Senate Bill sb0120

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    Florida Senate - 2001                                   SB 120

    By Senators Rossin, Campbell, Dyer, Klein, Mitchell and Geller





    35-96C-01

  1                      A bill to be entitled

  2         An act relating to pharmaceutical expense

  3         assistance; amending s. 409.9065, F.S.;

  4         revising the eligibility requirements for the

  5         pharmaceutical expense assistance program;

  6         deleting a requirement that a participant be

  7         eligible for the Medicaid program; requiring

  8         that the Agency for Health Care Administration

  9         notify Medicare recipients of the program;

10         requiring the agency to establish a toll-free

11         telephone number for obtaining information

12         about the program; providing an effective date.

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

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16         Section 1.  Section 409.9065, Florida Statutes, is

17  amended to read:

18         409.9065  Pharmaceutical expense assistance.--

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

20  program to provide pharmaceutical expense assistance to

21  certain low-income elderly individuals.

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

23  limited to those individuals who qualify for limited

24  assistance under the Florida Medicaid program as a result of

25  being dually eligible for both Medicare and Medicaid, but

26  whose limited assistance or Medicare coverage does not include

27  any pharmacy benefit. Specifically eligible are low-income

28  senior citizens who:

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

30         (b)  Have an income at or below 150 between 90 and 120

31  percent of the federal poverty level;

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    Florida Senate - 2001                                   SB 120
    35-96C-01




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

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

  3  organization that provides a pharmacy benefit; and

  4         (e)  Are not receiving prescription-drug assistance

  5  from the Federal Government; and

  6         (f)(e)  Request to be enrolled in the program.

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

  8  pharmaceutical expense assistance program are those covered

  9  under the Medicaid program in s. 409.906(20). Monthly benefit

10  payments shall be limited to $150 $80 per program participant.

11  Participants are required to make a 10-percent coinsurance

12  payment for each prescription purchased through this program.

13         (4)  ADMINISTRATION.--The pharmaceutical expense

14  assistance program shall be administered by the Agency for

15  Health Care Administration, in consultation with the

16  Department of Elderly Affairs.

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

18  Department of Elderly Affairs shall develop a single-page

19  application for the pharmaceutical expense assistance program.

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

21  by rule, establish for the pharmaceutical expense assistance

22  program eligibility requirements, limits on participation,

23  benefit limitations, a requirement for generic drug

24  substitution, and other program parameters comparable to those

25  of the Medicaid program.

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

27  Care Administration shall report to the Legislature on the

28  operation of the program. The report shall include information

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

30  expenditures under the program. The report shall also address

31  the impact of the program on reducing unmet pharmaceutical

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    Florida Senate - 2001                                   SB 120
    35-96C-01




  1  drug needs among the elderly and recommend programmatic

  2  changes.

  3         (5)  NONENTITLEMENT.--The pharmaceutical expense

  4  assistance program established by this section is not an

  5  entitlement.

  6         (6)  PHARMACEUTICAL MANUFACTURER PARTICIPATION.--In

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

  8  program, the product's manufacturer shall:

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

10  required by the Medicaid program; and

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

12  the best price that the manufacturer makes the drug product

13  available in the Medicaid program.

14         (7)  REIMBURSEMENT.--Reimbursements to pharmacies

15  participating in the pharmaceutical expense assistance program

16  established under this section shall be equivalent to

17  reimbursements under the Medicaid program.

18         (8)  NOTIFICATION.--The Agency for Health Care

19  Administration shall annually notify each Medicare recipient

20  of the pharmaceutical expense assistance program. The notice

21  must contain a description of the program and a toll-free

22  telephone number to call to obtain additional information

23  concerning the program.

24         Section 2.  This act shall take effect July 1, 2001.

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    Florida Senate - 2001                                   SB 120
    35-96C-01




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  2                          SENATE SUMMARY

  3    Revises the eligibility requirements for the
      pharmaceutical expense assistance program established to
  4    provide assistance to certain low-income elderly persons.
      Deletes a requirement that a participant be eligible for
  5    assistance under the Medicaid program. Provides that a
      participant must not be receiving federal assistance for
  6    prescription drugs. Requires that the Agency for Health
      Care Administration annually notify Medicare recipients
  7    of the program and provide a toll-free telephone number
      for obtaining information about the program.
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