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House File 17

Partial Bill History

Bill Text

  1  3    1.  For the purposes of this section, unless the context
  1  4 otherwise requires:
  1  5    a.  "Eligible person" means a person, sixty-five years of
  1  6 age or older with an annual net income of eleven thousand
  1  7 dollars or less or a person, sixty-five years of age or older,
  1  8 who with their spouse has an annual net income of sixteen
  1  9 thousand dollars or less.  "Eligible person" does not include
  1 10 a person who is eligible for financial assistance for the
  1 11 purchase of prescription drugs under another local, state, or
  1 12 federal program to the extent that the other program provides
  1 13 financial assistance for the purchase of prescription drugs.
  1 14    b.  "Prescription drug" means a prescription drug as
  1 15 defined in section 155A.3.
  1 16    c.  "Program" means the pharmaceutical assistance program
  1 17 established in the section.
  1 18    d.  "Reasonable cost" means a charge which is equal to the
  1 19 average wholesale cost of the prescription drug and the
  1 20 additional dispensing pharmacy's usual fee, not to exceed the
  1 21 seventy-fifth percentile of usual and customary fees in this
  1 22 state, as determined by the Iowa department of public health.
  1 23    2.  A pharmaceutical assistance program is created within
  1 24 the department to provide for subsidization of the
  1 25 prescription drug costs of eligible persons in rural and urban
  1 26 areas throughout the state.  The director shall appoint an
  1 27 advisory committee to make recommendations to the commission
  1 28 in the creation of the program and in adoption of rules to
  1 29 implement the program.  The commission shall also receive
  1 30 assistance from the Iowa pharmaceutical association in
  1 31 creation and implementation of the program.
  1 32    3.  The commission shall adopt rules to implement this
  1 33 section.  The rules shall provide for all of the following:
  1 34    a.  A means to determine the eligibility of a person,
  1 35 including proof of the person's actual and anticipated annual
  2  1 net income, evidence of complete or partial payment for the
  2  2 costs of prescription drugs from a provider other than the
  2  3 program, and other provisions consistent with this section.
  2  4    b.  A prescription copayment of twenty percent of the
  2  5 reasonable cost of the prescription which shall be collected
  2  6 from the person by the dispensing pharmacy.  The balance of
  2  7 the reasonable costs shall be paid by the program to the
  2  8 dispensing pharmacy after submission of a claim to the
  2  9 department.
  2 10    c.  A provision that if the cost of the prescription drug
  2 11 exceeds the reasonable cost and the prescription drug is
  2 12 available under a generic name, the eligible person may obtain
  2 13 the trade name drug by paying the difference in the amounts of
  2 14 the trade name and generic name drug.  However, if the
  2 15 prescribing practitioner indicates on the prescription that a
  2 16 substitution of the trade name drug is prohibited, the
  2 17 eligible person is subject only to payment of the copayment
  2 18 amount.
  2 19    d.  A reimbursement system which includes on-line point of
  2 20 service claims transmission and adjudication, with utilization
  2 21 review.
  2 22    e.  A form of identification for persons to use in proving
  2 23 eligibility.  The form of identification shall include a
  2 24 conspicuous notation of the penalties for violation of this
  2 25 section.
  2 26    f.  A requirement that prescriptions contain the name,
  2 27 address, and identification number of the eligible person.
  2 28    g.  A program of prospective and retrospective drug
  2 29 utilization review to ensure the appropriate use of
  2 30 prescription medication and to detect prescription drug
  2 31 therapy problems.
  2 32    h.  A provision to ensure choice of pharmaceutical services
  2 33 by the eligible person.
  2 34    4.  A person who supplies false information to establish
  2 35 eligibility for the program or to obtain reimbursement is
  3  1 guilty of a serious misdemeanor.  
  3  2                           EXPLANATION
  3  3    This bill creates a pharmaceutical assistance program in
  3  4 the department of elder affairs to provide for subsidization
  3  5 of prescription drug costs of eligible persons 65 years of age
  3  6 and older with limited incomes, as established in the bill.
  3  7 The Iowa department of public health is required to develop a
  3  8 reasonable cost, which includes a dispensing fee, for
  3  9 prescription drugs.  The department of elder affairs is
  3 10 required to adopt rules regarding copayments, reimbursement
  3 11 policies for generic and trade name drugs, a reimbursement
  3 12 system for dispensers, a form of identification for eligible
  3 13 persons, and requirements for information included in a
  3 14 prescription.  A person who supplies false information in
  3 15 order to become eligible for the program or to obtain
  3 16 reimbursement is guilty of a serious misdemeanor.  
  3 17 LSB 1072HH 76
  3 18 pf/cf/24

Text: HF00016                           Text: HF00018
Text: HF00000 - HF00099                 Text: HF Index
Bills and Amendments: General Index     Bill History: General Index

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