Amendment SSA1-AB815

LRBs0529/4

DAK:jlg&wlj:jf

1999 - 2000 LEGISLATURE

SENATE SUBSTITUTE AMENDMENT 1, TO 1999 ASSEMBLY BILL 815

March 30, 2000 - Offered by Senator Clausing.

AB815-SSA1,1,7 An Act to create 20.435 (4) (bv), 20.435 (4) (j), 20.435 (4) (jb) and 49.688 of the statutes; relating to: requiring pharmacies and pharmacists, as a condition of medical assistance participation, to charge elderly persons with specified income limitations for prescription drugs no more than specific amounts; authorizing the department of health and family services to enter into rebate agreements with drug manufacturers; requiring the exercise of rule-making authority; and making appropriations.

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

AB815-SSA1, s. 1 Section 1. 20.435 (4) (bv) of the statutes is created to read:

AB815-SSA1,1,11 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 (9) for prescription drug assistance for elderly persons.

AB815-SSA1, s. 2 Section 2. 20.435 (4) (j) of the statutes is created to read:

AB815-SSA1,2,4 20.435 (4) (j) Prescription drug assistance for elderly; manufacturer rebates. All moneys received from rebate payments by manufacturers under s. 49.688 (8), to be used for payment to pharmacies and pharmacists under s. 49.688 (9) for prescription drug assistance for elderly persons.

AB815-SSA1, s. 3 Section 3. 20.435 (4) (jb) of the statutes is created to read:

AB815-SSA1,2,8 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-SSA1, s. 4 Section 4. 49.688 of the statutes is created to read:

AB815-SSA1,2,11 49.688 Prescription drug assistance for elderly persons. (1) In this section:

AB815-SSA1,2,12 (a) "Generic name" has the meaning given in s. 450.12 (1) (b).

AB815-SSA1,2,13 (b) "Household income" has the meaning given in s. 71.52 (5).

AB815-SSA1,2,17 (c) "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 drug manufacturer that enters into a rebate agreement under sub. (8).

AB815-SSA1,2,18 (d) "Prescription order" has the meaning given in s. 450.01 (21).

AB815-SSA1,3,2 (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 the limitation specified in sub. (3) and who pays the program enrollment fee specified in sub. (4) (a) is eligible to purchase a prescription drug at the amounts specified in sub. (4) (c). 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-SSA1,3,4 (3) The household income of a person may not exceed $30,000 unless the amount that results from the following calculation is $30,000 or less:

AB815-SSA1,3,7 (a) The total amount of the person's prescription drug costs for 3 consecutive months in the 12 months immediately preceding the month in which the person applies under sub. (2) is multiplied by 4.

AB815-SSA1,3,8 (b) The result under par. (a) is subtracted from the person's household income.

AB815-SSA1,3,9 (4) Program participants shall pay all of the following:

AB815-SSA1,3,10 (a) Annually, a program enrollment fee of $25.

AB815-SSA1,3,12 (b) Annually, a deductible of $500, as applied to a legend drug, as specified under s. 49.46 (2) (b) 6. h.

AB815-SSA1,3,13 (c) After payment of the deductible under par. (b), all of the following:

AB815-SSA1,3,14 1. For each prescription drug, 25% of the average wholesale price minus 5%.

AB815-SSA1,3,15 2. A copayment of $5 for each prescription drug that bears only a generic name.

AB815-SSA1,3,17 3. A copayment of $10 for each prescription drug that does not bear only a generic name.

AB815-SSA1,3,21 (5) 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. (6).

AB815-SSA1,4,2 (6) Beginning July 1, 2001, as a condition of participation by a pharmacy or pharmacist in the program under s. 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. (4) (c).

AB815-SSA1,4,5 (7) (a) The rate for reimbursement 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-SSA1,4,7 (b) A pharmacy or pharmacist may charge a person specified in sub. (2) the copayment, as applicable, that is specified in sub. (4) (c) 2. or 3.

AB815-SSA1,4,12 (c) The department shall calculate and transmit to pharmacies and pharmacists that are certified providers of medical assistance the average wholesale prices of the prescription drugs provided under the program. The department shall periodically update this information and transmit the updated amounts to pharmacies and pharmacists.

AB815-SSA1,4,17 (8) 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:

AB815-SSA1,4,22 (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) and have paid the deductible under sub. (4) (b), 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-SSA1,4,24 (b) That the amount of the rebate payment shall be determined by a method specified in 42 USC 1396r-8 (c).

AB815-SSA1,5,12 (9) 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 rate specified in sub. (7) (a) for a prescription drug provided by the pharmacy or pharmacist to an eligible person, minus the amount paid by the person to the pharmacy or pharmacist under sub. (4) (b) or (c), plus a dispensing fee that is equal to the dispensing fee that is permitted to be charged for prescription drugs for which coverage is provided under s. 49.46 (2) (b) 6. h. and plus, if applicable, incentive payments that are similar to those provided under s. 49.45 (8v). The department shall devise and distribute a form for reports by pharmacies and pharmacists under this subsection.

AB815-SSA1,5,18 (10) The department shall monitor compliance by pharmacies and pharmacists that are certified providers of medical assistance with the requirements of sub. (6) 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.

AB815-SSA1,5,22 (11) 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).

AB815-SSA1,5,25 (12) Except as provided in subs. (10), (11) and (13), 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-SSA1,6,1 (13) The department shall promulgate all of the following as rules:

AB815-SSA1,6,3 (a) The methods by which the department shall monitor compliance by pharmacies and pharmacists under sub. (10).

AB815-SSA1,6,4 (b) Criteria and procedures for determinations of eligibility under sub. (2).

AB815-SSA1, s. 5 Section 5. Appropriation changes.

AB815-SSA1,6,11 (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 $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-SSA1, s. 6 Section 6. Effective dates; health and family services. This act takes effect on the day after publication, except as follows:

AB815-SSA1,6,15 (1) Prescription drug assistance for elderly. The treatment of section 20.435 (4) (bv) of the statutes takes effect on July 1, 2001.

AB815-SSA1,6,16 (End)