Senate Bill sb0940e2

    CS for CS for SB 940                          Second Engrossed



  1                      A bill to be entitled

  2         An act relating to delivery of health care

  3         services; providing a short title; creating a

  4         pharmaceutical expense assistance program;

  5         providing eligibility; prescribing duties of

  6         the Agency for Health Care Administration and

  7         other entities; providing for rules; requiring

  8         a report; prescribing prerequisites that drug

  9         manufacturers must meet in order for their drug

10         products to be covered under the program or

11         Medicaid; requiring reimbursements under the

12         program to be the same as those for Medicaid;

13         requiring pharmacies that participate in the

14         program or in Medicaid to agree to limitations

15         on compensation for Medicare beneficiaries;

16         providing appropriations; directing the use of

17         rebates received; providing an effective date.

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19  Be It Enacted by the Legislature of the State of Florida:

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21         Section 1.  This act may be cited as the "Prescription

22  Affordability Act for Seniors."

23         Section 2.  Pharmaceutical expense assistance.--

24         (1)  PROGRAM ESTABLISHED.--There is established a

25  program to provide pharmaceutical expense assistance to

26  certain low-income elderly individuals.

27         (2)  ELIGIBILITY.--Eligibility for the program is

28  limited to those individuals who qualify for limited

29  assistance under the Florida Medicaid program as a result of

30  being dually eligible for both Medicare and Medicaid, but

31  whose limited assistance or Medicare coverage does not include


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    CS for CS for SB 940                          Second Engrossed



  1  any pharmacy benefit. Specifically eligible are low-income

  2  senior citizens who:

  3         (a)  Are Florida residents age 65 and over;

  4         (b)  Have an income between 90 and 120 percent of the

  5  federal poverty level;

  6         (c)  Are eligible for both Medicare and Medicaid;

  7         (d)  Are not enrolled in a Medicare health maintenance

  8  organization that provides a pharmacy benefit; and

  9         (e)  Request to be enrolled in the program.

10         (3)  BENEFITS.--Medications covered under the

11  pharmaceutical expense assistance program are those covered

12  under the Medicaid program in section 409.906(20), Florida

13  Statutes. Monthly benefit payments shall be limited to $80 per

14  program participant. Participants are required to make a

15  10-percent coinsurance payment for each prescription purchased

16  through this program.

17         (4)  ADMINISTRATION.--The pharmaceutical expense

18  assistance program shall be administered by the Agency for

19  Health Care Administration, in consultation with the

20  Department of Elderly Affairs.

21         (a)  The Agency for Health Care Administration and the

22  Department of Elderly Affairs shall develop a single-page

23  application for the pharmaceutical expense assistance program.

24         (b)  The Agency for Health Care Administration shall,

25  by rule, establish for the pharmaceutical expense assistance

26  program eligibility requirements, limits on participation,

27  benefit limitations, a requirement for generic-drug

28  substitution, and other program parameters comparable to those

29  of the Medicaid program.

30         (c)  By January 1 of each year, the Agency for Health

31  Care Administration shall report to the Legislature on the


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    CS for CS for SB 940                          Second Engrossed



  1  operation of the program. The report shall include information

  2  on the number of individuals served, use rates, and

  3  expenditures under the program. The report shall also address

  4  the impact of the program on reducing unmet pharmaceutical

  5  drug needs among the elderly and recommend programmatic

  6  changes.

  7         (5)  NONENTITLEMENT.--The pharmaceutical expense

  8  assistance program established by this section is not an

  9  entitlement.

10         (6)  PHARMACEUTICAL MANUFACTURER PARTICIPATION.--In

11  order for a drug product to be covered under Medicaid or this

12  program, the product's manufacturer shall:

13         (a)  Provide a rebate to the state equal to the rebate

14  required by the Medicaid program; and

15         (b)  Make the drug product available to the program for

16  the best price that the manufacturer makes the drug product

17  available in the Medicaid program.

18         (7)  REIMBURSEMENT.--Reimbursements to pharmacies

19  participating in the pharmaceutical expense assistance program

20  established under this section shall be equivalent to

21  reimbursements under the Medicaid program.

22         Section 3.  Medicare prescription discount program.--

23         (1)  As a condition of participation in the Florida

24  Medicaid Program or the pharmaceutical expense assistance

25  program, a pharmacy must agree to charge any individual who is

26  a Medicare beneficiary and who is a Florida resident showing a

27  Medicare card when they present a prescription a price no

28  greater than the cost of ingredients equal to the average

29  wholesale price minus 9 percent, and a dispensing fee of

30  $4.50.

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    CS for CS for SB 940                          Second Engrossed



  1         (2)  In lieu of the provisions of subsection (1), and

  2  as a condition of participation in the Florida Medicaid

  3  Program or the pharmaceutical expense assistance program, a

  4  pharmacy must agree to:

  5         (a)  Provide a private voluntary prescription discount

  6  program to state residents who are Medicare beneficiaries; or

  7         (b)  Accept a private voluntary discount prescription

  8  program from state residents who are Medicare beneficiaries.

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10  Discounts under this subsection must be at least as great as

11  discounts under subsection (1).

12         Section 4.  For fiscal year 2000-2001, the sum of $15

13  million is appropriated from the General Revenue Fund to the

14  Agency for Health Care Administration for the purpose of

15  implementing the pharmaceutical expense assistance program

16  effective January 1, 2001. Rebates collected under subsection

17  (6) of section 1 of this act shall be used to provide

18  additional benefits or serve additional people in the program.

19         Section 5.  For fiscal year 2000-2001, the sum of

20  $250,000 is appropriated from the General Revenue Fund to the

21  Agency for Health Care Administration to administer the

22  pharmaceutical expense assistance program.

23         Section 6.  This act shall take effect July 1, 2000.

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