Text: SF00296 Text: SF00298 Text: SF00200 - SF00299 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 resident of Iowa, sixty-five
1 6 years of age or older, with an annual net income of not more
1 7 than two hundred fifty percent of the federal poverty level,
1 8 as defined by the most recent poverty income guidelines
1 9 published by the United States department of health and human
1 10 services; or a person, sixty-five years of age or older, who
1 11 together with the person's spouse has an annual net income of
1 12 not more than two hundred fifty percent of the federal poverty
1 13 level, as defined by the most recent poverty income guidelines
1 14 published by the United States department of health and human
1 15 services. "Eligible person" does not include a person who is
1 16 eligible for financial assistance for the purchase of
1 17 prescription drugs outside of a health care facility setting
1 18 under another local, state, or federal program to the extent
1 19 that the other program provides financial assistance for the
1 20 purchase of prescription drugs.
1 21 b. "Prescription drug" means a prescription drug as
1 22 defined in section 155A.3.
1 23 c. "Program" means the pharmaceutical assistance program
1 24 established in this section.
1 25 d. "Reasonable cost" means a charge which does not exceed
1 26 the reimbursement rate and any additional charges established
1 27 by the department of human services pursuant to section
1 28 249A.21 for dispensing of the prescription drug under the
1 29 medical assistance program.
1 30 2. A pharmaceutical assistance program is created within
1 31 the department to provide for subsidization of the
1 32 prescription drug costs of eligible persons.
1 33 3. The commission shall adopt rules to implement this
1 34 section. The rules shall provide for all of the following:
1 35 a. A means to determine the eligibility of a person,
2 1 including proof of the person's actual and anticipated annual
2 2 net income, evidence of complete or partial payment for the
2 3 costs of prescription drugs by a third-party payor other than
2 4 the program, and other provisions consistent with this
2 5 section.
2 6 b. The program application form, which includes an
2 7 explanation of the penalties for violation of this section.
2 8 An initial application shall be accompanied by proof of the
2 9 date of birth of the person.
2 10 c. Issuance by the department of a participation card,
2 11 upon approval of an application. The card shall act as a form
2 12 of identification for a person to use in proving eligibility.
2 13 The card shall include a conspicuous notation of the penalties
2 14 for violation of this section.
2 15 d. 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 copayment costs for each calendar year. The balance of the
2 20 reasonable costs shall be paid by the department to the
2 21 dispensing pharmacy after submission of a claim to the
2 22 department.
2 23 e. A provision that if the prescription drug is available
2 24 under a generic name, the eligible person may obtain the brand
2 25 name drug rather than the generic drug by paying the
2 26 difference in the cost of the brand name drug and the generic
2 27 name drug. However, if the prescribing practitioner indicates
2 28 on the prescription that a substitution of a generic drug for
2 29 the brand name drug is prohibited, the eligible person is
2 30 subject only to payment of the copayment amount.
2 31 f. A reimbursement system which includes on-line point-of-
2 32 service claims transmission and adjudication, with utilization
2 33 review.
2 34 g. A provision to ensure choice of pharmaceutical services
2 35 by the eligible person.
3 1 4. A person who supplies false information to establish
3 2 eligibility for the program or to obtain reimbursement is
3 3 guilty of a serious misdemeanor.
3 4 5. The department shall establish a pharmaceutical
3 5 assistance education program to provide information regarding
3 6 options for prescription drug cost assistance including but
3 7 not limited to existing prescription drug group discount
3 8 programs. The pharmaceutical assistance education program
3 9 shall be provided through the area agencies on aging. The
3 10 department shall also provide information regarding options
3 11 for pharmaceutical assistance through various media sources
3 12 including radio, television, and print media sources.
3 13 Sec. 2. NEW SECTION. 249A.21 PHARMACIES – CONDITION OF
3 14 PARTICIPATION IN MEDICAL ASSISTANCE PROGRAM.
3 15 1. As a condition of participation in the medical
3 16 assistance program, a pharmacy, upon presentation by an
3 17 individual of a valid prescription and the individual's
3 18 federal Medicare card, shall charge the individual a price for
3 19 the prescription that does not exceed the reimbursement rate
3 20 and any additional charges established by the department for
3 21 dispensing of the prescription under the medical assistance
3 22 program. The price requirements of this section do not apply
3 23 to the prices of over-the-counter medications or compounded
3 24 prescriptions.
3 25 2. The department shall provide a mechanism to calculate
3 26 and transmit the price to the pharmacy. The drug utilization
3 27 review process shall not apply to prescriptions provided under
3 28 this section unless the individual to whom the prescription is
3 29 dispensed is a recipient of medical assistance.
3 30 3. The department shall monitor pharmacy participation
3 31 under this section and shall report the results of the
3 32 monitoring to the general assembly by January 1, annually.
3 33 The report shall include but is not limited to information
3 34 regarding any pharmacy that discontinues participation in the
3 35 medical assistance program and the reasons provided for the
4 1 discontinued participation.
4 2 4. It is the intent of the general assembly that the
4 3 provision of benefits under this section is to be reevaluated
4 4 if a prescription drug benefit is provided through the federal
4 5 Medicare program. The department shall inform the legislative
4 6 fiscal bureau if a prescription drug benefit is provided
4 7 through the federal Medicare program.
4 8 Sec. 3. APPROPRIATION. There is appropriated from the
4 9 general fund of the state to the department of elder affairs
4 10 for the fiscal year beginning July 1, 2001, and ending June
4 11 30, 2002, the following amount, or so much thereof as is
4 12 necessary, to be used for the purpose designated:
4 13 For the pharmaceutical assistance program established
4 14 pursuant to section 231.61:
4 15 .................................................. $ 40,000,000
4 16 EXPLANATION
4 17 This bill creates a pharmaceutical assistance program in
4 18 the department of elder affairs to provide for subsidization
4 19 of prescription drug costs of eligible persons 65 years of age
4 20 and older with limited incomes, as established in the bill.
4 21 The department of elder affairs is required to adopt rules
4 22 regarding copayments, reimbursement policies for generic and
4 23 brand name drugs, a reimbursement system for dispensing
4 24 pharmacies, and a form of participation card identification
4 25 for eligible persons. A person who supplies false information
4 26 in order to become eligible for the program or to obtain
4 27 reimbursement is guilty of a serious misdemeanor. The bill
4 28 also establishes a pharmaceutical assistance education program
4 29 to provide information regarding options for prescription drug
4 30 cost assistance. The program is to be provided through the
4 31 area agencies on aging and is to include a component which
4 32 provides information through various media sources.
4 33 The bill also provides for an appropriation to the
4 34 department of elder affairs from the general fund of the state
4 35 to finance the pharmaceutical assistance program.
5 1 The bill also provides that as a condition of participation
5 2 in the medical assistance program, pharmacies are required to
5 3 charge the reimbursement rate plus any other charge
5 4 established by the department of human services for dispensing
5 5 of the prescription that is charged under the medical
5 6 assistance program for prescriptions of individuals who
5 7 present a valid prescription and a federal Medicare card to
5 8 the pharmacist. The price requirements do not apply to over-
5 9 the-counter medications or to compounded prescriptions. The
5 10 department of human services is to provide a mechanism to
5 11 calculate and transmit the price to the pharmacy. Drug
5 12 utilization review requirements under the medical assistance
5 13 program do not apply to the provisions of this portion of the
5 14 bill. The department of human services is directed to monitor
5 15 pharmacy participation under the bill and is to report
5 16 annually on the results of the monitoring. The bill provides
5 17 that it is the intent of the general assembly to reevaluate
5 18 the benefits provided under the bill if a prescription drug
5 19 benefit is provided through the federal Medicare program. The
5 20 department is directed to inform the legislative fiscal bureau
5 21 if such a benefit is provided through the federal Medicare
5 22 program.
5 23 LSB 2830XS 79
5 24 pf/cf/24
Text: SF00296 Text: SF00298 Text: SF00200 - SF00299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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