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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>80759</law_id><section_number>32.1-331.15</section_number><catch_line>Prior authorization of prescription drug products; coverage under state plan</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><structure><unit label="title" level="1" order_by="1" identifier="32.1">Health</unit><unit label="chapter" level="2" order_by="1" identifier="10">Department of Medical Assistance Services</unit><unit label="article" level="3" order_by="1" identifier="4">Medicaid Prior Authorization Advisory Committee</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> The <span class="dictionary">Committee</span> shall review prescription drug products to recommend prior authorization under the state plan in accordance with this article and regulations promulgated by the <span class="dictionary">Board</span>. Such review may be initiated by the <span class="dictionary">Director</span>, the <span class="dictionary">Committee</span> itself, or by written request of the <span class="dictionary">Board</span>. The <span class="dictionary">Committee</span> shall complete its recommendations to the <span class="dictionary">Board</span> within no more than six months from receipt of any such request. <a id="paragraph-289464" class="section-permalink" href="https://vacode.org/32.1-331.15/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> Coverage under the state plan for any drug requiring prior authorization shall not be approved unless the prescriber obtains prior approval of such use in accordance with regulations promulgated by the <span class="dictionary">Board</span> and procedures established by the <span class="dictionary">Department</span>.
			In formulating its recommendations to the <span class="dictionary">Board</span>, the <span class="dictionary">Committee</span> shall consider the potential impact on patient care and the potential fiscal impact of prior authorization on pharmacy, prescriber, hospitalization and outpatient costs. Any proposed regulation making a drug or category of drugs subject to prior authorization shall be accompanied by a statement of the estimated impact of such action on pharmacy, prescriber, hospitalization and outpatient costs. <a id="paragraph-289465" class="section-permalink" href="https://vacode.org/32.1-331.15/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> The <span class="dictionary">Committee</span> shall not review any drug for which it has recommended or the <span class="dictionary">Board</span> has required prior authorization within the previous 12 months, unless new or previously unavailable relevant and objective information is presented. <a id="paragraph-289466" class="section-permalink" href="https://vacode.org/32.1-331.15/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> Confidential proprietary information identified as such by a manufacturer or supplier in writing in advance and furnished to the <span class="dictionary">Committee</span> or the <span class="dictionary">Board</span> pursuant to this article shall not be subject to the disclosure requirements of the Virginia Freedom of Information Act (&#xA7; <a class="law" title="Short title; policy" href="/2.2-3700/">2.2-3700</a> et seq.). The <span class="dictionary">Board</span> shall establish by regulation the means by which such confidential proprietary information shall be protected. <a id="paragraph-289467" class="section-permalink" href="https://vacode.org/32.1-331.15/#D"><i class="fa fa-link"/></a></p></section></text><history>1993, c. 537; 2004, c. 855.</history><metadata></metadata></law>
