Text: HF00016 Text: HF00018 Text: HF00000 - HF00099 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. NEW SECTION. 231.61 PHARMACEUTICAL ASSISTANCE 1 2 PROGRAM ESTABLISHED. 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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