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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