Drug prior approval program.

1. Law
2. Utah Code
3. Utah Health Code
4. Medical Assistance Act
5. Drug Utilization Review Board
6. Drug prior approval program.

Affected by 63I-1-226 on 7/1/2027

26-18-105. Drug prior approval program.

• (1) A drug prior approval program approved or implemented by the board shall meet the following conditions:
  • (a) except as provided in Subsection (2), a drug may not be placed on prior approval for other than medical reasons;
  • (b) the board shall hold a public hearing at least 30 days prior to placing a drug on prior approval;
  • (c) notwithstanding the provisions of Section 52-4-202, the board shall provide not less than 14 days' notice to the public before holding a public hearing under Subsection (1)(b);
  • (d) the board shall consider written and oral comments submitted by interested parties prior to or during the hearing held in accordance with Subsection (1)(b);
  • (e) the board shall provide evidence that placing a drug class on prior approval:
    • (i) will not impede quality of recipient care; and
    • (ii) that the drug class is subject to clinical abuse or misuse;
  • (f) the board shall reconsider its decision to place a drug on prior approval:
    • (i) no later than nine months after any drug class is placed on prior approval; and
    • (ii) at a public hearing with notice as provided in Subsection (1)(b);
  • (g) the program shall provide an approval or denial of a request for prior approval:
    • (i) by either:
      • (A) fax;
      • (B) telephone; or
      • (C) electronic transmission;
    • (ii) at least Monday through Friday, except for state holidays; and
    • (iii) within 24 hours after receipt of the prior approval request;
  • (h) the program shall provide for the dispensing of at least a 72-hour supply of the drug on the prior approval program:
    • (i) in an emergency situation; or
    • (ii) on weekends or state holidays;
  • (i) the program may be applied to allow acceptable medical use of a drug on prior approval for appropriate off-label indications; and
  • (j) before placing a drug class on the prior approval program, the board shall:
    • (i) determine that the requirements of Subsections (1)(a) through (i) have been met; and
    • (ii) by majority vote, place the drug class on prior approval.

• (2) The board may, only after complying with Subsections (1)(b) through (j), consider the cost:
  • (a) of a drug when placing a drug on the prior approval program; and
  • (b) associated with including, or excluding a drug from the prior approval process, including:
    • (i) potential side effects associated with a drug; or
    • (ii) potential hospitalizations or other complications that may occur as a result of a drug's inclusion on the prior approval process.

Download our app to see the most-to-date content.