Amendment ASA2-AB815

LRBs0374/1

DAK&ISR:wlj:ch

1999 - 2000 LEGISLATURE

ASSEMBLY SUBSTITUTE AMENDMENT 2, TO 1999 ASSEMBLY BILL 815

March 7, 2000 - Offered by Representatives Wieckert, Krusick, Pettis, Huber, Hundertmark, Meyer, Underheim, Petrowski, Rhoades, Townsend, Kelso, Kestell, Handrick, Urban, Jeskewitz, Olsen, Spillner, Waukau, M. Lehman, Huebsch, Freese, Hoven, Ladwig, Montgomery and Miller.

AB815-ASA2,1,10 An Act to amend 49.47 (4) (b) 2m. b., 49.47 (4) (b) 2r., 49.47 (4) (b) 2w., 49.47 (4) (b) 3., 49.47 (4) (c) 1., 49.47 (4) (c) 3. and 49.47 (4) (i) 2. (intro.); and to create 20.435 (4) (bv), 20.435 (4) (j), 20.435 (4) (jb), 49.45 (48), 49.47 (4) (aq) and 49.688 of the statutes; relating to: expanding medical assistance income eligibility requirements for elderly persons; requiring pharmacies and pharmacists, as a condition of medical assistance participation, to charge elderly, low-income persons for prescription drugs no more than specific amounts; authorizing the department of health and family services to enter into rebate agreements with drug manufacturers; limiting prior authorization requirements under medical assistance; and making appropriations.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB815-ASA2, s. 1 Section 1. 20.435 (4) (bv) of the statutes is created to read:

AB815-ASA2,2,3 20.435 (4) (bv) Prescription drug assistance for elderly; aids. The amounts in the schedule for payment to pharmacies and pharmacists under s. 49.688 (8) for prescription drug assistance for elderly persons.

AB815-ASA2, s. 2 Section 2. 20.435 (4) (j) of the statutes is created to read:

AB815-ASA2,2,8 20.435 (4) (j) Prescription drug assistance for elderly; manufacturer rebates. All moneys received from rebate payments by manufacturers under s. 49.688 (7), to be used for payment to pharmacies and pharmacists under s. 49.688 (8) for prescription drug assistance for elderly persons.

AB815-ASA2, s. 3 Section 3. 20.435 (4) (jb) of the statutes is created to read:

AB815-ASA2,2,12 20.435 (4) (jb) Prescription drug assistance for elderly; enrollment fees. All moneys received from payment of enrollment fees under s. 49.688 (2), to be used for administration of the program under s. 49.688.

AB815-ASA2, s. 4 Section 4. 49.45 (48) of the statutes is created to read:

AB815-ASA2,2,19 49.45 (48) Prior authorization for legend drugs. After June 30, 2001, and before July 1, 2003, if a manufacturer enters into a rebate agreement under s. 49.688 (7), the department may not expand the prior authorization requirements for prescription drugs manufactured by the manufacturer for which coverage is provided under s. 49.46 (2) (b) 6. h. beyond those prior authorization requirements that are in effect on July 1, 2001.

AB815-ASA2, s. 5 Section 5. 49.47 (4) (aq) of the statutes is created to read:

AB815-ASA2,2,24 49.47 (4) (aq) 1. Subject to subd. 2., an individual who does not meet the limitation on income under par. (c) is eligible for medical assistance if the individual is 65 years of age or older and the individual's income does not exceed 100% of the federal poverty level.

AB815-ASA2,3,4 2. If a federal waiver is necessary to provide medical assistance to individuals specified in subd. 1., the department shall request a waiver from the secretary of the federal department of health and human services before providing medical assistance under this paragraph.

AB815-ASA2, s. 6 Section 6. 49.47 (4) (b) 2m. b. of the statutes is amended to read:

AB815-ASA2,3,8 49.47 (4) (b) 2m. b. For persons who are eligible under par. (a) 3. or 4. or (aq), motor vehicles are exempt from consideration as an asset to the same extent as provided under 42 USC 1381 to 1385.

AB815-ASA2, s. 7 Section 7. 49.47 (4) (b) 2r. of the statutes is amended to read:

AB815-ASA2,3,13 49.47 (4) (b) 2r. For a person who is eligible under par. (a) 3. or 4. or (aq), the value of any burial space or agreement representing the purchase of a burial space held for the purpose of providing a place for the burial of the person or any member of his or her immediate family.

AB815-ASA2, s. 8 Section 8. 49.47 (4) (b) 2w. of the statutes is amended to read:

AB815-ASA2,3,17 49.47 (4) (b) 2w. For a person who is eligible under par. (a) 3. or 4. or (aq), life insurance with cash surrender values if the total face value of all life insurance policies is not more than $1,500.

AB815-ASA2, s. 9 Section 9. 49.47 (4) (b) 3. of the statutes is amended to read:

AB815-ASA2,3,23 49.47 (4) (b) 3. For a person who is eligible under par. (a) 3. or 4. or (aq), funds set aside to meet the burial and related expenses of the person and his or her spouse in an amount not to exceed $1,500 each, minus the sum of the cash value of any life insurance excluded under subd. 2w. and the amount in any irrevocable burial trust under s. 445.125 (1) (a).

AB815-ASA2, s. 10 Section 10. 49.47 (4) (c) 1. of the statutes is amended to read:

AB815-ASA2,4,11 49.47 (4) (c) 1. Except as provided in par. pars. (am) and (aq) and as limited by subd. 3., eligibility exists if income does not exceed 133 1/3% of the maximum aid to families with dependent children payment under s. 49.19 (11) for the applicant's family size or the combined benefit amount available under supplemental security income under 42 USC 1381 to 1383c and state supplemental aid under s. 49.77 whichever is higher. In this subdivision "income" includes earned or unearned income that would be included in determining eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled under 42 USC 1381 to 1385. "Income" does not include earned or unearned income which would be excluded in determining eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled individual under 42 USC 1381 to 1385.

AB815-ASA2, s. 11 Section 11. 49.47 (4) (c) 3. of the statutes is amended to read:

AB815-ASA2,4,16 49.47 (4) (c) 3. Except as provided in par. pars. (am) and (aq), no person is eligible for medical assistance under this section if the person's income exceeds the maximum income levels that the U.S. department of health and human services sets for federal financial participation under 42 USC 1396b (f).

AB815-ASA2, s. 12 Section 12. 49.47 (4) (i) 2. (intro.) of the statutes is amended to read:

AB815-ASA2,4,20 49.47 (4) (i) 2. (intro.) Notwithstanding par. (b) 2r. and 3., a person who is described in par. (a) 3. or 4. or (aq) is not eligible for benefits under this section if any of the following criteria is met:

AB815-ASA2, s. 13 Section 13. 49.688 of the statutes is created to read:

AB815-ASA2,4,23 49.688 Prescription drug assistance for low-income elderly persons. (1) In this section:

AB815-ASA2,4,24 (a) "Generic name" has the meaning given in s. 450.12 (1) (b).

AB815-ASA2,5,4 (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).

AB815-ASA2,5,5 (c) "Prescription order" has the meaning given in s. 450.01 (21).

AB815-ASA2,5,13 (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.

AB815-ASA2,5,14 (3) Program participants shall pay all of the following:

AB815-ASA2,5,15 (a) Annually, a program enrollment fee of $25.

AB815-ASA2,5,16 (b) Annually, a deductible of $840.

AB815-ASA2,5,17 (c) After payment of the deductible under par. (b), all of the following:

AB815-ASA2,5,19 1. A copayment of $10 for each prescription drug that bears only a generic name.

AB815-ASA2,5,21 2. A copayment of $20 for each prescription drug that does not bear only a generic name.

AB815-ASA2,5,25 (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-ASA2,6,6 (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).

AB815-ASA2,6,9 (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.

AB815-ASA2,6,11 (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:

AB815-ASA2,6,15 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.

AB815-ASA2,6,17 2. After the deductible under subd. 1. is charged, the copayment, as applicable, that is specified in sub. (3) (c) 1. or 2.

AB815-ASA2,6,21 (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.