KRS § 205.5632 Prior authorization requirements -- Administrative regulations.

A new drug is generally exempt from prior authorization when it first gets Kentucky Medicaid coverage, unless specified review and approval steps apply or the drug is in a class requiring prior authorization.

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Jurisdiction: United States — Kentucky
Instrument: Regulation
Version: Undated source snapshot
Language: en
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administrative rulemaking drug coverage medicaid prior authorization

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Provisions of KRS § 205.5632 Prior authorization requirements -- Administrative regulations.

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205.5632
KRS § 205.5632 Prior authorization requirements -- Administrative regulations.
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AI-assisted research summary: A new drug is generally exempt from prior authorization when it first gets Kentucky Medicaid coverage, unless specified review and approval steps apply or the drug is in a class requiring prior authorization.

205.5632 Prior authorization requirements -- Administrative regulations. (1) Upon initial coverage by the Kentucky Medicaid program, a new drug shall be exempt from prior authorization unless: (a) There has been a review of the drug and recommendation regarding prior authorization by the Pharmacy and Therapeutics Advisory Committee as provided under KRS 205.564 and a final determination regarding prior authorization by the secretary of the Cabinet for Health and Family Services; or (b) The drug is in a specific class of drugs for which the Pharmacy and Therapeutics Advisory Committee has recommended, and the secretary of health and family services has determined, that all new drugs shall require prior authorization upon initial availability, in which case the drug shall require prior authorization and shall be scheduled for review by the Pharmacy and Therapeutics Advisory Committee within seventy-five (75) days. (2) The Cabinet for Health and Family Services shall promulgate an administrative regulation in accordance with KRS Chapter 13A that describes the process by which drugs under this section shall be determined to require prior authorization. Effective: June 20, 2005 History: Amended 2005 Ky. Acts ch. 99, sec. 236, effective June 20, 2005. -- Amended 2002 Ky. Acts ch. 7, sec. 3, effective February 21, 2002. -- Amended 2000 Ky. Acts ch. 521, sec. 26, effective July 14, 2000. -- Created 1998 Ky. Acts ch. 561, sec. 2, effective July 15, 1998.

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KRS § 205.5632 Prior authorization requirements -- Administrative regulations.

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