HB 0843 2003
1	A bill to be entitled
2	An act relating to prescription drugs; amending s.
3	409.9065, F.S.; revising the pharmaceutical expense
4	assistance program for low-income elderly individuals;
5	adding eligibility groups; providing benefits; requiring
6	the Agency for Health Care Administration, in
7	administering the program, to collaborate with both the
8	Department of Elderly Affairs and the Department of
9	Children and Family Services; requiring federal approval
10	of benefits; providing an effective date.
11
12	Be It Enacted by the Legislature of the State of Florida:
13
14	Section 1. Section 409.9065, Florida Statutes, is amended
15	to read:
16	409.9065 Pharmaceutical expense assistance.--
17	(1) PROGRAM ESTABLISHED.--There is established a program
18	to provide pharmaceutical expense assistance to eligiblecertain
19	low-income elderly individuals, which shall be known as the "Ron
20	Silver Senior Drug Program" and may be referred to as the
21	"Silver Lifesaver Program."
22	(2) ELIGIBILITY.--Eligibility for the program is limited
23	to those individuals who qualify for limited assistance under
24	the Florida Medicaid program as a result of being dually
25	eligible for both Medicare and Medicaid, but whose limited
26	assistance or Medicare coverage does not include any pharmacy
27	benefit. To the extent funds are appropriated, specifically
28	eligible individuals are individuals who:
29	(a) Are Florida residents age 65 and over;
30	(b) Have an income of up to 200 percent of the federal
31	poverty level;:
32	1. Between 88 and 120 percent of the federal poverty
33	level;
34	2. Between 88 and 150 percent of the federal poverty level
35	if the Federal Government increases the federal Medicaid match
36	for persons between 100 and 150 percent of the federal poverty
37	level; or
38	3. Between 88 percent of the federal poverty level and a
39	level that can be supported with funds provided in the General
40	Appropriations Act for the program offered under this section
41	along with federal matching funds approved by the Federal
42	Government under a s. 1115 waiver. The agency is authorized to
43	submit and implement a federal waiver pursuant to this
44	subparagraph. The agency shall design a pharmacy benefit that
45	includes annual per-member benefit limits and cost-sharing
46	provisions and limits enrollment to available appropriations and
47	matching federal funds. Prior to implementing this program, the
48	agency must submit a budget amendment pursuant to chapter 216;
49	(c) Are eligible for both Medicare and Medicaid;
50	(d) Have exhausted pharmacy benefits under Medicare,
51	Medicaid, or any other insurance planAre not enrolled in a
52	Medicare health maintenance organization that provides a
53	pharmacy benefit; and
54	(e) Request to be enrolled in the program.
55	(3) BENEFITS.--Eligible individuals shall receive a
56	discount for prescription drugsMedications covered under the
57	pharmaceutical expense assistance program are those covered
58	under the Medicaid program in s. 409.906(20)(19). Monthly
59	benefit payments shall be limited to $80 per program
60	participant. Participants are required to make a 10-percent
61	coinsurance payment for each prescription purchased through this
62	program.
63	(a) Eligible individuals with incomes of up to 120 percent
64	of the federal poverty level shall receive a discount of 100
65	percent for the first $160 worth of prescription drugs they
66	receive each month, subject to copayments that the agency
67	requires on these benefits. For all other prescription drugs
68	received each month, eligible individuals shall receive a
69	discount of 50 percent.
70	(b) Eligible individuals with incomes of between 120
71	percent and 150 percent of the federal poverty level shall
72	receive a discount of 50 percent.
73	(c) Eligible individuals with incomes of between 150
74	percent and 175 percent of the federal poverty level shall
75	receive a discount of 41 percent.
76	(d) Eligible individuals with incomes of between 175
77	percent and 200 percent of the federal poverty level shall
78	receive a discount of 37 percent.
79	(4) ADMINISTRATION.--The pharmaceutical expense assistance
80	program shall be administered by the agency for Health Care
81	Administration, in collaborationconsultationwith the
82	Department of Elderly Affairs and the Department of Children and
83	Family Services.
84	(a) The Agency for Health Care Administration and the
85	Department of Elderly Affairs shall develop a single-page
86	application for the pharmaceutical expense assistance program.
87	(a)(b) The agency for Health Care Administrationshall, by
88	rule, establish for the pharmaceutical expense assistance
89	program eligibility requirements;, limits on participation;,
90	benefit limitations, including copayments;a requirement for
91	generic drug substitution;,and other program parameters
92	comparable to those of the Medicaid program. However, there
93	shall be no monetary limit on prescription drugs purchased with
94	discounts of less than 51 percent unless the agency determines
95	there is a risk of a funding shortfall in the program. If the
96	agency determines there is a risk of a funding shortfall, the
97	agency may establish monetary limits on prescription drugs which
98	shall not be less than $160 worth of prescription drugs per
99	month.
100	(b)(c) By January 1 of each year, the agency for Health
101	Care Administrationshall report to the Legislature on the
102	operation of the program. The report shall include information
103	on the number of individuals served, use rates, and expenditures
104	under the program. The report shall also address the impact of
105	the program on reducing unmet pharmaceutical drug needs among
106	the elderly and recommend programmatic changes.
107	(5) NONENTITLEMENT.--The pharmaceutical expense assistance
108	program established by this section is not an entitlement.
109	Enrollment levels are limited to those authorized by the
110	Legislature in the annual General Appropriations Act. If, after
111	establishing monetary limits as required by paragraph (4)(a),
112	funds are insufficient to serve all eligible individuals
113	eligible under subsection (2) andseeking coverage, the agency
114	may develop a waiting list based on application dates to use in
115	enrolling individuals in unfilled enrollment slots.
116	(6) PHARMACEUTICAL MANUFACTURER PARTICIPATION.--In order
117	for a drug product to be covered under Medicaid or this program,
118	the product's manufacturer shall:
119	(a) Provide a rebate to the state equal to the rebate
120	required by the Medicaid program; and
121	(b) Make the drug product available to the program for the
122	best price that the manufacturer makes the drug product
123	available in the Medicaid program.
124	(7) REIMBURSEMENT.--Totalreimbursements to pharmacies
125	participating in the pharmaceutical expense assistance program
126	established under this section shall be equivalent to
127	reimbursements under the Medicaid program.
128	(8) FEDERAL APPROVAL.--The benefits provided in this
129	section are limited to those approved by the Federal Government
130	pursuant to a Medicaid waiver or an amendment to the state
131	Medicaid plan.
132	Section 2. This act shall take effect upon becoming a law.