LRBb1426/1
DAK:hmh:pg
2001 - 2002 LEGISLATURE
ASSEMBLY AMENDMENT 2,
TO ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO 2001 SENATE BILL 55
June 29, 2001 - Offered by Representatives Krusick, Plouff and Miller.
SB55-ASA1-AA2,1,4
21. Page 207, line 19: increase the dollar amount for fiscal year 2001-02 by
3$1,000,000 to increase funding for administration of the prescription drug assistance
4for elderly program.
SB55-ASA1-AA2,2,3
14. Page 288, line 2: increase the dollar amount for fiscal year 2001-02 by
2$1,000,000 to increase funding for administration of the prescription drug assistance
3for elderly program.
SB55-ASA1-AA2,2,5
5"
Section 707bg. 20.435 (4) (bv) of the statutes is created to read:
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20.435
(4) (bv)
Prescription drug assistance for elderly; aids. A sum sufficient
7for payment to pharmacies and pharmacists under s. 49.688 (7) for prescription drug
8assistance for elderly persons.".
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20.435
(4) (j)
Prescription drug assistance for elderly; manufacturer rebates. 12All moneys received from rebate payments by manufacturers under s. 49.688 (6), to
13be used for payment to pharmacies and pharmacists under s. 49.688 (7) for
14prescription drug assistance for elderly persons.
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20.435
(4) (jb)
Prescription drug assistance for elderly; enrollment fees. All
17moneys received from payment of enrollment fees under s. 49.688 (3), to be used for
18administration of the program under s. 49.688.".
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2149.688 Prescription drug assistance for elderly persons. (1) In this
22section:
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(a) "Generic name" has the meaning given in s. 450.12 (1) (b).
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1(b) "Poverty line" means the nonfarm federal poverty line for the continental
2United States, as defined by the federal department of labor under
42 USC 9902 (2).
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(c) "Prescription drug" means a prescription drug, as defined in s. 450.01 (20),
4that is included in the drugs specified under s. 49.46 (2) (b) 6. h. and that is
5manufactured by a drug manufacturer that enters into a rebate agreement in force
6under sub. (6).
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(d) "Prescription order" has the meaning given in s. 450.01 (21).
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(e) "Program payment rate" means the rate of payment made for the identical
9drug specified under s. 49.46 (2) (b) 6. h., plus 5%, plus a dispensing fee that is equal
10to the dispensing fee permitted to be charged for prescription drugs for which
11coverage is provided under s. 49.46 (2) (b) 6. h.
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12(2) (a) A person to whom all of the following applies is eligible to purchase a
13prescription drug for the amounts specified in sub. (5) (a) 1. and 2.:
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1. The person is a resident, as defined in s. 27.01 (10) (a), of this state.
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2. The person is at least 65 years of age.
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3. The person is not a recipient of medical assistance.
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4. The person's annual household income, as determined by the department,
18does not exceed 300% of the federal poverty line for a family the size of the person's
19eligible family.
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5. The person pays the program enrollment fee specified in sub. (3) (a).
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(b) A person to whom par. (a) 1. to 3. and 5. applies, but whose annual household
22income, as determined by the department, exceeds 300% of the federal poverty line
23for a family the size of the persons' eligible family, is eligible to purchase a
24prescription drug at the amounts specified in sub. (5) (a) 4. only during the remaining
25amount of any 12-month period in which the person has first paid the annual
1deductible specified in sub. (3) (b) 2. a. in purchasing prescription drugs at the retail
2price and has then paid the annual deductible specified in sub. (3) (b) 2. b.
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3(3) Program participants shall pay all of the following:
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(a) For each 12-month benefit period, a program enrollment fee of $20.
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(b) 1. For each 12-month benefit period, for a person specified in sub. (2) (a),
6a deductible for prescription drugs of $500, except that a person whose annual
7household income, as determined by the department, is 175% or less of the federal
8poverty line for a family the size of the person's eligible family pays no deductible.
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2. For each 12-month benefit period, for a person specified in sub. (2) (b), a
10deductible for prescription drugs that equals all of the following:
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a. The difference between the person's annual household income and 300% of
12the federal poverty line for a family the size of the person's eligible family.
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b. Five hundred dollars.
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(c) After payment of any applicable deductible under par. (b), all of the
15following:
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1. A copayment of $5 for each prescription drug that bears only a generic name.
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2. A copayment of $10 for each prescription drug that does not bear only a
18generic name.
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(d) Notwithstanding s. 49.002, if a person who is eligible under this section has
20other available coverage for payment of a prescription drug, this section applies only
21to costs for prescription drugs for the persons that are not covered under the person's
22other available coverage.
SB55-ASA1-AA2,5,3
23(4) The department shall devise and distribute a form for application for the
24program under sub. (2), shall determine eligibility for each 12-month benefit period
25of applicants and shall issue to eligible persons a prescription drug card for use in
1purchasing prescription drugs, as specified in sub. (5). The department shall
2promulgate rules that specify the criteria to be used to determine household income
3under sub. (2) (a) 4. and (b) and (3) (b) 1.
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4(5) (a) Beginning September 1, 2002, as a condition of participation by a
5pharmacy or pharmacist in the program under s. 49.45, 49.46, or 49.47, the
6pharmacy or pharmacist may not charge a person who presents a valid prescription
7order and a card indicating that he or she meets eligibility requirements under sub.
8(2) an amount for a prescription drug under the order that exceeds the following:
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1. For a deductible, as specified in sub. (3) (b) 1. and 2. b., the program payment
10rate.
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2. After any applicable deductible under subd. 1. is charged, the copayment, as
12applicable, that is specified in sub. (3) (c) 1. or 2. No dispensing fee may be charged
13to a person under this subdivision.
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3. For a deductible, as specified in sub. (3) (b) 2. a., the retail price.
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4. After the deductible under subd. 3. is charged, the copayment, as applicable,
16that is specified in sub. (3) (c) 1. or 2. No dispensing fee may be charged to a person
17under this subdivision.
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(b) The department shall calculate and transmit to pharmacies and
19pharmacists that are certified providers of medical assistance amounts that may be
20used in calculating charges under par. (a). The department shall periodically update
21this information and transmit the updated amounts to pharmacies and pharmacists.
SB55-ASA1-AA2,6,2
22(6) The department, or an entity with which the department contracts, shall
23provide to a drug manufacturer that sells drugs for prescribed use in this state
24documents designed for use by the manufacturer in entering into a rebate agreement
25with the department or entity that is modeled on the rebate agreement specified
1under
42 USC 1396r-8. A rebate agreement under this subsection shall include all
2of the following as requirements:
