Florida Senate - 2009 SB 894
By Senator Bennett
21-01132-09 2009894__
1 A bill to be entitled
2 An act relating to the purchasing of Medicaid
3 prescribed drugs; amending s. 409.908, F.S.; requiring
4 providers of Medicaid prescribed drugs to give
5 purchasing preference to drugs manufactured or
6 repackaged at certain facilities; creating s.
7 499.01205, F.S.; defining the term “qualifying
8 facility”; providing for the Department of Health's
9 recognition of a qualifying facility; requiring the
10 department to adopt procedures and criteria for the
11 recognition of a qualifying facility; providing an
12 effective date.
13
14 Be It Enacted by the Legislature of the State of Florida:
15
16 Section 1. Subsection (14) of section 409.908, Florida
17 Statutes, is amended to read:
18 409.908 Reimbursement of Medicaid providers.—Subject to
19 specific appropriations, the agency shall reimburse Medicaid
20 providers, in accordance with state and federal law, according
21 to methodologies set forth in the rules of the agency and in
22 policy manuals and handbooks incorporated by reference therein.
23 These methodologies may include fee schedules, reimbursement
24 methods based on cost reporting, negotiated fees, competitive
25 bidding pursuant to s. 287.057, and other mechanisms the agency
26 considers efficient and effective for purchasing services or
27 goods on behalf of recipients. If a provider is reimbursed based
28 on cost reporting and submits a cost report late and that cost
29 report would have been used to set a lower reimbursement rate
30 for a rate semester, then the provider's rate for that semester
31 shall be retroactively calculated using the new cost report, and
32 full payment at the recalculated rate shall be effected
33 retroactively. Medicare-granted extensions for filing cost
34 reports, if applicable, shall also apply to Medicaid cost
35 reports. Payment for Medicaid compensable services made on
36 behalf of Medicaid eligible persons is subject to the
37 availability of moneys and any limitations or directions
38 provided for in the General Appropriations Act or chapter 216.
39 Further, nothing in this section shall be construed to prevent
40 or limit the agency from adjusting fees, reimbursement rates,
41 lengths of stay, number of visits, or number of services, or
42 making any other adjustments necessary to comply with the
43 availability of moneys and any limitations or directions
44 provided for in the General Appropriations Act, provided the
45 adjustment is consistent with legislative intent.
46 (14) A provider of prescribed drugs shall be reimbursed the
47 least of the amount billed by the provider, the provider's usual
48 and customary charge, or the Medicaid maximum allowable fee
49 established by the agency, plus a dispensing fee. The Medicaid
50 maximum allowable fee for ingredient cost will be based on the
51 lower of: average wholesale price (AWP) minus 16.4 percent,
52 wholesaler acquisition cost (WAC) plus 4.75 percent, the federal
53 upper limit (FUL), the state maximum allowable cost (SMAC), or
54 the usual and customary (UAC) charge billed by the provider.
55 Medicaid providers are required to dispense generic drugs if
56 available at lower cost and the agency has not determined that
57 the branded product is more cost-effective, unless the
58 prescriber has requested and received approval to require the
59 branded product. The agency is directed to implement a variable
60 dispensing fee for payments for prescribed medicines while
61 ensuring continued access for Medicaid recipients. The variable
62 dispensing fee may be based upon, but not limited to, either or
63 both the volume of prescriptions dispensed by a specific
64 pharmacy provider, the volume of prescriptions dispensed to an
65 individual recipient, and dispensing of preferred-drug-list
66 products. The agency may increase the pharmacy dispensing fee
67 authorized by statute and in the annual General Appropriations
68 Act by $0.50 for the dispensing of a Medicaid preferred-drug
69 list product and reduce the pharmacy dispensing fee by $0.50 for
70 the dispensing of a Medicaid product that is not included on the
71 preferred drug list. The agency may establish a supplemental
72 pharmaceutical dispensing fee to be paid to providers returning
73 unused unit-dose packaged medications to stock and crediting the
74 Medicaid program for the ingredient cost of those medications if
75 the ingredient costs to be credited exceed the value of the
76 supplemental dispensing fee. The agency is authorized to limit
77 reimbursement for prescribed medicine in order to comply with
78 any limitations or directions provided for in the General
79 Appropriations Act, which may include implementing a prospective
80 or concurrent utilization review program. A provider of
81 prescribed drugs must give preference in the purchasing of
82 Medicaid prescribed drugs, including generic drugs, to those
83 manufactured or repackaged at a qualifying facility located in
84 this state and recognized by the Department of Health under s.
85 499.01205.
86 Section 2. Section 499.01205, Florida Statutes, is created
87 to read:
88 499.01205 Recognition of qualifying facility for Medicaid
89 purchasing preference.—
90 (1) As used in this section, the term “qualifying facility”
91 means a new or expanding facility located in this state at which
92 prescription drugs are manufactured or repackaged.
93 (2) A permittee that manufactures or repackages
94 prescription drugs at a qualifying facility may apply to the
95 department for recognition of the facility. The department shall
96 adopt rules prescribing the application form, procedures, and
97 criteria for recognition of a qualifying facility. A permittee,
98 upon the department's recognition of the qualifying facility, is
99 eligible for the Medicaid purchasing preference provided in s.
100 409.908(14).
101 Section 3. This act shall take effect July 1, 2009.