Text: S05368 Text: S05370 Text: S05300 - S05399 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend Senate File 2280 as follows:
1 2 #1. Page 20, by inserting after line 7 the
1 3 following:
1 4 "Sec. 100. NEW SECTION. 231.61 PHARMACEUTICAL
1 5 ASSISTANCE PROGRAM ESTABLISHED.
1 6 1. For the purposes of this section, unless the
1 7 context otherwise requires:
1 8 a. "Eligible person" means a person, sixty-five
1 9 years of age or older with an annual net income of not
1 10 more than one hundred fifty percent of the federal
1 11 poverty level, as defined by the most recent poverty
1 12 income guidelines published by the United States
1 13 department of health and human services, or a person
1 14 sixty-five years of age or older, who with the
1 15 person's spouse has an annual net income of not more
1 16 than one hundred fifty percent of the federal poverty
1 17 level, as defined by the most recent poverty income
1 18 guidelines published by the United States department
1 19 of health and human services. "Eligible person" does
1 20 not include a person who is eligible for financial
1 21 assistance for the purchase of prescription drugs
1 22 under another local, state, or federal program to the
1 23 extent that the other program provides financial
1 24 assistance for the purchase of prescription drugs.
1 25 b. "Prescription drug" means a prescription drug
1 26 as defined in section 155A.3.
1 27 c. "Program" means the pharmaceutical assistance
1 28 program established in this section.
1 29 d. "Reasonable cost" means a charge which is equal
1 30 to the average wholesale cost of the prescription drug
1 31 and the additional dispensing pharmacy's usual fee,
1 32 not to exceed the seventy-fifth percentile of usual
1 33 and customary fees in this state, as determined by the
1 34 Iowa department of public health.
1 35 2. A pharmaceutical assistance program is created
1 36 within the department of elder affairs to provide for
1 37 subsidization of the prescription drug costs of
1 38 eligible persons in rural and urban areas throughout
1 39 the state. The director shall appoint an advisory
1 40 committee to make recommendations to the commission in
1 41 the creation of the program and in adoption of rules
1 42 to implement the program. The Iowa pharmaceutical
1 43 association shall assist the commission in the
1 44 creation and implementation of the program.
1 45 3. The commission shall adopt rules to implement
1 46 this section. The rules shall provide for all of the
1 47 following:
1 48 a. A means to determine the eligibility of a
1 49 person, including proof of the person's actual and
1 50 anticipated annual net income, evidence of complete or
2 1 partial payment for the costs of prescription drugs
2 2 from a provider other than the program, and other
2 3 provisions consistent with this section.
2 4 b. Issuance by the department of a participation
2 5 card upon approval of an application. The annual fee
2 6 for participation in the program is eighty dollars.
2 7 An initial application shall be accompanied by proof
2 8 of the date of birth of the person.
2 9 c. A prescription copayment of twenty percent of
2 10 the reasonable cost of the prescription which shall be
2 11 collected from the person participating in the program
2 12 by the dispensing pharmacy not to exceed eight hundred
2 13 dollars in prescription costs for each calendar year.
2 14 Thereafter, a copayment of forty percent of the
2 15 reasonable cost of prescriptions in excess of eight
2 16 hundred dollars for the remainder of any calendar year
2 17 shall be collected. The balance of the reasonable
2 18 costs shall be paid by the department to the
2 19 dispensing pharmacy after submission of a claim to the
2 20 department.
2 21 d. A provision that if the cost of the
2 22 prescription drug exceeds the reasonable cost and the
2 23 prescription drug is available under a generic name,
2 24 the eligible person may obtain the trade name drug
2 25 rather than the generic drug by paying the difference
2 26 in the amounts of the trade name drug and generic name
2 27 drug. However, if the prescribing practitioner
2 28 indicates on the prescription that a substitution of
2 29 the trade name drug is prohibited, the eligible person
2 30 is subject only to payment of the copayment amount.
2 31 e. A reimbursement system which includes on-line
2 32 point of service claims transmission and adjudication,
2 33 with utilization review.
2 34 f. A form of identification for persons to use in
2 35 proving eligibility. The form of identification shall
2 36 include a conspicuous notation of the penalties for
2 37 violation of this section.
2 38 g. A requirement that prescriptions contain the
2 39 name, address, and identification number of the
2 40 eligible person.
2 41 h. A provision to ensure choice of pharmaceutical
2 42 services by the eligible person.
2 43 4. A person who supplies false information to
2 44 establish eligibility for the program or to obtain
2 45 reimbursement is guilty of a serious misdemeanor."
2 46 #2. By renumbering as necessary.
2 47
2 48
2 49
2 50 PATRICIA HARPER
3 1 SF 2280.514 77
3 2 rn/jw/28
Text: S05368 Text: S05370 Text: S05300 - S05399 Text: S Index Bills and Amendments: General Index Bill History: General Index
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