§ 274. Clinical drug review program. 1. In addition to the preferred\ndrug program established by this article, the commissioner may establish\na clinical drug review program. The commissioner may, from time to time,\nrequire prior authorization under such program for prescription drugs or\npatterns of utilization under state public health plans. When a\nprescriber prescribes a drug which requires prior authorization under\nthis section, state public health plan reimbursement shall be denied\nunless such prior authorization is obtained.\n 2. The clinical drug review program shall make available a twenty-four\nhour per day, seven days per week response system.\n 3. In establishing a prior authorization requirement for a drug under\nthe clinical drug review program, the commissioner shall consider the\nfollowing:\n (a) whether the drug requires monitoring of prescribing protocols to\nprotect both the long-term efficacy of the drug and the public health;\n (b) the potential for, or a history of, overuse, abuse, drug diversion\nor illegal utilization; and\n (c) the potential for, or a history of, utilization inconsistent with\napproved indications. Where the commissioner finds that a drug meets at\nleast one of these criteria, in determining whether to make the drug\nsubject to prior authorization under the clinical drug review program,\nthe commissioner shall consider whether similarly effective alternatives\nare available for the same disease state and the effect of that\navailability or lack of availability.\n 4. The commissioner shall obtain an evaluation of the factors set\nforth in subdivision three of this section and a recommendation as to\nthe establishment of a prior authorization requirement for a drug under\nthe clinical drug review program from the drug utilization review board.\nFor this purpose, the commissioner and the board, as applicable, shall\ncomply with the following meeting and notice processes established by\nthis article:\n (a) the open meetings law and freedom of information law provisions of\nsubdivision six of section two hundred seventy-one of this article; and\n (b) the public notice and interested party provisions of subdivisions\nseven, eight and nine of section two hundred seventy-two of this\narticle.\n 5. The board shall recommend a procedure and criteria for the approval\nof drugs subject to prior authorization under the clinical drug review\nprogram. Such criteria shall include the specific approved clinical\nindications for use of the drug.\n 6. The commissioner shall identify a drug for which prior\nauthorization is required, as well as the procedures and criteria for\napproval of use of the drug, under the clinical drug review program\nafter considering the recommendations from the board and any comments\nreceived from prescribers, dispensers, consumers and manufacturers of\nthe drug. In no event shall the prior authorization criteria for\napproval pursuant to this subdivision result in denial of the prior\nauthorization request based on the relative cost of the drug subject to\nprior authorization.\n 7. In the event that the patient does not meet the criteria for\napproval established by the commissioner in subdivision six of this\nsection, the clinical drug review program shall provide a reasonable\nopportunity for a prescriber to reasonably present his or her\njustification for prior authorization. If, after consultation with the\nprogram, the prescriber, in his or her reasonable professional judgment,\ndetermines that the use of the prescription drug is warranted, the\nprescriber's determination shall be final and prior authorization shall\nbe granted under this section; provided, however, that prior\nauthorization may be denied in cases where the department has\nsubstantial evidence that the prescriber or patient is engaged in fraud\nor abuse relating to the drug.\n 8. In the event that a patient presents a prescription to a pharmacist\nfor a prescription drug that requires
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