Page:United States Statutes at Large Volume 104 Part 2.djvu/559

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PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-151 "(8) DELAYED EFFECTIVE DATE. —The provisions of paragraph (5) shall become effective with respect to drugs dispensed under this title on or after July 1, 1991. " (e) DENIAL OF FEDERAL FINANCIAL PARTICIPATION IN CERTAIN CASES.— The Secretary shall provide that no payment shall be made to a State under section 1903(a) for an innovator multiple-source drug dispensed on or after July 1, 1991, if, under applicable State law, a less expensive noninnovator multiple source drug (other than the innovator multiple-source drug) could have been dispensed. " (f) PHARMACY REIMBURSEMENT. — "(1) No REDUCTIONS IN REIMBURSEMENT LIMITS. —(A) During the period of time beginning on January 1, 1991, and ending on December 31, 1994, the Secretary may not modify by regulation the formula used to determine reimbursement limits described in the regulations under 42 CFR 447.331 through 42 CFR 447.334 (as in effect on the date of the enactment of the Omnibus Budget Reconciliation Act of 1990) to reduce such limits for covered outpatient drugs. (B) 3* During the period of time described in subpargigraph (A), any State that was in compliance with the regulations described in subparagraph (A) may not reduce the limits for covered outpatient drugs described in subparagraph (A) or dispensing fees for such drugs. "(2) ESTABLISHMENT OF UPPER PAYMENT LIMITS.— HCFA shall establish a Federal upper reimbursement limit for each multiple source drug for which the FDA has rated three or more products therapeutically and pharmaceutically equivalent, regardless of whether all such additional formulations are rated as such and shall use only such formulations when determining any such upper limit. "(g) DRUG USE REVIEW. — "(1) IN GENERAL. — "(A) In order to meet the requirement of section 1903(i)(10XB), a State shall provide, by not later than January 1, 1993, for a drug use review program described in paragraph (2) for covered outpatient drugs in order to assure that prescriptions (i) are appropriate, (ii) are medically necessary, and (iii) are not likely to result in adverse medical results. The program shall be designed to educate physicians and pharmacists to identify and reduce the frequency of patterns of fraud, abuse, gross overuse, or inappropriate or medically unnecessary care, among physicians, pharmacists, and patients, or associated with specific drugs or groups of drugs, as well as potential and actual severe adverse reactions to drugs including education on therapeutic appropriateness, overutilization and underutilization, appropriate use of generic products, therapeutic duplication, drug-disease contraindications, drug-drug interactions, incorrect drug dosage or duration of drug treatment, drug-allergy interactions, and clinical abuse/ misuse. "(B) The program shall assess data on drug use against predetermined standards, consistent with the following: "(i) compendia which shall consist of the following: '* So in original. Probably should be " "(B)".