Text: SF02117 Text: SF02119 Text: SF02100 - SF02199 Text: SF 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 3757SS 77
3 30 pf/cf/24.1
Text: SF02117 Text: SF02119 Text: SF02100 - SF02199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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