Text: HF00327 Text: HF00329 Text: HF00300 - HF00399 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 AND CASE MANAGEMENT BY PHARMACISTS 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
1 11 person's spouse has an annual net income of not more than one
1 12 hundred fifty percent of the federal poverty level, as defined
1 13 by the most recent poverty income guidelines published by the
1 14 United States department of health and human services.
1 15 "Eligible person" does not include a person who is eligible
1 16 for financial assistance for the purchase of prescription
1 17 drugs under another local, state, or federal program to the
1 18 extent that the other program provides financial assistance
1 19 for the 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 and case
1 23 management program by pharmacists 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 and case management program
1 30 is created within the department to provide for subsidization
1 31 of the prescription drug costs of eligible persons and to
1 32 provide case management by pharmacists to eligible persons
1 33 throughout the state. The director shall appoint an advisory
1 34 committee to make recommendations to the commission in the
1 35 creation of the program and in adoption of rules to implement
2 1 the program. The Iowa pharmacy association shall assist the
2 2 commission in the creation and implementation 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. The program application form, which includes an
2 11 explanation of the penalties for violation of the section. An
2 12 initial application shall be accompanied by proof of the date
2 13 of birth of the person.
2 14 c. Issuance by the department of a participation card,
2 15 upon approval of an application. The card shall act as a form
2 16 of identification for a person to use in proving eligibility.
2 17 The card shall include a conspicuous notation of the penalties
2 18 for violation of this section. The annual fee for
2 19 participation in the program is eighty dollars.
2 20 d. A prescription copayment of twenty percent of the
2 21 reasonable cost of the prescription, which shall be collected
2 22 from the person participating in the program by the dispensing
2 23 pharmacy, not to exceed eight hundred dollars in prescription
2 24 costs for each calendar year. Thereafter, a copayment of
2 25 forty percent of the reasonable cost of prescriptions in
2 26 excess of eight hundred dollars for the remainder of any
2 27 calendar year shall be collected. The balance of the
2 28 reasonable costs shall be paid by the department to the
2 29 dispensing pharmacy after submission of a claim to the
2 30 department.
2 31 e. A provision that if the prescription drug is available
2 32 under a generic name, the eligible person may obtain the brand
2 33 name drug rather than the generic drug by paying the
2 34 difference in the costs of the brand name drug and generic
2 35 name drug. However, if the prescribing practitioner indicates
3 1 on the prescription that a substitution of a generic drug for
3 2 the brand name drug is prohibited, the eligible person is
3 3 subject only to payment of the copayment amount.
3 4 f. A reimbursement system which includes on-line point of
3 5 service claims transmission and adjudication, with utilization
3 6 review.
3 7 g. A provision to ensure choice of pharmaceutical services
3 8 by the eligible person.
3 9 h. A program of prospective and retrospective drug
3 10 utilization review to ensure the appropriate use of
3 11 prescription medication and to detect prescription drug
3 12 therapy problems.
3 13 i. A program of prescription drug case management by
3 14 pharmacists to ensure appropriate use and understanding of
3 15 prescription medications and drug interaction potential with
3 16 prescription and nonprescription medications.
3 17 4. A person who supplies false information to establish
3 18 eligibility for the program or to obtain reimbursement is
3 19 guilty of a serious misdemeanor.
3 20 Sec. 2. APPROPRIATION.
3 21 1. Notwithstanding section 99D.17 for the fiscal year
3 22 beginning July 1, 1999, and ending June 30, 2000, of the tax
3 23 revenues received pursuant to section 99D.15, subsections 1,
3 24 3, and 4, an amount equal to three-tenths of one percent of
3 25 the gross sum wagered by the pari-mutuel method shall be
3 26 deposited in the gambling treatment fund pursuant to section
3 27 99E.10, subsection 1, paragraph "a", for use by the
3 28 pharmaceutical assistance and case management by pharmacists
3 29 program.
3 30 2. Notwithstanding any provision to the contrary, there is
3 31 appropriated from the gambling treatment fund established
3 32 pursuant to section 99E.10, subsection 1, paragraph "a", for
3 33 the fiscal year beginning July 1, 1999, and ending June 30,
3 34 2000, receipts in excess of $1,900,000 to the department of
3 35 elder affairs for the pharmaceutical assistance and case
4 1 management by pharmacists program.
4 2 3. If moneys appropriated under this section are not
4 3 sufficient to fund the pharmaceutical assistance and case
4 4 management by pharmacists program, the benefits under the
4 5 program shall be reduced proportionately.
4 6 EXPLANATION
4 7 This bill creates a pharmaceutical assistance and case
4 8 management by pharmacists program in the department of elder
4 9 affairs to provide for subsidization of prescription drug
4 10 costs of eligible persons 65 years of age and older with
4 11 limited incomes, as established in the bill and to provide
4 12 case management by pharmacists to eligible persons. The Iowa
4 13 department of public health is required to develop a
4 14 reasonable cost, which includes a dispensing fee, for
4 15 prescription drugs. The department of elder affairs is
4 16 required to adopt rules regarding copayments, reimbursement
4 17 policies for generic and brand name drugs, a reimbursement
4 18 system for dispensing pharmacies, and a form of participation
4 19 card identification for eligible persons. A person who
4 20 supplies false information in order to become eligible for the
4 21 program or to obtain reimbursement is guilty of a serious
4 22 misdemeanor.
4 23 The bill also provides for an appropriation to the
4 24 department of elder affairs from pari-mutuel tax revenues and
4 25 the gambling treatment fund to finance the program.
4 26 LSB 1269HH 78
4 27 pf/cf/24.1
Text: HF00327 Text: HF00329 Text: HF00300 - HF00399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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