Senate Bill sb2098
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Florida Senate - 2003 SB 2098
By Senator Wasserman Schultz
34-657-03 See HB 161
1 A bill to be entitled
2 An act relating to prescription drugs; creating
3 s. 409.960, F.S.; providing a popular name;
4 creating s. 409.962, F.S.; creating "The
5 LifeSaver Rx Program"; providing purpose of the
6 program; creating s. 409.964, F.S.; providing
7 definitions; creating s. 409.966, F.S.;
8 providing that the Secretary of Health Care
9 Administration shall operate the LifeSaver Rx
10 Program as a state pharmaceutical assistance
11 program to provide discounts to participants
12 for prescription drugs covered by a rebate
13 agreement; providing that the secretary shall
14 negotiate discount prices or rebates for
15 prescription drugs from manufacturers or
16 labelers; providing that the Agency for Health
17 Care Administration shall contract with
18 participating retail pharmacies to deliver
19 discounted prices to program participants;
20 providing factors to be considered in
21 negotiating discounts or rebates; providing for
22 quarterly calculation of discounts; creating s.
23 409.968, F.S.; providing for calculation of
24 payment by program participants and the agency;
25 requiring participating retail pharmacies in
26 the state to charge the rate allowable under
27 the Medicaid program for prescription drugs
28 sold to program participants; providing for
29 rate of reimbursement of participating retail
30 pharmacies; creating s. 409.970, F.S.;
31 providing requirements for program eligibility;
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Florida Senate - 2003 SB 2098
34-657-03 See HB 161
1 requiring the Agency for Health Care
2 Administration to establish enrollment
3 procedures; providing for an annual enrollment
4 fee; providing for use of enrollment fees and
5 rebates from drug manufacturers; creating s.
6 409.972, F.S.; providing for operation of the
7 program; authorizing the Board of Pharmacy to
8 adopt certain rules; creating s. 409.974, F.S.;
9 providing procedure for resolution of
10 discrepancies in rebate amounts; creating s.
11 409.976, F.S.; requiring an annual report;
12 creating s. 409.978, F.S.; authorizing
13 coordination with other programs; creating s.
14 409.980, F.S.; authorizing the agency to adopt
15 rules; creating s. 409.982, F.S.; authorizing
16 the agency to seek certain waivers; providing a
17 specified contribution by the agency toward the
18 cost of prescription drugs purchased by program
19 participants; providing severability; providing
20 an appropriation; providing an effective date.
21
22 Be It Enacted by the Legislature of the State of Florida:
23
24 Section 1. Section 409.960, Florida Statutes, is
25 created to read:
26 409.960 Popular name.--Sections 409.960-409.982 shall
27 be known by the popular name "LifeSaver Rx Program."
28 Section 2. Section 409.962, Florida Statutes, is
29 created to read:
30 409.962 LifeSaver Rx Program established; findings;
31 purpose.--
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Florida Senate - 2003 SB 2098
34-657-03 See HB 161
1 (1) It is the finding of the Legislature that
2 approximately one in four residents of Florida have no
3 prescription drug insurance coverage or wholly inadequate
4 prescription drug insurance coverage. These uninsured
5 residents pay excessive prices for prescription drugs, far
6 higher prices than are paid by managed care organizations,
7 insurance companies, and the Federal Government for the same
8 medicines and dosages. In many cases, these excessive drug
9 prices have the effect of denying residents access to
10 medically necessary care, thereby threatening their health and
11 safety. Many Florida residents require repeated doctor or
12 medical clinic appointments, having become sicker because they
13 could not afford to purchase the prescription drugs prescribed
14 for them. Many residents are admitted to or treated at
15 hospitals each year because they cannot afford the
16 prescription drugs that could have prevented the need for
17 hospitalization. Many others enter expensive institutional
18 care settings because they cannot afford the necessary
19 prescription drugs that could have supported them outside of
20 an institution. In each of these circumstances, state medical
21 assistance programs, including the Medicaid program, literally
22 pay the price. One major reason uninsured residents pay such
23 high prices for prescription drugs is that, unlike insured
24 residents, they have no prescription benefits manager
25 negotiating a fair price with drug companies on their behalf.
26 State government currently provides prescription drugs and
27 acts as a prescription benefit manager through a variety of
28 health plans and assistance programs and, in 2001, the
29 Legislature expanded the state's role in negotiating better
30 prescription drug prices for Medicaid. State government is the
31 only agent that, as a practical matter, can play an effective
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Florida Senate - 2003 SB 2098
34-657-03 See HB 161
1 role as a market participant on behalf of all residents who
2 are uninsured or underinsured. The state can and should act as
3 a prescription benefit manager, negotiating drug rebates and
4 using these funds to reimburse retail pharmacies for offering
5 lower drug prices.
6 (2) Recognizing that the state already acts as a
7 prescription benefit manager for a variety of health plans and
8 assistance programs, including the Medicaid program, the
9 LifeSaver Rx Program is established within the Agency for
10 Health Care Administration. The purpose of the program is to
11 expand Medicaid eligibility for prescription drug benefits
12 only, at a level that does not exceed available funding,
13 thereby providing prescription drug coverage to new
14 populations by expanding the state's role as a participant in
15 the prescription drug marketplace, negotiating rebates from
16 drug companies, and using the funds from such rebates to make
17 prescription drugs more affordable to Florida residents. Each
18 program participant shall receive a discount toward the
19 purchase of all prescription drugs that are covered by the
20 Florida Medicaid program. The Legislature finds that such a
21 program will improve public health and welfare, promote the
22 economic strength of our society, and substantially benefit
23 state health assistance programs, including the Medicaid
24 program.
25 Section 3. Section 409.964, Florida Statutes, is
26 created to read:
27 409.964 Definitions.--As used in this act, unless the
28 context otherwise indicates, the term:
29 (1) "Agency" means the Agency for Health Care
30 Administration.
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Florida Senate - 2003 SB 2098
34-657-03 See HB 161
1 (2) "Labeler" means an entity or person that receives
2 prescription drugs from a manufacturer or wholesaler and
3 repackages those drugs for later retail sale and that has a
4 labeler code from the federal Food and Drug Administration
5 under 21 C.F.R. s. 207.20 (1999).
6 (3) "Manufacturer" means a manufacturer of
7 prescription drugs and includes a subsidiary or affiliate of a
8 manufacturer.
9 (4) "Participating retail pharmacy" means a retail
10 pharmacy or other business licensed to dispense prescription
11 drugs in this state that:
12 (a) Participates in the state Medicaid program; or
13 (b) Agrees to participate in the LifeSaver Rx Program.
14 (5) "Program" means the LifeSaver Rx Program.
15 (6) "Secretary" means the Secretary of Health Care
16 Administration or the secretary's designee.
17 (7) "Qualified resident" means an uninsured resident
18 of the state who has obtained from the agency a LifeSaver Rx
19 Program enrollment card.
20 Section 4. Section 409.966, Florida Statutes, is
21 created to read:
22 409.966 Prescription drug discounts; negotiation of
23 discounts or rebates; calculation of discounts.--The secretary
24 shall operate the program as a state pharmaceutical assistance
25 program under 42 U.S.C. s. 1396r-8(c)(1)(C)(i)(III) to provide
26 discounts to participants for prescription drugs covered by a
27 rebate agreement.
28 (1) The secretary shall negotiate discount prices or
29 rebates for prescription drugs from drug manufacturers and
30 labelers for the program. Using sums from negotiated rebates,
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Florida Senate - 2003 SB 2098
34-657-03 See HB 161
1 the agency shall contract with participating retail pharmacies
2 to deliver discounted prices to program participants.
3 (2) In negotiating discount or rebate terms, the
4 secretary shall take into consideration:
5 (a) The rebate calculated under the Medicaid rebate
6 program pursuant to 42 U.S.C. s. 1396r-8;
7 (b) The price provided to eligible entities under 42
8 U.S.C. s. 256b; and
9 (c) Any other available information on prescription
10 drug prices, discounts, and rebates.
11 (3) The secretary may consider any supplemental
12 rebate negotiated pursuant to s. 409.912(38)(a)7.
13 (4) The drug discounts received by program
14 participants shall be calculated by the secretary on a
15 quarterly basis.
16 Section 5. Section 409.968, Florida Statutes, is
17 created to read:
18 409.968 Discounted prices for program participants.--
19 (1) Each program participant's payment shall be equal
20 to the Medicaid allowable charge for the prescription minus
21 the payment made by the agency. The payment made by the agency
22 shall include the estimated manufacturer rebate plus the state
23 subsidy of 2 percent per prescription as provided under this
24 act and the federal matching share for the state general
25 revenue contribution.
26 (2) A participating retail pharmacy shall charge the
27 Medicaid allowable rate for prescription drugs sold to
28 participants in the program.
29 (3) The participating retail pharmacy shall be
30 reimbursed by the agency at the agency's manufacturer
31 estimated rebate amount.
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Florida Senate - 2003 SB 2098
34-657-03 See HB 161
1 (4) The program as established in s. 409.962 is not an
2 entitlement.
3 Section 6. Section 409.970, Florida Statutes, is
4 created to read:
5 409.970 Program eligibility.--
6 (1) An individual is eligible to participate in the
7 program if he or she:
8 (a) Is a resident of the state;
9 (b) Is 65 years of age or older and is a Medicare
10 participant;
11 (c) Has a net family income at or below 300 percent of
12 the federal poverty level;
13 (d) Has exhausted all third-party prescription
14 coverage; and
15 (e) Requests to be enrolled in the program.
16 (2) An individual is ineligible to participate in the
17 program if he or she is eligible for assistance under the
18 state's Medicaid program.
19 (3) The agency shall establish simple procedures for
20 enrolling program participants. Such procedures shall include
21 the assessment of an annual enrollment fee of up to $50 per
22 enrollee. The agency shall undertake outreach efforts to build
23 public awareness of the program and maximize enrollment by
24 eligible residents. Revenues generated from program enrollment
25 fees and rebates from drug manufacturers shall be used for,
26 but not be limited to, offsetting state costs to administer
27 the program, the purchase of prescription drugs, and any
28 public awareness campaigns.
29 Section 7. Section 409.972, Florida Statutes, is
30 created to read:
31 409.972 Program operation.--
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Florida Senate - 2003 SB 2098
34-657-03 See HB 161
1 (1) The Board of Pharmacy, as created by s. 465.004,
2 in consultation with the agency, is authorized to adopt rules
3 pursuant to ss. 120.536(1) and 120.54 requiring disclosure by
4 participating retail pharmacies to program participants of the
5 amount of savings provided as a result of the program. Such
6 rules must protect information that is proprietary in nature.
7 (2) Participating retail pharmacies shall be paid in
8 advance for program discounts or shall be reimbursed by the
9 agency on a weekly or biweekly basis, in accordance with
10 contracts between the agency and such businesses.
11 (3) The agency shall collect from the participating
12 retail pharmacies utilization data necessary to calculate the
13 amount of the rebate from the manufacturer or labeler. The
14 agency shall protect the confidentiality of all information
15 subject to confidentiality protection under the laws of this
16 state or federal laws, rules, or regulations.
17 Section 8. Section 409.974, Florida Statutes, is
18 created to read:
19 409.974 Discrepancies in rebate
20 amounts.--Discrepancies in rebate amounts must be resolved
21 using the process established in this section.
22 (1) If there is a discrepancy in the manufacturer's or
23 labeler's favor between the amount claimed by a participating
24 retail pharmacy and the amount rebated by the manufacturer or
25 labeler, the agency, at the agency's expense, may hire a
26 mutually agreed-upon independent auditor. If a discrepancy
27 still exists following the audit, the manufacturer or labeler
28 shall justify the reason for the discrepancy or make payment
29 to the agency for any additional amount due.
30 (2) If there is a discrepancy against the interest of
31 the manufacturer or labeler in the information provided by the
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Florida Senate - 2003 SB 2098
34-657-03 See HB 161
1 agency to the manufacturer or labeler regarding the
2 manufacturer's or labeler's rebate, the manufacturer or
3 labeler, at the manufacturer's or labeler's expense, may hire
4 a mutually agreed-upon independent auditor to verify the
5 accuracy of the data supplied to the agency. If a discrepancy
6 still exists following the audit, the agency shall justify the
7 reason for the discrepancy or refund the manufacturer or
8 labeler.
9 (3) Following the completion of procedures established
10 in subsection (1) or subsection (2), the agency, the
11 manufacturer, or the labeler may request a hearing. Hearings
12 shall be conducted pursuant to ss. 120.569 and 120.57.
13 Supporting documentation must accompany the request for a
14 hearing.
15 Section 9. Section 409.976, Florida Statutes, is
16 created to read:
17 409.976 Report.--The agency shall provide a report on
18 the enrollment and financial status of the program to the
19 Governor, the President of the Senate, and the Speaker of the
20 House of Representatives by the second week in January each
21 year.
22 Section 10. Section 409.978, Florida Statutes, is
23 created to read:
24 409.978 Coordination with other programs.--The
25 secretary shall combine drug pricing negotiations to maximize
26 drug rebates when the secretary determines that the
27 combination of such negotiations is beneficial to both the
28 LifeSaver Rx Program and another state program, including the
29 state Medicaid program.
30 Section 11. Section 409.980, Florida Statutes, is
31 created to read:
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Florida Senate - 2003 SB 2098
34-657-03 See HB 161
1 409.980 Rulemaking.--The agency is authorized to adopt
2 rules pursuant to ss. 120.536(1) and 120.54 to implement the
3 provisions of this act. Such rules shall include eligibility
4 requirements, limits on participation, benefit limitations, a
5 requirement for generic drug substitution, and other program
6 parameters comparable to those of the Medicaid program.
7 Section 12. Section 409.982, Florida Statutes, is
8 created to read:
9 409.982 Waivers.--The agency shall seek any waivers of
10 federal law, rule, or regulation necessary to implement the
11 provisions of this act.
12 Section 13. The agency shall contribute 2 percent
13 toward the cost of each prescription purchased by the program
14 participant.
15 Section 14. The Legislature shall appropriate from the
16 General Revenue Fund to the Agency for Health Care
17 Administration an amount that is sufficient to implement the
18 provisions of this act.
19 Section 15. If any provision of this act or the
20 application thereof to any person or circumstance is held
21 invalid, the invalidity shall not affect other provisions or
22 applications of the act which can be given effect without the
23 invalid provision or application, and to this end the
24 provisions of this act are declared severable.
25 Section 16. This act shall take effect upon becoming a
26 law.
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