SB476: Bill Text

SB476,6,6 49.688 Prescription drug assistance for low-income elderly persons. (1) In this section:

SB476,6,7 (a) "Generic name" has the meaning given in s. 450.12 (1) (b).

SB476,6,11 (b) "Prescription drug" means a prescription drug, as defined in s. 450.01 (20), that is included in the drugs specified under s. 49.46 (2) (b) 6. h. and that is manufactured by a manufacturer that enters into a rebate agreement in force under sub. (7).

SB476,6,12 (c) "Prescription order" has the meaning given in s. 450.01 (21).

SB476,6,20 (2) A person who is a resident, as defined in s. 27.01 (10) (a), of this state, who is at least 65 years of age, who is ineligible for medical assistance, whose income does not exceed 185% of the poverty line and who pays the program enrollment fee specified in sub. (3) (a) is eligible to purchase a prescription drug at the amounts specified in sub. (6) (b). The person may apply to the department, on a form provided by the department together with program enrollment fee payment, for a determination of eligibility and issuance of a prescription drug card for purchase of prescription drugs under this section.

SB476,6,21 (3) Program participants shall pay all of the following:

SB476,6,22 (a) Annually, a program enrollment fee of $25.

SB476,6,23 (b) Annually, a deductible of $840.

SB476,6,24 (c) After payment of the deductible under par. (b), all of the following:

SB476,7,2 1. A copayment of $10 for each prescription drug that bears only a generic name.

SB476,7,4 2. A copayment of $20 for each prescription drug that does not bear only a generic name.

SB476,7,8 (4) The department shall devise and distribute a form for application for the program under sub. (2), shall determine eligibility of applicants and shall issue to eligible persons a prescription drug card for use in purchasing prescription drugs, as specified in sub. (5).

SB476,7,14 (5) Beginning July 1, 2001, as a condition of participation by a pharmacy or pharmacist in the program under ss. 49.45, 49.46 or 49.47, the pharmacy or pharmacist may not charge a person who presents a valid prescription order and a card indicating that he or she meets eligibility requirements under sub. (2) an amount for a prescription drug under the order that exceeds the amounts specified in sub. (6) (b).

SB476,7,17 (6) (a) The charge for a prescription drug shall be calculated at the average wholesale price minus 5% or the maximum allowable cost, as determined by the department, whichever is less.

SB476,7,19 (b) The amounts that a pharmacy or pharmacist may charge a person specified in sub. (2) in a calendar year period for a prescription drug are the following:

SB476,7,23 1. If applicable, a deductible, as specified in sub. (3) (b), for a prescription drug that is charged at the rate specified in par. (a), plus a dispensing fee that is equal to the dispensing fee permitted to be charged for prescription drugs for which coverage is provided under s. 49.46 (2) (b) 6. h.

SB476,7,25 2. After the deductible under subd. 1. is charged, the copayment, as applicable, that is specified in sub. (3) (c) 1. or 2.

SB476,8,4 (c) The department shall calculate and transmit to pharmacies and pharmacists that are certified providers of medical assistance amounts that may be used in calculating charges under par. (a). The department shall periodically update this information and transmit the updated amounts to pharmacies and pharmacists.

SB476,8,9 (7) The department or an entity with which the department contracts may enter into a rebate agreement that is modeled on the rebate agreement specified under 42 USC 1396r-8 with a drug manufacturer that sells drugs for prescribed use in this state. The rebate agreement, if negotiated, shall include all of the following as requirements:

SB476,8,13 (a) That the manufacturer shall make rebate payments for each prescription drug of the manufacturer that is prescribed for persons who are eligible under sub. (2), to the state treasurer to be credited to the appropriation under s. 20.435 (4) (j), each calendar quarter or according to a schedule established by the department.

SB476,8,15 (b) That the amount of the rebate payment shall be determined by a method specified in 42 USC 1396r-8 (c).

SB476,8,24 (8) From the appropriation accounts under s. 20.435 (4) (bv) and (j), beginning July 1, 2001, the department shall provide to pharmacies and pharmacists payments, under a schedule that is identical to that used by the department for payment of pharmacy provider claims under medical assistance, that correspond to the amounts charged by the pharmacies and pharmacists to persons who meet criteria for eligibility under sub. (2) for a prescription drug at the rate specified in sub. (6) (a), minus the amount of a copayment charged under sub. (6) (b) 2., plus a dispensing fee, as specified in sub. (6) (b) 1. The department shall devise and distribute a form for reports by pharmacies and pharmacists under this subsection.

SB476,9,6 (9) The department shall monitor compliance by pharmacies and pharmacists that are certified providers of medical assistance with the requirements of sub. (5) and shall annually report to the legislature under s. 13.172 (2) concerning the compliance. The report shall include information on any pharmacies or pharmacists that discontinue participation as certified providers of medical assistance and the reasons given for the discontinuance.

SB476,9,10 (10) If federal law is amended to provide coverage for prescription drugs for outpatient care as a benefit under medicare or to provide similar coverage under another program, the department shall submit a report concerning this fact to appropriate standing committees of the legislature under s. 13.172 (3).

SB476,9,14 (11) After June 30, 2001, and before July 1, 2003, the department may not under sub. (4) subject a manufacturer that enters into a rebate agreement under sub. (7) to prior authorization requirements for a prescription drug for outpatient care for treatment of a chronic condition.

SB476,9,17 (12) Except as provided in subs. (9) to (11), the department may enter into a contract with an entity to perform the duties and exercise the powers of the department under this section.

SB476, s. 14 Section 14. Appropriation changes.

SB476,9,24 (1) Prescription drug assistance for elderly; administration. In the schedule under section 20.005 (3) of the statutes for the appropriation to the joint committee on finance under section 20.865 (4) (a) of the statutes, as affected by the acts of 1999, the dollar amount is increased by $2,000,000 for fiscal year 2000-01 to increase funding for administration of the prescription drug assistance for elderly program under section 49.688 of the statutes, as created by this act.

SB476, s. 15 Section 15. Initial applicability.

SB476,10,3 (1) The treatment of section 49.47 (4) (aq), (b) 2m. b., 2r., 2w. and 3., (c) 1. and 3. and (i) (2) (intro.) of the statutes first applies to eligibility determinations made for medical assistance on July 1, 2001.

SB476, s. 16 Section 16. Effective dates; health and family services. This act takes effect on the day after publication, except as follows:

SB476,10,7 (1) Prescription drug assistance for elderly. The treatment of section 20.435 (4) (bv) of the statutes takes effect on July 1, 2001.

SB476,10,8 (End)