Feed for /1999/related/proposals/sb335 PDF
1999 - 2000 LEGISLATURE
January 21, 2000 - Introduced by Senators Clausing, Wirch, Robson, Risser,
Grobschmidt, Burke, Moen, Erpenbach, Baumgart, Breske, Chvala,
Shibilski, Drzewiecki
and Darling, cosponsored by Representatives Waukau,
Krusick, Hasenohrl, La Fave, Kreuser, Gronemus, Schooff, Musser
and
Pettis. Referred to Health, Utilities, Veterans and Military Affairs.
SB335,1,3 1An Act to create 20.435 (4) (bv), 20.435 (4) (j) and 49.688 of the statutes;
2relating to: prescription drug assistance for elderly persons and making
3appropriations.
Analysis by the Legislative Reference Bureau
This bill creates an entitlement program for prescription drug assistance for
elderly persons in the department of health and family services (DHFS) and a sum
sufficient appropriation of general purpose revenues for the program. Under the
program, beginning January 1, 2001, state residents who are aged at least 65 years,
who are ineligible for medical assistance and whose gross incomes, if single, are not
more than $50,000 or, if married, are not more than $75,000 per couple, as annually
indexed for inflation, may apply for assistance of up to $10,000 per year in paying for
prescription drugs. Prescription drugs for which a program participant may receive
coverage are those prescription drugs that are covered under the medical assistance
program. Participants in the prescription drug assistance program must pay 25%
of the cost of the prescription drug, at the rate under which pharmacists are
reimbursed under the medical assistance program, plus copayments of $5 for each
generic prescription drug and $10 for each brand-name drug. Under the program,
DHFS is the payer of last resort for coverage for prescription drugs and must
reimburse pharmacist providers at the rate under which pharmacists are
reimbursed under the medical assistance program. DHFS must also maintain or
contract for the maintenance of a toll-free telephone number to provide application
information about the prescription drug assistance program. In order for drugs

manufactured by a manufacturer doing business in this state to be included in the
program, the manufacturer must enter with DHFS into a rebate agreement that is
modeled on rebate agreements under federal medicaid law. The rebate agreement
must provide that the manufacturer make payments to DHFS each calendar quarter
or as scheduled by DHFS and that the rebate payment amounts be determined by
the method specified in federal medicaid law. The bill appropriates $1,000,000 in
general purpose revenues in fiscal year 1999-2000 to the general program
supplementation appropriation account of the joint committee on finance (JCF) and
requires DHFS to submit to JCF a plan for expenditure of these funds for
administration of the prescription drug assistance program. If the cochairpersons
of JCF do not notify the secretary of health and family services of the committee's
intent to schedule a meeting to review the plan, JCF must supplement the DHFS
general program operations appropriation account as provided in the DHFS plan.
If the cochairpersons of JCF notify the secretary of health and family services that
JCF intends to schedule a meeting to review the plan, the DHFS appropriation
account may be supplemented only as approved by JCF.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB335, s. 1 1Section 1. 20.435 (4) (bv) of the statutes is created to read:
SB335,2,32 20.435 (4) (bv) Prescription drug assistance for elderly; aids. A sum sufficient
3for the program for prescription drug assistance for elderly persons under s. 49.688.
SB335, s. 2 4Section 2. 20.435 (4) (j) of the statutes is created to read:
SB335,2,75 20.435 (4) (j) Prescription drug assistance for elderly; manufacturer rebates.
6All moneys received from rebate payments by manufacturers under s. 49.688 (5), to
7be used for prescription drug assistance for elderly persons under s. 49.688.
SB335, s. 3 8Section 3. 49.688 of the statutes is created to read:
SB335,2,10 949.688 Prescription drug assistance for elderly persons. (1) In this
10section:
SB335,2,1111 (a) "Brand name" has the meaning given in s. 450.12 (1) (a).
SB335,2,1212 (b) "Generic name" has the meaning given in s. 450.12 (1) (b).
SB335,3,2
1(c) "Gross income" means all income, from whatever source derived and in
2whatever form realized, whether in money, property or services.
SB335,3,33 (d) "Prescription drug" has the meaning given in s. 450.01 (20).
SB335,3,15 4(2) From the appropriations under s. 20.435 (4) (bv) and (j), beginning January
51, 2001, the department shall reimburse pharmacists for the provision of up to
6$10,000 per year of prescription drugs that correspond to those prescription drugs
7for which reimbursement is made under s. 49.46 (2) (b) 6. h. and for which the
8manufacturer has entered into a rebate agreement with the department under sub.
9(5), to a person who meets criteria for eligibility under sub. (3). The department is
10the payer of last resort for coverage for prescription drugs under this subsection. The
11payment rate for provider reimbursement shall be the allowable charges paid under
12s. 49.46 (2) (b) 6. h. for prescription drugs. The department shall maintain, or
13contract for the maintenance of, a toll-free telephone number at department
14headquarters to provide information about participation in the program under this
15subsection.
SB335,3,17 16(3) (a) An individual is eligible for participation in the program under sub. (2)
17if the individual meets all of the following requirements:
SB335,3,2018 1. The individual is at least 65 years of age, is a resident, as defined in s. 27.01
19(10) (a), of this state and is ineligible for medical assistance under s. 49.46, 49.465,
2049.468 or 49.47.
SB335,3,2321 2. If single, the individual's gross income does not exceed $50,000 or, if married,
22the couple's gross income does not exceed $75,000. These limitations shall be
23annually adjusted as specified in sub. (4).
SB335,3,2424 (b) Program participants shall pay all of the following:
SB335,4,2
11. Twenty-five percent of the allowable charge paid under s. 49.46 (2) (b) 6. h.
2for each prescription drug provided under the program.
SB335,4,43 2. A copayment of $5 for each prescription drug provided under the program
4that bears only a generic name.
SB335,4,65 3. A copayment of $10 for each prescription drug provided under the program
6that bears a brand name.
SB335,4,87 (c) No program participant may be required to demonstrate that he or she has
8no disability insurance policy, as defined in s. 632.895 (1) (a).
SB335,4,15 9(4) Beginning by January 1, 2001, the department shall annually by January
101 increase the dollar amounts specified under sub. (3) (a) 2. by a percentage equal to
11the percentage change between the U.S. consumer price index for all urban
12consumers, U.S. city average, for the month of December of the previous year and the
13U.S. consumer price index for all urban consumers, U.S. city average,for the month
14of December of the year before the previous year, as determined by the federal
15department of labor.
SB335,4,20 16(5) A drug manufacturer that sells drugs for prescribed use in this state shall,
17as a condition of inclusion of those drugs in the program under this section, enter
18with the department into a rebate agreement that is modeled on the rebate
19agreement specified under 42 USC 1396r-8. The rebate agreement shall include all
20of the following as requirements:
SB335,4,2221 (a) That the manufacturer shall make rebate payments to the department each
22calendar quarter or according to a schedule established by the department.
SB335,4,2423 (b) That the amount of the rebate payment shall be determined by the method
24specified in 42 USC 1396r-8 (c).
SB335, s. 4 25Section 4. Nonstatutory provisions.
SB335,5,23
1(1) Prescription drug assistance for elderly persons; administration. The
2department of health and family services may request the joint committee on finance
3to supplement, from the appropriation account under section 20.865 (4) (a) of the
4statutes, the appropriation account under section 20.435 (4) (a) of the statutes, to pay
5the costs of staffing and administration of the program of prescription drug
6assistance for elderly persons under section 49.688 of the statutes, as created by this
7act. If the department of health and family services requests supplementation of the
8appropriation account under section 20.435 (4) (a) of the statutes, the department
9shall submit a plan to the joint committee on finance to expend not more than
10$1,000,000 for fiscal year 1999-2000. The plan shall be based on a review by the
11department of health and family services of the pharmacy assistance programs of
12other states and the feasibility of contracting with the medical assistance fiscal agent
13for this state to administer the program under section 49.688 of the statutes, as
14created by this act. If the cochairpersons of the committee do not notify the secretary
15of the department within 14 working days after the date of the department's
16submittal that the committee intends to schedule a meeting to review the request,
17the appropriation account shall be supplemented as provided in the request. If,
18within 14 working days after the date of the department's submittal, the
19cochairpersons of the committee notify the secretary of the department that the
20committee intends to schedule a meeting to review the request, the appropriation
21account shall be supplemented only as approved by the committee. Notwithstanding
22section 13.101 (3) (a) 1. of the statutes, the committee is not required to find that an
23emergency exists.
SB335, s. 5 24Section 5. Appropriation changes; joint committee on finance.
SB335,6,7
1(1) Prescription drug assistance for elderly; administration. In the schedule
2under section 20.005 (3) of the statutes for the appropriation to the joint committee
3on finance under section 20.865 (4) (a) of the statutes, as affected by the acts of 1999,
4the dollar amount is increased by $1,000,000 for fiscal year 1999-00 and the dollar
5amount is increased by $1,000,000 for fiscal year 2000-01 to increase funding for
6administration of the prescription drug assistance for elderly program under section
749.688 of the statutes, as created by this act.
SB335,6,88 (End)
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