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SB1,5,12 4(2) The department shall request from the secretary of the federal department
5of health and human services a waiver, under 42 USC 1315 (a), of federal medicaid
6laws necessary to permit the department to conduct a project to expand eligibility for
7medical assistance to include individuals who are eligible for and enrolled in
8medicare and individuals whose annual household incomes, as determined by the
9department, do not exceed 300% of the federal poverty line for a family the size of the
10individual's eligible family. Eligibility for medical assistance under this subsection
11entitles an individual, after payment of a $20 annual enrollment fee, only to the
12discounted purchase of prescription drugs as specified under sub. (3).
SB1,5,20 13(3) Under the project under sub. (2), as a condition of participation by a
14pharmacy or pharmacist in the program under s. 49.45, 49.46, or 49.47, the
15pharmacy or pharmacist may not charge an individual who is eligible for medical
16assistance under sub. (2), who is not enrolled in the program under s. 49.688, and who
17presents a valid prescription order an amount for a prescription drug under the order
18that exceeds the amount obtained by subtracting the amount under sub. (4) from the
19medical assistance reimbursement amount for the drug, as determined by the
20department.
SB1,6,4 21(4) From the appropriations under s. 20.435 (4) (b) and (o), the department
22shall pay the pharmacy or pharmacist for a prescription drug purchased as specified
23under sub. (3) an amount that results from applying to the medical assistance
24reimbursement rate amount for the drug the percentage that results from dividing
25the revenue for the prescription drug that the department received the previous year

1under the rebate agreement under 42 USC 1396r-8 with a prescription drug
2manufacturer that sells the prescription drug for prescribed use in this state by the
3total amount of medical assistance expenditures for prescription drugs for the
4previous year, as determined by the department.
SB1,6,9 5(5) The department may not implement the program under this section unless
6a waiver that is consistent with all of the provisions of this section is granted and in
7effect. If the department receives the waiver, at the end of the period during which
8the waiver remains in effect the department shall request any available extension
9of the waiver.
SB1, s. 6 10Section 6. 49.688 of the statutes is created to read:
SB1,6,12 1149.688 Prescription drug assistance for elderly persons. (1) In this
12section:
SB1,6,1313 (a) "Generic name" has the meaning given in s. 450.12 (1) (b).
SB1,6,1514 (b) "Poverty line" means the nonfarm federal poverty line for the continental
15United States, as defined by the federal department of labor under 42 USC 9902 (2).
SB1,6,1916 (c) "Prescription drug" means a prescription drug, as defined in s. 450.01 (20),
17that is included in the drugs specified under s. 49.46 (2) (b) 6. h. and that is
18manufactured by a drug manufacturer that enters into a rebate agreement in force
19under sub. (6).
SB1,6,2020 (d) "Prescription order" has the meaning given in s. 450.01 (21).
SB1,6,2221 (e) "Program payment rate" means the rate of payment made for the identical
22drug specified under s. 49.46 (2) (b) 6. h., plus 5%.
SB1,6,24 23(2) (a) A person to whom all of the following applies is eligible to purchase a
24prescription drug for the amounts specified in sub. (5) (a) 1. and 2.:
SB1,6,2525 1. The person is a resident, as defined in s. 27.01 (10) (a), of this state.
SB1,7,1
12. The person is at least 65 years of age.
SB1,7,22 3. The person is not a recipient of medical assistance.
SB1,7,53 4. The person's annual household income, as determined by the department,
4does not exceed 300% of the federal poverty line for a family the size of the person's
5eligible family.
SB1,7,66 5. The person pays the program enrollment fee specified in sub. (3) (a).
SB1,7,137 (b) A person to whom par. (a) 1. to 3. and 5. applies, but whose annual household
8income, as determined by the department, exceeds 300% of the federal poverty line
9for a family the size of the persons' eligible family, is eligible to purchase a
10prescription drug at the amounts specified in sub. (5) (a) 4. only during the remaining
11amount of any 12-month period in which the person has first paid the annual
12deductible specified in sub. (3) (b) 2. a. in purchasing prescription drugs at the retail
13price and has then paid the annual deductible specified in sub. (3) (b) 2. b.
SB1,7,14 14(3) Program participants shall pay all of the following:
SB1,7,1515 (a) For each 12-month benefit period, a program enrollment fee of $20.
SB1,7,1916 (b) 1. For each 12-month benefit period, for a person specified in sub. (2) (a),
17a deductible for prescription drugs of $500, except that a person whose annual
18household income, as determined by the department, is 175% or less of the federal
19poverty line for a family the size of the person's eligible family pays no deductible.
SB1,7,2120 2. For each 12-month benefit period, for a person specified in sub. (2) (b), a
21deductible for prescription drugs that equals all of the following:
SB1,7,2322 a. The difference between the person's annual household income and 300% of
23the federal poverty line for a family the size of the person's eligible family.
SB1,7,2424 b. Five hundred dollars.
SB1,8,2
1(c) After payment of any applicable deductible under par. (b), all of the
2following:
SB1,8,33 1. A copayment of $5 for each prescription drug that bears only a generic name.
SB1,8,54 2. A copayment of $10 for each prescription drug that does not bear only a
5generic name.
SB1,8,96 (d) Notwithstanding s. 49.002, if a person who is eligible under this section has
7other available coverage for payment of a prescription drug, this section applies only
8to costs for prescription drugs for the person that are not covered under the person's
9other available coverage.
SB1,8,15 10(4) The department shall devise and distribute a form for application for the
11program under sub. (2), shall determine eligibility for each 12-month benefit period
12of applicants and shall issue to eligible persons a prescription drug card for use in
13purchasing prescription drugs, as specified in sub. (5). The department shall
14promulgate rules that specify the criteria to be used to determine household income
15under sub. (2) (a) 4. and (b) and (3) (b) 1.
SB1,8,20 16(5) (a) Beginning March 1, 2002, as a condition of participation by a pharmacy
17or pharmacist in the program under s. 49.45, 49.46, or 49.47, the pharmacy or
18pharmacist may not charge a person who presents a valid prescription order and a
19card indicating that he or she meets eligibility requirements under sub. (2) (a) an
20amount for a prescription drug under the order that exceeds the following:
SB1,8,2321 1. For a deductible, as specified in sub. (3) (b) 1. and 2. b., the program payment
22rate, plus a dispensing fee that is equal to the dispensing fee permitted to be charged
23for prescription drugs for which coverage is provided under s. 49.46 (2) (b) 6. h.
SB1,9,3
12. After any applicable deductible under subd. 1. is charged, the copayment, as
2applicable, that is specified in sub. (3) (c) 1. or 2. No dispensing fee, as specified under
3subd. 1., may be charged to a person under this subdivision.
SB1,9,44 3. For a deductible, as specified in sub. (3) (b) 2. a., the retail price.
SB1,9,75 4. After the deductible under subd. 3. is charged, the copayment, as applicable,
6that is specified in sub. (3) (c) 1. or 2. No dispensing fee, as specified under subd. 1.,
7may be charged to a person under this subdivision.
SB1,9,118 (b) The department shall calculate and transmit to pharmacies and
9pharmacists that are certified providers of medical assistance amounts that may be
10used in calculating charges under par. (a). The department shall periodically update
11this information and transmit the updated amounts to pharmacies and pharmacists.
SB1,9,17 12(6) The department or an entity with which the department contracts shall
13provide to a drug manufacturer that sells drugs for prescribed use in this state
14material designed for use by the manufacturer in entering into a rebate agreement
15with the department or entity that is modeled on the rebate agreement specified
16under 42 USC 1396r-8. A rebate agreement under this subsection shall include all
17of the following as requirements:
SB1,9,2318 (a) That the manufacturer shall make rebate payments for each prescription
19drug of the manufacturer that is prescribed for and purchased by persons who meet
20criteria under sub. (2) (a) and persons who meet criteria under sub. (2) (b) and have
21paid the deductible under sub. (3) (b) 2. a., to the state treasurer to be credited to the
22appropriation under s. 20.435 (4) (j), each calendar quarter or according to a schedule
23established by the department.
SB1,9,2524 (b) That the amount of the rebate payment shall be determined by a method
25specified in 42 USC 1396r-8 (c).
SB1,10,17
1(7) From the appropriation accounts under s. 20.435 (4) (bv) and (j), beginning
2March 1, 2002, the department shall, under a schedule that is identical to that used
3by the department for payment of pharmacy provider claims under medical
4assistance, provide to pharmacies and pharmacists payments for prescription drugs
5sold by the pharmacies or pharmacists to persons eligible under sub. (2) who have
6paid the deductible specified under sub. (3) (b) 1. or 2. or who, under sub. (3) (b) 1.,
7are not required to pay a deductible. The payment for each prescription drug under
8this subsection shall be at the program payment rate, minus any copayment paid by
9the person under sub. (5) (a) 2. or 4., plus a dispensing fee, as specified under sub.
10(5) (a) 1., and plus, if applicable, incentive payments that are similar to those
11provided under s. 49.45 (8v). The department shall devise and distribute a claim
12form for use by pharmacies and pharmacists under this subsection and may limit
13payment under this subsection to those prescription drugs for which payment claims
14are submitted by pharmacists or pharmacies directly to the department. The
15department may apply to the program under this section the same utilization and
16cost control procedures that apply under rules promulgated by the department to
17medical assistance under subch. IV of ch. 49.
SB1,10,24 18(8) The department shall, under methods promulgated by the department by
19rule, monitor compliance by pharmacies and pharmacists that are certified providers
20of medical assistance with the requirements of sub. (5) and shall annually report to
21the legislature under s. 13.172 (2) concerning the compliance. The report shall
22include information on any pharmacies or pharmacists that discontinue
23participation as certified providers of medical assistance and the reasons given for
24the discontinuance.
SB1,11,2
1(9) (a) The department shall promulgate rules relating to prohibitions on fraud
2that are substantially similar to applicable provisions under s. 49.49 (1) (a).
SB1,11,63 (b) A person who is convicted of violating a rule promulgated by the department
4under par. (a) in connection with that person's furnishing of prescription drugs under
5this section may be fined not more than $25,000, or imprisoned for not more than 7
6years and 6 months, or both.
SB1,11,97 (c) A person other than a person specified in par. (b) who is convicted of violating
8a rule promulgated by the department under par. (a) may be fined not more than
9$10,000, or imprisoned for not more than one year, or both.
SB1,11,15 10(10) If federal law is amended to provide coverage for prescription drugs for
11outpatient care as a benefit under medicare or to provide similar coverage under
12another program, the department shall submit to appropriate standing committees
13of the legislature under s. 13.172 (3) a report that contains an analysis of the
14differences between such a federal program and the program under this section and
15that provides recommendations concerning alignment, if any, of the differences.
SB1,11,19 16(11) Except as provided in subs. (8) to (10) and except for the department's
17rule-making requirements and authority, the department may enter into a contract
18with an entity to perform the duties and exercise the powers of the department under
19this section.
SB1, s. 7 20Section 7. Nonstatutory provisions.
SB1,12,2121 (1) Prescription drug assistance for elderly; administration. Before July 1,
222002, the department of health and family services may develop and submit to the
23department of administration a proposal for expenditure of the funds appropriated
24under section 20.865 (4) (a) of the statutes for administration of the prescription drug
25assistance for elderly program under section 49.688 of the statutes, as created by this

1act. The department of administration may approve, disapprove, or modify and
2approve any proposal it receives under this subsection. If the department of
3administration approves the proposal, the department shall submit the proposal,
4together with any modifications, to the cochairpersons of the joint committee on
5finance. If the cochairpersons of the committee do not notify the secretaries of
6administration and health and family services within 14 working days after
7receiving the proposal that the cochairpersons have scheduled a meeting for the
8purpose of reviewing the proposal, the secretary of administration may transfer from
9the appropriation under section 20.865 (4) of the statutes to the appropriation under
10section 20.435 (4) (a) of the statutes the amount specified in the proposal or any
11proposed modifications of the proposal for expenditure as specified in the proposal
12or any proposed modifications of the proposal and may approve any position
13authority specified in the proposal or any proposed modifications of the proposal. If,
14within 14 working days after receiving the proposal, the cochairpersons notify the
15secretaries of administration and health and family services that the cochairpersons
16have scheduled a meeting for the purpose of reviewing the proposal, the secretary of
17administration may not transfer any amount specified in the proposal or any
18proposed modifications of the proposal from the appropriation under section 20.865
19(4) of the statutes and may not approve any position authority specified in the
20proposal or any proposed modifications of the proposal, except as approved by the
21committee.
SB1, s. 8 22Section 8. Appropriation changes.
SB1,13,323 (1) Prescription drug assistance for elderly; administration. In the schedule
24under section 20.005 (3) of the statutes for the appropriation to the department of
25health and family services under section 20.435 (4) (a) of the statutes, as affected by

1the acts of 2001, the dollar amount is increased by $1,000,000 for fiscal year 2001-02
2to increase funding for administration of the prescription drug assistance for elderly
3program under section 49.688 of the statutes, as created by this act.
SB1,13,94 (2) Prescription drug assistance for elderly; additional administration. In
5the schedule under section 20.005 (3) of the statutes for the appropriation to the joint
6committee on finance under section 20.865 (4) (a) of the statutes, as affected by the
7acts of 2001, the dollar amount is increased by $1,000,000 for fiscal year 2001-02 to
8increase funding for administration of the prescription drug assistance for elderly
9program under section 49.688 of the statutes, as created by this act.
SB1, s. 9 10Section 9. Effective dates; health and family services. This act takes
11effect on the 2nd day after publication of the biennial budget act, except as follows:
SB1,13,1312 (1) Prescription drug assistance for elderly. The treatment of section 20.435
13(4) (bv) of the statutes takes effect on March 1, 2002.
SB1,13,1514 (2) Prescription drug assistance project. The treatment of section 49.477 (2)
15of the statutes takes effect on the day after publication.
SB1,13,1616 (End)
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