Text: HF02267 Text: HF02269 Text: HF02200 - HF02299 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 not more than one 1 7 hundred fifty percent of the federal poverty level, as defined 1 8 by the most recent poverty income guidelines published by the 1 9 United States department of health and human services, or a 1 10 person sixty-five years of age or older, who with the person's 1 11 spouse has an annual net income of not more than one hundred 1 12 fifty percent of the federal poverty level, as defined by the 1 13 most recent poverty income guidelines published by the United 1 14 States department of health and human services. "Eligible 1 15 person" does not include a person who is eligible for 1 16 financial assistance for the purchase of prescription drugs 1 17 under another local, state, or federal program to the extent 1 18 that the other program provides financial assistance for the 1 19 purchase of prescription drugs. 1 20 b. "Prescription drug" means a prescription drug as 1 21 defined in section 155A.3. 1 22 c. "Program" means the pharmaceutical assistance program 1 23 established in this section. 1 24 d. "Reasonable cost" means a charge which is equal to the 1 25 average wholesale cost of the prescription drug and the 1 26 additional dispensing pharmacy's usual fee, not to exceed the 1 27 seventy-fifth percentile of usual and customary fees in this 1 28 state, as determined by the Iowa department of public health. 1 29 2. A pharmaceutical assistance program is created within 1 30 the department to provide for subsidization of the 1 31 prescription drug costs of eligible persons in rural and urban 1 32 areas throughout the state. The director shall appoint an 1 33 advisory committee to make recommendations to the commission 1 34 in the creation of the program and in adoption of rules to 1 35 implement the program. The Iowa pharmaceutical association 2 1 shall assist the commission in the creation and implementation 2 2 of the program. 2 3 3. The commission shall adopt rules to implement this 2 4 section. The rules shall provide for all of the following: 2 5 a. A means to determine the eligibility of a person, 2 6 including proof of the person's actual and anticipated annual 2 7 net income, evidence of complete or partial payment for the 2 8 costs of prescription drugs from a provider other than the 2 9 program, and other provisions consistent with this section. 2 10 b. Issuance by the department of a participation card upon 2 11 approval of an application. The annual fee for participation 2 12 in the program is eighty dollars. An initial application 2 13 shall be accompanied by proof of the date of birth of the 2 14 person. 2 15 c. A prescription copayment of twenty percent of the 2 16 reasonable cost of the prescription which shall be collected 2 17 from the person participating in the program by the dispensing 2 18 pharmacy not to exceed eight hundred dollars in prescription 2 19 costs for each calendar year. Thereafter, a copayment of 2 20 forty percent of the reasonable cost of prescriptions in 2 21 excess of eight hundred dollars for the remainder of any 2 22 calendar year shall be collected. The balance of the 2 23 reasonable costs shall be paid by the department to the 2 24 dispensing pharmacy after submission of a claim to the 2 25 department. 2 26 d. A provision that if the cost of the prescription drug 2 27 exceeds the reasonable cost and the prescription drug is 2 28 available under a generic name, the eligible person may obtain 2 29 the trade name drug rather than the generic drug by paying the 2 30 difference in the amounts of the trade name drug and generic 2 31 name drug. However, if the prescribing practitioner indicates 2 32 on the prescription that a substitution of the trade name drug 2 33 is prohibited, the eligible person is subject only to payment 2 34 of the copayment amount. 2 35 e. A reimbursement system which includes on-line point of 3 1 service claims transmission and adjudication, with utilization 3 2 review. 3 3 f. A form of identification for persons to use in proving 3 4 eligibility. The form of identification shall include a 3 5 conspicuous notation of the penalties for violation of this 3 6 section. 3 7 g. A requirement that prescriptions contain the name, 3 8 address, and identification number of the eligible person. 3 9 h. A provision to ensure choice of pharmaceutical services 3 10 by the eligible person. 3 11 4. A person who supplies false information to establish 3 12 eligibility for the program or to obtain reimbursement is 3 13 guilty of a serious misdemeanor. 3 14 EXPLANATION 3 15 This bill creates a pharmaceutical assistance program in 3 16 the department of elder affairs to provide for subsidization 3 17 of prescription drug costs of eligible persons 65 years of age 3 18 and older with limited incomes, as established in the bill. 3 19 The Iowa department of public health is required to develop a 3 20 reasonable cost, which includes a dispensing fee, for 3 21 prescription drugs. The department of elder affairs is 3 22 required to adopt rules regarding copayments, reimbursement 3 23 policies for generic and trade name drugs, a reimbursement 3 24 system for dispensers, a form of identification for eligible 3 25 persons, and requirements for information included in a 3 26 prescription. A person who supplies false information in 3 27 order to become eligible for the program or to obtain 3 28 reimbursement is guilty of a serious misdemeanor. 3 29 LSB 3757HH 77 3 30 pf/cf/24.1
Text: HF02267 Text: HF02269 Text: HF02200 - HF02299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
© 1998 Cornell College and League of Women Voters of Iowa
Comments about this site or page?
webmaster@legis.iowa.gov.
Please remember that the person listed above does not vote on bills. Direct all comments concerning legislation to State Legislators.
Last update: Thu Feb 26 03:42:49 CST 1998
URL: /DOCS/GA/77GA/Legislation/HF/02200/HF02268/980213.html
jhf