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Committee hears department request to remove prior‑auth requirement for children on five or more psychotropic drugs
Summary
Senate Bill 2076 would remove a statutory requirement that Medicaid prior‑authorize psychotropic medications for children taking five or more concurrent psychotropic prescriptions and would add limited language to address discriminatory supplemental rebate offers to protect state rebate revenue. Medicaid officials told the House Human Services
Bridal Joyce, pharmacy and clinical services director for Medicaid: The House Human Services Committee heard Senate Bill 2076, which the Department of Health and Human Services brought forward for two purposes: first, to remove the statutory requirement that Medicaid prior‑authorize psychotropic medications for children on five or more concurrent psychotropic prescriptions; and second, to add situational authority so the department can avoid discriminatory supplemental rebate offers that would reduce North Dakota’s rebate revenue.
Why it matters: The 2019 law required prior authorization for children on five or more psychotropics, and initial legislative estimates expected about a dozen children would be impacted. After programming and data review, Medicaid staff concluded that many more children would fall under that requirement—estimates rose from an expected 12 to as high as 78 or around 100 in recent months—so the department did not activate the mandatory prior-authorization workflow and instead proposed statute removal.
Alternatives and oversight: Medicaid officials told the committee they will continue other oversight activities, including drug utilization review, provider education and academic detailing, claim‑processing edits and outreach to prescribers and pharmacies. The department said those steps can address concerns about overprescribing without imposing the administrative disruption of a mandatory prior‑auth requirement.
Rebates: The bill also adds a narrowly targeted provision to allow the department to access higher supplemental rebate rates in situations where manufacturers submit discriminatory offers that would otherwise give North Dakota lower supplemental rebates because of the state’s existing statutory exclusions. The department said multistate rebate pool partners discourage such offers, but the statutory language would help preserve the state’s negotiating position if manufacturers submit discriminatory proposals.
Questions from lawmakers focused on why the affected population grew beyond early estimates and whether removing the statutory prior‑auth would reduce clinical oversight. Joyce and other Medicaid staff said population growth, changes in prescribing patterns and additional drugs in psychotropic classes contributed to the higher counts. They emphasized ongoing monitoring and education efforts and federal reporting and monitoring requirements that already apply to antipsychotic use in children and certain adult populations.
Where it stands: Supporters of the department’s request testified in committee. The transcript records department explanations and questions but does not record a committee action or vote.
