Amendment ASA1-AB815

AB815-ASA1,5,13 (3) Program participants shall pay all of the following:

AB815-ASA1,5,14 (a) Annually, a program enrollment fee of $25.

AB815-ASA1,5,15 (b) Monthly, a deductible of $40.

AB815-ASA1,5,16 (c) Annually for prescription drugs, all of the following:

AB815-ASA1,5,17 1. Fifty percent of the first $2,000 in charges, as specified in sub. (6) (a).

AB815-ASA1,5,19 2. Thirty percent of the charges, as specified in sub. (6) (a), that exceed $2,000 but that do not exceed $6,250.

AB815-ASA1,5,21 3. One hundred percent of the charges, calculated at the retail price of the pharmacy or pharmacist, that exceed $6,250.

AB815-ASA1,5,25 (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).

AB815-ASA1,6,8 (5) Beginning April 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, a card indicating that he or she meets eligibility requirements under sub. (2) and payment, if applicable, of the monthly deductible amount specified in sub. (3) (b) an amount for a prescription drug under the order that exceeds the amount specified in sub. (6) (b). The pharmacy or pharmacist shall forward to the state treasurer, for deposit in the appropriation account under s. 20.435 (4) (j), the monthly deductible amount.

AB815-ASA1,6,12 (6) (a) The charge for prescription drugs shall be calculated at the average wholesale price minus 10% or the maximum allowable cost, as determined by the department, whichever is less, plus a dispensing fee. The charge does not include a deductible, as specified in sub. (3) (b).

AB815-ASA1,6,14 (b) The amounts that a pharmacy or pharmacist may charge a person specified in sub. (2) in a calendar year period for the prescription drugs are the following:

AB815-ASA1,6,16 1. If applicable, a deductible, as specified in sub. (3) (b), for prescription drugs that are charged at the rate specified in par. (a).

AB815-ASA1,6,18 2. Fifty percent of the first $2,000 in charges, as specified in par. (a), for the prescription drugs after the deductible, if applicable, is charged.

AB815-ASA1,6,20 3. Thirty percent of the charges, as specified in par. (a), that exceed the amount specified in subd. 2. but that do not exceed $6, 250, for the prescription drugs.

AB815-ASA1,6,22 4. One hundred percent of charges, calculated at the retail price of the pharmacy or pharmacist, that exceed $6,250, for the prescription drugs.

AB815-ASA1,7,2 (c) The department shall, for the purposes of par. (a), 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.

AB815-ASA1,7,7 (7) The department or an entity with which the department contracts shall attempt to negotiate with a drug manufacturer that sells drugs for prescribed use in this state a rebate agreement that is modeled on the rebate agreement specified under 42 USC 1396r-8. The rebate agreement, if negotiated, shall include all of the following as requirements:

AB815-ASA1,7,11 (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.

AB815-ASA1,7,13 (b) That the amount of the rebate payment shall be determined by a method specified in 42 USC 1396r-8 (c).

AB815-ASA1,7,21 (8) From the appropriation accounts under s. 20.435 (4) (bv) and (j), beginning April 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 discounts specified under sub. (6) (a) and (b) provided by the pharmacies and pharmacists to persons who meet criteria for eligibility under sub. (2). The department shall devise and distribute a form for reports by pharmacies and pharmacists under this subsection.

AB815-ASA1,8,2 (9) The department shall identify and list prescription drugs that account for significant prescription order expenditure by persons who are aged at least 65 years. Provision of a prescription drug so listed is reimbursable under sub. (8) only if the pharmacy or pharmacist that provides the drug receives prior authorization from the department for the provision. The department shall distribute to pharmacies and pharmacists the list required under this subsection.

AB815-ASA1,8,4 (10) The department may enter into a contract with an entity to perform the duties and exercise the powers of the department under this section.

AB815-ASA1, s. 14 Section 14. Nonstatutory provisions.

AB815-ASA1,8,24 (1) Prescription drug assistance for elderly persons; administration. The department of health and family services may request the joint committee on finance to supplement, from the appropriation account under section 20.865 (4) (a) of the statutes, the appropriation account under section 20.435 (4) (a) of the statutes, to pay the costs of administration of the program of prescription drug assistance for elderly persons under section 49.688 of the statutes, as created by this act. If the department of health and family services requests supplementation of the appropriation account under section 20.435 (4) (a) of the statutes, the department shall submit a plan to the joint committee on finance to expend not more than $1,500,000 for fiscal year 1999-2000 and not more than $1,500,000 for fiscal year 2000-01. If the cochairpersons of the committee do not notify the secretary of the department within 14 working days after the date of the department's submittal that the committee intends to schedule a meeting to review the request, the appropriation account shall be supplemented as provided in the request. If, within 14 working days after the date of the department's submittal, the cochairpersons of the committee notify the secretary of the department that the committee intends to schedule a meeting to review the request, the appropriation account shall be supplemented only as approved by the committee. Notwithstanding section 13.101 (3) (a) 1. of the statutes, the committee is not required to find that an emergency exists.

AB815-ASA1, s. 15 Section 15. Appropriation changes.

AB815-ASA1,9,7 (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 $1,500,000 for fiscal year 1999-00 and the dollar amount is increased by $1,500,000 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.

AB815-ASA1,9,12 (2) Expanded medical assistance eligibility. In the schedule under section 20.005 (3) of the statutes for the appropriation to the department of health and family services under section 20.435 (4) (b) of the statutes, as affected by the acts of 1999, the dollar amount is increased by $1,200,000 for fiscal year 2000-01 to increase funding for expanded eligibility for medical assistance program benefits.

AB815-ASA1, s. 16 Section 16. Initial applicability.

AB815-ASA1,9,16 (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 January 1, 2001.

AB815-ASA1,9,17 (End)