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Committee advances first substitute to change Medicaid drug overrides and allow 'deeming' for behavioral health providers
Summary
A first substitute to House Bill 347 would remove a long-standing Medicaid dispense-as-written override for most psychotropic medications while creating a process to accept national accreditation as evidence that adult behavioral-health providers meet state licensing standards.
Representative Dunnigan presented the first substitute for House Bill 347 as a package of Medicaid pharmacy and behavioral-health regulatory changes. The first portion would remove a longstanding dispense-as-written (DAW) override for most psychotropic medication classes — such as many antidepressants and ADHD drugs — so new patients would generally be required to try a preferred drug on Medicaid’s preferred drug list (PDL) before a non-preferred agent. The sponsor and Jen Strohacker, the State Medicaid Director, said individuals already stabilized on a non-preferred drug would be grandfathered and that a continuity-of-care protocol exists for people newly enrolling in Medicaid.
Strohacker said the current carve-out for psychotropic medications dates to the mid-2000s and that the substitute proposes removing that override for most psychotropic classes while preserving it for atypical antipsychotics. She said the administration expects Medicaid savings of about $4 million per year if the changes are fully implemented and emphasized that preferred lists still retain dozens of options within therapeutic classes.
The substitute also includes “deeming” provisions, described by Jared Sanford, CEO of Valley Behavioral Health, that would let state regulators accept national accreditation as evidence that an adult behavioral-health provider meets Utah licensing standards. Sanford and other witnesses said deeming could reduce duplicative inspections, administrative burden and licensing delays while maintaining high standards by relying on nationally accredited reviewers.
Committee members asked whether “grandfathering” covered people who enroll in Medicaid while on a non-preferred drug; Strohacker said continuity-of-care protocols would allow a newly enrolling but stable patient to continue their current medication. The committee adopted the first substitute on voice vote and later voted unanimously to pass HB 347 with a favorable recommendation.
