House Bill 0769c2
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Florida House of Representatives - 2000 CS/CS/HBs 769 & 1087
By the Committees on Health & Human Services
Appropriations, Health Care Services and Representatives
Argenziano, Byrd, Pruitt, Goode, Harrington, Dockery, Fasano,
Morroni, Detert, Murman, Littlefield, Kelly, K. Smith,
(Additional Sponsors on Last Printed Page)
1 A bill to be entitled
2 An act relating to pharmacy benefits; providing
3 intent; establishing a pharmacy benefit program
4 for certain low-income persons, under the
5 Agency for Health Care Administration;
6 providing eligibility; providing program
7 parameters; providing for processing and
8 payment of claims; providing requirements for
9 participation by pharmaceutical manufacturers;
10 providing for the purchase of medications from
11 foreign sources; providing rulemaking
12 authority; establishing a medication purchasing
13 cooperative to assist qualified individuals
14 with the purchase of prescribed drugs at the
15 best possible price; requiring the Agency for
16 Health Care Administration to administer the
17 cooperative; authorizing the agency to
18 promulgate rules; providing for membership in
19 the cooperative; requiring the cooperative to
20 annually solicit competitive bids from licensed
21 pharmacies to obtain discounts for members;
22 authorizing the agency to charge a monthly
23 membership fee to cover administrative costs;
24 providing for the issuance of membership
25 identification cards; requiring participating
26 pharmacies to guarantee the discount on a
27 prescribed drug at the rate quoted in their
28 contract with the state; providing
29 appropriations; providing for repeal of the
30 pharmacy benefit program and the medication
31 purchasing cooperative upon enactment of
1
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Florida House of Representatives - 2000 CS/CS/HBs 769 & 1087
611-180-00
1 federal pharmacy benefits through the Medicare
2 program; providing an effective date.
3
4 Be It Enacted by the Legislature of the State of Florida:
5
6 Section 1. Pharmacy benefit program.--
7 (1) INTENT.--It is the intent of the Legislature to
8 initiate a pharmacy benefit program for those persons with
9 very low incomes who are most in need. It is further the
10 intent of the Legislature to attempt to leverage maximum
11 pharmaceutical manufacturer participation in this program.
12 (2) PROGRAM ESTABLISHED.--There is established a
13 pharmacy benefit program which is designed to provide
14 prescription drug coverage to a limited group of most needy
15 individuals. The program is to be administered by the Agency
16 for Health Care Administration, under the authority provided
17 in s. 409.914(1), Florida Statutes, in conjunction with the
18 Department of Elderly Affairs and the Department of Health.
19 (3) ELIGIBILITY.--Eligibility for the program is
20 limited to those individuals who qualify for limited
21 assistance under the Florida Medicaid program as a result of
22 being dually eligible for both Medicare and Medicaid, but
23 whose limited assistance does not include any pharmacy
24 benefit. Specifically eligible are the following low-income
25 senior citizens:
26 (a) Those with incomes between 90 percent and 100
27 percent of the federal poverty level, the so-called qualified
28 Medicare beneficiaries.
29 (b) Those with incomes between 100 percent and 120
30 percent of the federal poverty level, the so-called specified
31 low-income Medicare beneficiaries.
2
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Florida House of Representatives - 2000 CS/CS/HBs 769 & 1087
611-180-00
1 (c) Those who live in counties without a participating
2 Medicare health maintenance organization.
3 (4) PROGRAM PARAMETERS.--
4 (a) The program shall make available the same
5 formulary of prescription medications that is made available
6 to Medicaid recipients. Medications shall be provided in the
7 generic equivalent if a generic equivalent exists, except when
8 a brand name medication is available at a cost lower than its
9 generic equivalent or when a physician has determined that the
10 brand name medication is necessary to achieve the desired
11 therapeutic effect and the agency approves.
12 (b) The agency shall, by rule, determine an
13 eligibility process, a 20-percent copayment requirement, an
14 annual limit of $1,000 per beneficiary, and other program
15 parameters as necessary.
16 (c) The Medicaid fiscal agent or a separately
17 contracted pharmacy benefits manager, or both, shall be used
18 for the processing and payment of claims.
19 (5) PHARMACEUTICAL MANUFACTURER PARTICIPATION.--In
20 order for a drug product to be covered under this program, the
21 product's manufacturer shall:
22 (a) Provide the maximum rebate to the state as
23 authorized in federal Medicaid regulations or other applicable
24 federal drug regulations or guidelines.
25 (b) Make the drug product available to the program for
26 the best price that the manufacturer makes the drug product
27 available under any purchasing arrangement.
28 (c) Agree to be an active participant in Florida with
29 the Indigent Drug Program of the Pharmaceutical Research and
30 Manufacturers of America and the pharmacy benefit counseling
31
3
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Florida House of Representatives - 2000 CS/CS/HBs 769 & 1087
611-180-00
1 and assistance program as established under s. 430.072,
2 Florida Statutes.
3 (6) PURCHASE OF FOREIGN MEDICATIONS.--The agency may
4 petition the United States Food and Drug Administration for
5 approval to purchase otherwise prohibited medications from
6 foreign sources for purposes of distribution under this
7 program.
8 (7) RULES.--The agency is authorized to adopt rules to
9 implement the provisions of this section.
10 Section 2. Medication purchasing cooperative.--
11 (1) Notwithstanding any other general or special law
12 to the contrary, the Agency for Health Care Administration, in
13 consultation with the Department of Health, the Department of
14 Elderly Affairs, and the Department of Management Services,
15 shall establish a medication purchasing cooperative to assist
16 qualified individuals with the purchase of prescribed drugs at
17 the best possible price.
18 (2) The medication purchasing cooperative shall be
19 administered by the agency.
20 (3) The agency is authorized to promulgate
21 administrative rules necessary to implement the provisions of
22 this section.
23 (4) Individuals eligible for membership in the
24 medication purchasing cooperative include residents of the
25 state who are 65 years of age or older, or disabled as defined
26 in s. 415.102(10), Florida Statutes, and who have incomes at
27 or below 250 percent of the federal poverty level. The
28 cooperative shall develop and implement application and
29 eligibility determination policies and procedures necessary to
30 determine eligibility for and enroll individuals in the
31 cooperative.
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Florida House of Representatives - 2000 CS/CS/HBs 769 & 1087
611-180-00
1 (5) At least annually, the medication purchasing
2 cooperative shall solicit competitive bids from licensed
3 pharmacies to obtain discounts on all prescribed medicines for
4 cooperative members. Companies bidding to serve the
5 cooperative's membership must bid a percentage discount on all
6 prescribed medicines listed in the state's procurement
7 document. The cooperative may solicit bids on a county,
8 regional, or statewide basis. The agency shall select
9 pharmacies to participate in the program based on price,
10 extent of drugs discounted, geographic coverage, and other
11 factors.
12 (6) The agency may charge individuals enrolled in the
13 cooperative a monthly membership fee at a level needed to
14 fully offset the administrative costs of the cooperative. The
15 agency shall issue an identification card to cooperative
16 members for purposes of member identification to participating
17 pharmacies.
18 (7) Member use of the identification card or
19 participating pharmacies when purchasing prescribed drugs is
20 voluntary. However, if a member presents a cooperative
21 identification card to a participating pharmacy, the pharmacy
22 must guarantee the member a discount on a prescribed drug at
23 the rate quoted in their contract with the state.
24 (8) The agency shall submit a report to the Speaker of
25 the House of Representatives and the President of the Senate
26 by January 1 of each year on the status of the cooperative,
27 including areas such as total enrollment, number of
28 participating pharmacies, level of discounts, and savings
29 realized by members enrolled in the program.
30 Section 3. There is hereby appropriated from the
31 General Revenue Fund to the Agency for Health Care
5
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Florida House of Representatives - 2000 CS/CS/HBs 769 & 1087
611-180-00
1 Administration for fiscal year 2000-2001 the sum of
2 $15,224,242 to fund the pharmacy benefit program established
3 under this act.
4 Section 4. There is hereby appropriated from the
5 General Revenue Fund to the Agency for Health Care
6 Administration the sum of $250,000 for implementation of the
7 medication purchasing cooperative provided for under this act.
8 Section 5. The provisions of this act shall be
9 repealed upon the federal enactment of pharmaceutical benefits
10 through the Medicare program.
11 Section 6. This act shall take effect upon becoming a
12 law.
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17 ADDITIONAL SPONSORS
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Sublette, Lynn, Russell, Waters, Rubio, Chestnut, Fiorentino,
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Jacobs, Crow, Bullard, Ritter, Wasserman Schultz, Greenstein,
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Sobel, Kosmas, Peaden, Fuller, Wallace, Futch, Brown, Rayson,
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Levine, Heyman, Melvin, Ogles, Kilmer, Argenio, Goodlette,
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Trovillion, Crist, Andrews, Merchant, Feeney, Putnam, Hart,
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Brummer, C. Green, Bilirakis, Sorensen, Prieguez, Barreiro, J.
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Miller, Edwards, Ritchie, Ball and Sanderson
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