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Senate amends Medicaid preferred drug list to allow handwritten "dispense as written" overrides; reporting requirement discussed
Summary
Senate Bill 42, establishing a preferred drug list for Medicaid, was amended on the floor to allow a handwritten "dispense as written" override while prohibiting preprinted DAW pads; senators debated physician discretion, patient access, and tracking/monitoring before approving the amended bill.
The Utah Senate amended and passed Senate Bill 42, a measure to implement a preferred drug list (PDL) intended to control Medicaid prescription costs, after extensive floor debate that produced a key amendment allowing limited "dispense as written" (DAW) overrides.
Sponsor Senator Christensen, who described the PDL as a tool to make Medicaid pharmacy spending more reasonable and cost-effective, resisted the DAW amendment as potentially diluting savings. Opponents of the original PDL — including Senators Kilpach and Knudson — argued DAW is necessary to protect patients and permit physicians to prescribe what they believe is clinically best for their patients without burdensome prior-authorization delays. Senator Kilpach offered Amendment #2 (dated Jan. 24, 2007) requiring a handwritten DAW notation and prohibiting preprinted DAW pads; the amendment also generated substitute proposals to require notification to the Department of Health when an override is used so the program could track how often DAW is invoked.
Senator McCoy proposed and then pressed a substitute motion that a health-care provider be required to notify the Department when an override is written; proponents said such a reporting requirement would allow the Department and Legislature to evaluate whether DAW undermines the program's savings. Senator Stevenson cited published literature indicating that PDLs without DAW requirements may produce larger savings. Senators Peterson, Jones and Davis offered personal and policy examples of why physician discretion matters for certain patients, including seniors and those with complex conditions.
The bill as amended includes a reporting pathway: the sponsor explained the Department will report back to the Health and Human Services Committee by August 2008 and to the general session in 2009 on implementation and outcomes. After floor debate and division votes, the Senate clerk announced the amended SB42 passed the Senate (tally announced: 29 yes, 0 nay votes as amended) and it will be transmitted to the House for further consideration.
Why it matters: SB42 changes how Medicaid prescriptions are managed and balances cost-control goals with physician discretion and patient access concerns; the adopted DAW guardrails and reporting plan create a mechanism to measure whether the override undermines projected savings.
Next steps: SB42 as amended moves to the Utah House for consideration; the Department of Health will report implementation outcomes as described in the bill.
