Text: HF02581 Text: HF02583 Text: HF02500 - HF02599 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 135M.1 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. "Department" means the Iowa department of public
1 6 health.
1 7 b. "Eligible person" means a person, sixty-five years of
1 8 age or older, with an annual net income of not more than two
1 9 hundred percent of the federal poverty level for a family of
1 10 one, as defined by the most recent poverty income guidelines
1 11 published by the United States department of health and human
1 12 services, or a person sixty-five years of age or older who,
1 13 with the person's spouse, has an annual net income of not more
1 14 than two hundred fifty percent of the federal poverty level
1 15 for a family of two as defined by the most recent poverty
1 16 income guidelines published by the United States department of
1 17 health and human services. "Eligible person" does not include
1 18 a person who is eligible for financial assistance for the
1 19 purchase of prescription drugs under another local, state, or
1 20 federal program to the extent that the other program provides
1 21 financial assistance for the purchase of prescription drugs
1 22 and does not include a person who is covered under or who
1 23 voluntarily lost coverage within the prior six months under a
1 24 health benefit plan which provides coverage for the purchase
1 25 of prescription drugs.
1 26 c. "Prescription drug" means a prescription drug as
1 27 defined in section 155A.3.
1 28 d. "Program" means the pharmaceutical assistance program
1 29 established in this section.
1 30 e. "Reasonable cost" means a charge which is equal to the
1 31 average wholesale cost of the prescription drug and the
1 32 additional dispensing pharmacy's usual fee, not to exceed the
1 33 seventy-fifth percentile of usual and customary fees in this
1 34 state, as determined by the department.
1 35 2. A pharmaceutical assistance program is established
2 1 within the department to provide for subsidization of
2 2 prescription drug purchases by eligible persons. The director
2 3 of public health shall appoint an advisory committee to make
2 4 recommendations regarding the establishment of the program and
2 5 the adoption of rules to administer the program.
2 6 3. The department shall adopt rules to administer this
2 7 section. The rules shall provide for, but are not limited to,
2 8 all of the following:
2 9 a. A means to determine the eligibility of a person,
2 10 including proof of the person's date of birth, proof of the
2 11 person's actual and anticipated annual net income, evidence of
2 12 complete or partial payment for the costs of prescription
2 13 drugs from a provider other than the program, and other
2 14 provisions consistent with this section.
2 15 b. Issuance by the department of a participation card,
2 16 upon approval of an application. The participation card shall
2 17 include a conspicuous notation of the penalties for violation
2 18 of this section.
2 19 c. A prescription copayment based on the reasonable cost
2 20 of the prescription. The eligible person may choose to
2 21 participate in either an annual limited fee plan or a
2 22 deductible plan with annual limits on copayments.
2 23 d. A provision that if the cost of the prescription drug
2 24 exceeds the reasonable cost and the prescription drug is
2 25 available under a generic name, the eligible person may obtain
2 26 the trade name drug rather than the generic drug by paying the
2 27 difference in the cost of the trade name drug and the generic
2 28 drug. However, if the prescribing practitioner indicates on
2 29 the prescription that a substitution of the trade name drug is
2 30 prohibited, the eligible person is subject only to payment of
2 31 the copayment amount.
2 32 e. A reimbursement system that includes on-line point of
2 33 service claims transmission and adjudication, with utilization
2 34 review.
2 35 f. A requirement that prescriptions contain the name,
3 1 address, and identification number of the eligible person.
3 2 g. A provision to ensure choice of pharmaceutical services
3 3 by the eligible person.
3 4 4. A person who supplies false information to establish
3 5 eligibility for the program or to obtain reimbursement is
3 6 guilty of a serious misdemeanor.
3 7 5. This section does not create an entitlement to any
3 8 funds available for the program, and the department may expend
3 9 funds only to the extent funds are available and within its
3 10 discretion to expend under the program.
3 11 Sec. 2. APPROPRIATION. There is appropriated from the
3 12 tobacco settlement fund created in section 12.65, to the Iowa
3 13 department of public health for the fiscal year beginning July
3 14 1, 2000, and ending June 30, 2001, the following amount, or so
3 15 much thereof as is necessary, to be used for the purpose
3 16 designated:
3 17 For the pharmaceutical assistance program established in
3 18 section 135M.1:
3 19 .................................................. $ 10,000,000
3 20 EXPLANATION
3 21 This bill creates a pharmaceutical assistance program for
3 22 elderly Iowans in the Iowa department of public health to
3 23 provide for subsidization of prescription drug purchases by
3 24 eligible persons 65 years of age and older with limited
3 25 incomes, as established in the bill. The department is
3 26 required to develop a reasonable cost, which includes a
3 27 dispensing fee, for prescription drugs. The Iowa department
3 28 of public health is required to adopt rules regarding
3 29 copayments, reimbursement policies for generic and trade name
3 30 drugs, a reimbursement system for dispensers, and requirements
3 31 for information included in a prescription. A person who
3 32 supplies false information in order to become eligible for the
3 33 program or to obtain reimbursement is guilty of a serious
3 34 misdemeanor. The bill provides that the program does not
3 35 establish an entitlement. The bill also provides an
4 1 appropriation from the tobacco settlement fund of $10 million
4 2 to the Iowa department of public health for the program.
4 3 LSB 6194YH 78
4 4 pf/cf/24
Text: HF02581 Text: HF02583 Text: HF02500 - HF02599 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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