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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