following: (1) The availability
of appropriate pharmaceutical benefits to every Alabama citizen is a critical component to
the overall health of its population. (2) Alabama should strive to provide appropriate, safe,
effective, and cost-efficient pharmaceutical care to those who depend on health benefits through
state funded programs. (3) The Alabama Medicaid Agency should endeavor to manage the Medicaid
Pharmacy Program utilizing clinical management tools in a manner to foster optimal health
outcomes at reasonable costs. (4) State Medicaid programs and private insurance plans across
the country utilize preferred drug lists as an effective way to foster and encourage clinically
appropriate and safe use of pharmaceuticals in a cost-effective manner. (5) Based on the proven
effectiveness of preferred drug programs to foster appropriate use of drugs, it is in the
best interests of Alabama and its citizens for the Alabama...
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27-1-16
Section 27-1-16 Standard health insurance claim form; electronic claims form; various claim
forms. (a)(1) The Commissioner of the Department of Insurance shall prescribe a standard health
insurance claim form to be used by all hospitals. The forms shall be prescribed in a format
which allows for the use of generally accepted diagnosis and treatment coding systems by providers
of health care and payors. The standard form shall be accepted and used by all insurers doing
business in the State of Alabama and by all state agencies which pay providers of health care
for hospital services. (2) The Commissioner of the Department of Insurance shall also prescribe
a format for all health insurance claims transmitted or submitted for payment by electronic
or electro-mechanical means. Such a format shall be used by all insurers doing business in
the State of Alabama and by all state agencies which pay providers of health care for hospital
services. (b) An advisory committee of five persons, two...
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27-1-22
Section 27-1-22 Uniform prescription drug information card or technology. (a) Every health
benefit plan that provides coverage for prescription drugs or devices, or administers a plan,
including, but not limited to, third party administrators for self-insured plans and state
administered plans, excluding the Alabama Medicaid Program, shall issue to its insureds a
card or other technology containing prescription drug information. The uniform prescription
drug information card or technology shall be in the format approved by the National Council
for Prescription Drug Programs (NCPDP) and shall include all of the required fields and conform
to the most recent pharmacy ID card or technology implementation guide produced by NCPDP or
conform to a national format acceptable to the Commissioner of Insurance. If a health care
plan includes a conditional or situational field, it shall conform to the most recent pharmacy
information card or technology implementation guide by the NCPDP or conform...
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34-23-32
Section 34-23-32 Manufacturer, bottler, packager, repackager, etc., of drugs. (a) Commencing
on August 1, 2017, every manufacturer, bottler, packager, repackager, third party logistic
provider, wholesale drug distributor, private label distributor, outsourcing facility, or
pharmacy business identified in the supply chain of drugs, medicines, chemicals, or poisons
for medicinal purposes shall register annually with the board by application for a permit
on a form furnished by the board and accompanied by a fee to be determined by the board as
follows: (1) The fee shall not be less than five hundred dollars ($500) nor more than two
thousand dollars ($2,000) for a new establishment. (2) The fee shall not be less than two
hundred fifty dollars ($250) nor more than one thousand dollars ($1,000) for a renewal permit.
(3) The fee shall not be less than five hundred dollars ($500) nor more than two thousand
dollars ($2,000) for a permit due to transfer of ownership. (b) A holder of a permit...
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27-45-2
Section 27-45-2 Definitions. As used in this article, the following terms shall have the respective
meanings herein set forth, unless the context shall otherwise require: (1) ALABAMA INSURANCE
CODE. Title 27 of the Code of Alabama 1975. (2) INSURER. Such term shall have the meaning
ascribed in Section 27-1-2. (3) PERSON. Such term shall have the meaning ascribed in Section
27-1-2. (4) COMMISSIONER and DEPARTMENT. Such terms, respectively, shall have the meanings
ascribed in Section 27-1-2. (5) CONTRACTUAL OBLIGATION. Any obligation under covered policies
or employee benefit plans. (6) COVERED POLICY OR PLAN. Any policy, employee benefit plan,
or contract within the scope of this article. (7) HEALTH INSURANCE POLICY. Any individual,
group, blanket, or franchise insurance policy, insurance agreement, or group hospital service
contract providing for pharmaceutical services, including without limitation, prescription
drugs, incurred as a result of accident or sickness, or to prevent same....
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27-1-20
Section 27-1-20 Patient Right to Know Act. (a) This section shall be known and may be cited
as the "Patient Right to Know Act." (b) As used in this section, unless the context
clearly indicates otherwise, the following words shall have the following meanings: (1) ENROLLEE.
A person who purchases individual health care coverage or an employer who purchases a group
health care plan. (2) PROVIDER. A physician, dentist, podiatrist, pharmacist, optometrist,
psychologist, clinical social worker, advanced nurse practitioner, registered optician, licensed
professional counselor, physical therapist, and chiropractor. (c)(1) All persons, firms, corporations,
associations, health maintenance organizations, health insurance services, or preferred provider
organizations, any employer-sponsored health benefit plan, or any similar organization or
entity, providing health, accident, or dental insurance coverage, either directly or indirectly,
shall provide an enrollee with a written description of the...
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34-23-184
Section 34-23-184 Audit procedures; report. (a) The entity conducting an audit shall follow
these procedures: (1) The pharmacy contract shall identify and describe in detail the audit
procedures. (2) The entity conducting the on-site audit shall give the pharmacy written notice
at least two weeks before conducting the initial on-site audit for each audit cycle. If the
pharmacy benefit manager does not include their auditing guidelines within their provider
manual, then the notice must include a documented checklist of all items being audited and
the manual, including the name, date, and edition or volume, applicable to the audit and auditing
guidelines. For on-site audits a pharmacy benefit manager shall also provide a list of material
that is copied or removed during the course of an audit to the pharmacy. The pharmacy benefit
manager may document this material on either a checklist or on an audit acknowledgement form.
The pharmacy shall produce any items during the course of the...
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