House Journal: Page 942: Wednesday, April 2, 2003
Page 8
1 prescription drug, including on each refill of such
2 prescription, as follows:
3 a. A copayment of $1 for each covered generic
4 prescription drug.
5 b. A copayment of 50 cents for each covered brand-
6 name prescription drug for which the cost to the state
7 is $10 or less.
8 c. A copayment of $1 for each covered brand-name
9 prescription drug for which the cost to the state is
10 more than $10 and up to and including $25.
11 d. A copayment of $2 for each covered brand-name
12 prescription drug for which the cost to the state is
13 more than $25 and up to and including $50.
14 e. A copayment of $3 for each covered brand-name
15 prescription drug for which the cost to the state is
16 over $50.
17 3. The department of human services shall
18 establish an ingredient reimbursement basis equal to
19 the average wholesale price minus 12 percent for
20 pharmacy reimbursement for prescription drugs under
21 the medical assistance program.
22 4. a. The department of human services shall
23 continue the sole source contract relative to the
24 state maximum allowable cost (SMAC) program as
25 authorized in 2001 Iowa Acts, chapter 191, section 31,
26 subsection 1, paragraph "b", subparagraph (5). The
27 department shall expand the state maximum allowable
28 cost program for prescription drugs to the greatest
29 extent possible as determined under the contract.
30 b. Pharmacies and providers that are enrolled in
31 the medical assistance program shall make available
32 drug acquisition cost information, product
33 availability information, and other information deemed
34 necessary by the department for the determination of
35 reimbursement rates and the efficient operation of the
36 pharmacy benefit. Pharmacies and providers shall
37 produce and submit the requested information in the
38 manner and format requested by the department or its
39 designee at no cost to the department or designee.
40 Pharmacies and providers shall submit information to
41 the department or its designee within thirty days
42 following receipt of a request for information unless
43 the department or its designee grants an extension
44 upon written request of the pharmacy or provider.
45 c. The state maximum allowable cost shall be
46 established at the average wholesale acquisition cost
47 for a prescription drug and all equivalent products,
48 adjusted by a multiplier of 1.4. The department shall
49 update the state maximum allowable cost every two
50 months, or more often if necessary, to ensure adequate
© 2003 Cornell College and
League of Women Voters of Iowa
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