HOUSE AMENDMENT Bill No. SB 460
1	CHAMBER ACTION
2	Senate House
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12	Representative Goodlette offered the following:
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14	Amendment (with title amendment)
15	On page 3, between line(s) 3 and 4, insert:
16	Section 2. Section 430.83, Florida Statutes, is created to
17	read:
18	430.83 Sunshine for Seniors Program.--
19	(1) POPULAR NAME.--This section shall be known by the
20	popular name "The Sunshine for Seniors Act."
21	(2) DEFINITIONS.--As used in this section, the term:
22	(a) "Application assistance organization" means any
23	private organization that assists individuals with obtaining
24	prescription drugs through manufacturers’ pharmaceutical
25	assistance programs.
26	(b) "Eligible individual" means any individual who is 60
27	years of age or older who lacks adequate pharmaceutical
28	insurance coverage.
29	(c) "Manufacturers’ pharmaceutical assistance program"
30	means any program offered by a pharmaceutical manufacturer that
31	provides low-income individuals with prescription drugs free or
32	at reduced prices, including, but not limited to, senior
33	discount card programs and patient assistance programs.
34	(3) LEGISLATIVE FINDINGS AND INTENT.--The Legislature
35	finds that the pharmaceutical manufacturers, seeing a need, have
36	created charitable programs to aid low-income seniors with the
37	cost of prescription drugs. The Legislature also finds that many
38	low-income seniors are unaware of such programs or either do not
39	know how to apply for or need assistance in completing the
40	applications for such programs. Therefore, it is the intent of
41	the Legislature that the Department of Elderly Affairs, in
42	consultation with the Agency for Health Care Administration,
43	implement and oversee the Sunshine for Seniors Program to help
44	seniors in accessing manufacturers’ pharmaceutical assistance
45	programs.
46	(4) SUNSHINE FOR SENIORS PROGRAM.--There is established a
47	program to assist low-income seniors with obtaining prescription
48	drugs from manufacturers’ pharmaceutical assistance programs,
49	which shall be known as the "Sunshine for Seniors Program."
50	Implementation of the program is subject to the availability of
51	funding and any limitations or directions provided for by the
52	General Appropriations Act or chapter 216.
53	(5) IMPLEMENTATION AND OVERSIGHT DUTIES.--In implementing
54	and overseeing the Sunshine for Seniors Program, the Department
55	of Elderly Affairs:
56	(a) Shall promote the availability of manufacturers’
57	pharmaceutical assistance programs to eligible individuals with
58	various outreach initiatives.
59	(b) Shall, working cooperatively with pharmaceutical
60	manufacturers and consumer advocates, develop a uniform
61	application form, which shall be available in English, Spanish,
62	and Creole, to be completed by seniors who wish to participate
63	in the Sunshine for Seniors Program.
64	(c) May request proposals from application assistance
65	organizations to assist eligible individuals with obtaining
66	prescription drugs through manufacturers’ pharmaceutical
67	assistance programs.
68	(d) Shall train volunteers to help eligible individuals
69	fill out applications for the manufacturers’ pharmaceutical
70	assistance programs.
71	(e) Shall train volunteers to determine if applicants are
72	available for other state programs.
73	(f) Shall seek federal funds to help fund the Sunshine for
74	Seniors Program.
75	(g) May seek federal waivers to help fund the Sunshine for
76	Seniors Program.
77	(6) COMMUNITY PARTNERSHIPS.--The Department of Elderly
78	Affairs may build private-sector and public-sector partnerships
79	with corporations, hospitals, physicians, pharmacists,
80	foundations, volunteers, state agencies, community groups, area
81	agencies on aging, and any other entities that will further the
82	intent of this section. These community partnerships may also be
83	used to facilitate other pro bono benefits for eligible
84	individuals, including, but not limited to, medical, dental, and
85	prescription services.
86	(7) CONTRACTS.--The Department of Elderly Affairs may
87	select and contract with application assistance organizations to
88	assist eligible individuals in obtaining their prescription
89	drugs through the manufacturers’ pharmaceutical assistance
90	programs. If the department contracts with an application
91	assistance organization, the department shall evaluate quarterly
92	the performance of the application assistance organization to
93	ensure compliance with the contract and the quality of service
94	provided to eligible individuals.
95	(8) REPORTS AND EVALUATIONS.--By January 1 of each year,
96	while the Sunshine for Seniors Program is operating, the
97	Department of Elderly Affairs shall report to the Legislature
98	regarding the implementation and operation of the Sunshine for
99	Seniors Program.
100	(9) NONENTITLEMENT.--The Sunshine for Seniors Program
101	established by this section is not an entitlement. If funds are
102	insufficient to assist all eligible individuals, the Department
103	of Elderly Affairs may develop a waiting list prioritized by
104	application date.
105	Section 3. Section 409.9065, Florida Statutes, is amended
106	to read:
107	409.9065 Pharmaceutical expense assistance.--
108	(1) PROGRAM ESTABLISHED.--There is established a program
109	to provide pharmaceutical expense assistance to eligiblecertain
110	low-income elderly individuals, which shall be known as the "Ron
111	Silver Senior Drug Program" and may be referred to as the
112	"Silver Lifesaver Program."
113	(2) ELIGIBILITY.--Eligibility for the program is limited
114	to those individuals who qualify for limited assistance under
115	the Florida Medicaid program as a result of being dually
116	eligible for both Medicare and Medicaid, but whose limited
117	assistance or Medicare coverage does not include any pharmacy
118	benefit. To the extent funds are appropriated, specifically
119	eligible individuals are individuals who:
120	(a) Are Florida residents age 65 and over;
121	(b) Have an income equal to or less than 200 percent of
122	the federal poverty level;:
123	1. Between 88 and 120 percent of the federal poverty
124	level;
125	2. Between 88 and 150 percent of the federal poverty level
126	if the Federal Government increases the federal Medicaid match
127	for persons between 100 and 150 percent of the federal poverty
128	level; or
129	3. Between 88 percent of the federal poverty level and a
130	level that can be supported with funds provided in the General
131	Appropriations Act for the program offered under this section
132	along with federal matching funds approved by the Federal
133	Government under a s. 1115 waiver. The agency is authorized to
134	submit and implement a federal waiver pursuant to this
135	subparagraph. The agency shall design a pharmacy benefit that
136	includes annual per-member benefit limits and cost-sharing
137	provisions and limits enrollment to available appropriations and
138	matching federal funds. Prior to implementing this program, the
139	agency must submit a budget amendment pursuant to chapter 216;
140	(c) Are eligible for both Medicare and Medicaid;
141	(d) Have exhausted pharmacy benefits under Medicare,
142	Medicaid, or any other insurance planAre not enrolled in a
143	Medicare health maintenance organization that provides a
144	pharmacy benefit; and
145	(e) Request to be enrolled in the program.
146	(3) BENEFITS.--Eligible individuals shall receive a
147	discount for prescription drugsMedications covered under the
148	pharmaceutical expense assistance program are those covered
149	under the Medicaid program in s. 409.906(20)(19). Monthly
150	benefit payments shall be limited to $80 per program
151	participant. Participants are required to make a 10-percent
152	coinsurance payment for each prescription purchased through this
153	program.
154	(a) Eligible individuals with incomes equal to or less
155	than 120 percent of the federal poverty level shall receive a
156	discount of 100 percent for the first $160 worth of prescription
157	drugs they receive each month, subject to copayments that the
158	agency requires on these benefits. For all other prescription
159	drugs received each month, eligible individuals shall receive a
160	discount of 50 percent.
161	(b) Eligible individuals with incomes of more than 120
162	percent but not more than 150 percent of the federal poverty
163	level shall receive a discount of 50 percent.
164	(c) Eligible individuals with incomes of more than 150
165	percent but not more than 175 percent of the federal poverty
166	level shall receive a discount of 41 percent.
167	(d) Eligible individuals with incomes of more than 175
168	percent but not more than 200 percent of the federal poverty
169	level shall receive a discount of 37 percent.
170	(4) ADMINISTRATION.--The pharmaceutical expense assistance
171	program shall be administered by the agency for Health Care
172	Administration, in collaborationconsultationwith the
173	Department of Elderly Affairs and the Department of Children and
174	Family Services.
175	(a) The Agency for Health Care Administration and the
176	Department of Elderly Affairs shall develop a single-page
177	application for the pharmaceutical expense assistance program.
178	(a)(b) The agency for Health Care Administrationshall, by
179	rule, establish for the pharmaceutical expense assistance
180	program eligibility requirements;, limits on participation;,
181	benefit limitations, including copayments;a requirement for
182	generic drug substitution;,and other program parameters
183	comparable to those of the Medicaid program. However, there
184	shall be no monetary limit on prescription drugs purchased with
185	discounts of less than 51 percent unless the agency determines
186	there is a risk of a funding shortfall in the program. If the
187	agency determines there is a risk of a funding shortfall, the
188	agency may establish monetary limits on prescription drugs which
189	shall not be less than $160 worth of prescription drugs per
190	month.
191	(b)(c) By January 1 of each year, the agency for Health
192	Care Administrationshall report to the Legislature on the
193	operation of the program. The report shall include information
194	on the number of individuals served, use rates, and expenditures
195	under the program. The report shall also address the impact of
196	the program on reducing unmet pharmaceutical drug needs among
197	the elderly and recommend programmatic changes.
198	(5) NONENTITLEMENT.--The pharmaceutical expense assistance
199	program established by this section is not an entitlement.
200	Enrollment levels are limited to those authorized by the
201	Legislature in the annual General Appropriations Act. If, after
202	establishing monetary limits as required by paragraph (4)(a),
203	funds are insufficient to serve all eligible individuals
204	eligible under subsection (2) andseeking coverage, the agency
205	may develop a waiting list based on application dates to use in
206	enrolling individuals in unfilled enrollment slots.
207	(6) PHARMACEUTICAL MANUFACTURER PARTICIPATION.--In order
208	for a drug product to be covered under Medicaid or this program,
209	the product's manufacturer shall:
210	(a) Provide a rebate to the state equal to the rebate
211	required by the Medicaid program; and
212	(b) Make the drug product available to the program for the
213	best price that the manufacturer makes the drug product
214	available in the Medicaid program.
215	(7) REIMBURSEMENT.--Totalreimbursements to pharmacies
216	participating in the pharmaceutical expense assistance program
217	established under this section shall be equivalent to
218	reimbursements under the Medicaid program.
219	(8) FEDERAL APPROVAL.--The benefits provided in this
220	section are limited to those approved by the Federal Government
221	pursuant to a Medicaid waiver or an amendment to the state
222	Medicaid plan.
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224	================= T I T L E A M E N D M E N T =================
225	On page 1, line(s) 8,
226	remove: all of said line
227
228	and insert:
229	to the Legislature; creating s. 430.83, F.S.; providing a
230	popular name; providing definitions; providing legislative
231	findings and intent; creating the Sunshine for Seniors Program
232	to assist low-income seniors with obtaining prescription drugs
233	from manufacturers’ pharmaceutical assistance programs;
234	providing implementation and oversight duties of the Department
235	of Elderly Affairs; providing for community partnerships;
236	providing for contracts; requiring annual evaluation reports on
237	the program; specifying that the program is not an entitlement;
238	amending s. 409.9065, F.S.; revising the pharmaceutical expense
239	assistance program for low-income elderly individuals; adding
240	eligibility groups; providing benefits; requiring the Agency for
241	Health Care Administration, in administering the program, to
242	collaborate with both the Department of Elderly Affairs and the
243	Department of Children and Family Services; requiring federal
244	approval of benefits; providing an effective