Are there any laws governing the prescription of drugs in managed care and other cost containment programs?

Yes, there are laws that govern the prescription of drugs in managed care and other cost containment programs in California. The laws that govern these programs are called the Knox-Keene Health Care Service Plan Act and the California Department of Managed Health Care (DMHC) regulations. These laws outline the circumstances under which providers may not be able to prescribe medications and what steps must be taken to obtain authorization for prescribing certain drugs. For example, providers are not able to prescribe certain medications covered by a managed care plan without prior authorization. This includes medications that the plan might consider to be medically unnecessary or not cost effective. Providers must explain the medical necessity of the medication and submit the necessary paperwork in order to obtain authorization. In addition, there are restrictions on how drugs can be prescribed in cost containment programs. For example, plans must require providers to use generic medications where available, as well as the lowest cost brand name medications. In conclusion, there are laws governing the prescription of drugs in managed care and other cost containment programs in California. These laws are designed to ensure that medication decisions are based on both medical need and cost effectiveness.

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Are there any laws governing the prescription of drugs in managed care and other cost containment programs?

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