Text: S03584 Text: S03586 Text: S03500 - S03599 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend House File 715, as amended, passed, and
1 2 reprinted by the House, as follows:
1 3 #1. Page 57, by inserting after line 22 the
1 4 following:
1 5 "Sec. . NEW SECTION. 217.13A PHARMACEUTICAL
1 6 ASSISTANCE PROGRAM ESTABLISHED.
1 7 1. For the purposes of this section, unless the
1 8 context otherwise requires:
1 9 a. "Eligible person" means a person, sixty-five
1 10 years of age or older with an annual net income of not
1 11 more than one hundred fifty percent of the federal
1 12 poverty level, as defined by the most recent poverty
1 13 income guidelines published by the United States
1 14 department of health and human services, or a person
1 15 sixty-five years of age or older, who with the
1 16 person's spouse has an annual net income of not more
1 17 than one hundred fifty percent of the federal poverty
1 18 level, as defined by the most recent poverty income
1 19 guidelines published by the United States department
1 20 of health and human services. "Eligible person" does
1 21 not include a person who is eligible for financial
1 22 assistance for the purchase of prescription drugs
1 23 under another local, state, or federal program to the
1 24 extent that the other program provides financial
1 25 assistance for the purchase of prescription drugs.
1 26 b. "Prescription drug" means a prescription drug
1 27 as defined in section 155A.3.
1 28 c. "Program" means the pharmaceutical assistance
1 29 program established in this section.
1 30 d. "Reasonable cost" means a charge which is equal
1 31 to the average wholesale cost of the prescription drug
1 32 and the additional dispensing pharmacy's usual fee,
1 33 not to exceed the seventy-fifth percentile of usual
1 34 and customary fees in this state, as determined by the
1 35 Iowa department of public health.
1 36 2. A pharmaceutical assistance program is created
1 37 within the department to provide for subsidization of
1 38 the prescription drug costs of eligible persons in
1 39 rural and urban areas throughout the state. The
1 40 director shall appoint an advisory committee to make
1 41 recommendations to the council in the creation of the
1 42 program and in adoption of rules to implement the
1 43 program. The Iowa pharmaceutical association shall
1 44 assist the council in the creation and implementation
1 45 of the program.
1 46 3. The council shall adopt rules to implement this
1 47 section. The rules shall provide for all of the
1 48 following:
1 49 a. A means to determine the eligibility of a
1 50 person, including proof of the person's actual and
2 1 anticipated annual net income, evidence of complete or
2 2 partial payment for the costs of prescription drugs
2 3 from a provider other than the program, and other
2 4 provisions consistent with this section.
2 5 b. Issuance by the department of a participation
2 6 card upon approval of an application. The annual fee
2 7 for participation in the program is eighty dollars.
2 8 An initial application shall be accompanied by proof
2 9 of the date of birth of the person.
2 10 c. A prescription copayment of twenty percent of
2 11 the reasonable cost of the prescription which shall be
2 12 collected from the person participating in the program
2 13 by the dispensing pharmacy not to exceed eight hundred
2 14 dollars in prescription costs for each calendar year.
2 15 Thereafter, a copayment of forty percent of the
2 16 reasonable cost of prescriptions in excess of eight
2 17 hundred dollars for the remainder of any calendar year
2 18 shall be collected. The balance of the reasonable
2 19 costs shall be paid by the department to the
2 20 dispensing pharmacy after submission of a claim to the
2 21 department.
2 22 d. A provision that if the cost of the
2 23 prescription drug exceeds the reasonable cost and the
2 24 prescription drug is available under a generic name,
2 25 the eligible person may obtain the trade name drug
2 26 rather than the generic drug by paying the difference
2 27 in the amounts of the trade name drug and generic name
2 28 drug. However, if the prescribing practitioner
2 29 indicates on the prescription that a substitution of
2 30 the trade name drug is prohibited, the eligible person
2 31 is subject only to payment of the copayment amount.
2 32 e. A reimbursement system which includes on-line
2 33 point of service claims transmission and adjudication,
2 34 with utilization review.
2 35 f. A form of identification for persons to use in
2 36 proving eligibility. The form of identification shall
2 37 include a conspicuous notation of the penalties for
2 38 violation of this section.
2 39 g. A requirement that prescriptions contain the
2 40 name, address, and identification number of the
2 41 eligible person.
2 42 h. A provision to ensure choice of pharmaceutical
2 43 services by the eligible person.
2 44 4. A person who supplies false information to
2 45 establish eligibility for the program or to obtain
2 46 reimbursement is guilty of a serious misdemeanor."
2 47 #2. By renumbering as necessary.
2 48
2 49
2 50
3 1 PATRICIA HARPER
3 2 STEVEN D. HANSEN
3 3
3 4
3 5
3 6 ROD HALVORSON
3 7 HF 715.318 77
3 8 pf/cf/28
Text: S03584 Text: S03586 Text: S03500 - S03599 Text: S Index Bills and Amendments: General Index Bill History: General Index
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