SB204,5,1815 (e) "Program payment rate" means the average wholesale price minus 5%, or
16the maximum allowable cost, as determined by the department, whichever is less,
17plus a dispensing fee that is equal to the dispensing fee permitted to be charged for
18legend drugs for which coverage is provided under s. 49.46 (2) (b) 6. h.
SB204,5,20 19(2) (a) A person to whom all of the following applies is eligible to purchase a
20prescription drug for the amounts specified in sub. (5) (a) 1. and 2.:
SB204,5,2121 1. The person is a resident, as defined in s. 27.01 (10) (a), of this state.
SB204,5,2222 2. The person is at least 65 years of age.
SB204,5,2323 3. The person is not a recipient of medical assistance.
SB204,6,3
14. The person's annual household income, as determined by the department,
2does not exceed 200% of the poverty line for a family the size of the person's eligible
3family.
SB204,6,44 5. The person pays the program enrollment fee specified in sub. (3) (a).
SB204,6,115 (b) A person to whom par. (a) 1. to 3. and 5. applies, but whose annual household
6income, as determined by the department, exceeds 200% of the federal poverty line
7for a family the size of the person's eligible family, is eligible to purchase a
8prescription drug at the amounts specified in sub. (5) (a) 4. only during the remaining
9amount of any 12-month period in which the person has first paid the annual
10deductible specified in sub. (3) (b) 2. a. in purchasing prescription drugs at the retail
11price and has then paid the annual deductible specified in sub. (3) (b) 2. b.
SB204,6,12 12(3) Program participants shall pay all of the following:
SB204,6,1613 (a) For each 12-month benefit period, a program enrollment fee of $30, except,
14for a person whose annual household income, as determined by the department, is
15125% or less of the federal poverty line for a family the size of the person's eligible
16family, a program enrollment fee of $15.
SB204,6,2017 (b) 1. For each 12-month benefit period, for a person specified in sub. (2) (a),
18a deductible for prescription drugs of $750, except that a person whose annual
19household income, as determined by the department, is 125% or less of the federal
20poverty line for a family the size of the person's eligible family pays no deductible.
SB204,6,2221 2. For each 12-month benefit period, for a person specified in sub. (2) (b), a
22deductible for prescription drugs that equals all of the following:
SB204,6,2423 a. The difference between the person's annual household income and 200% of
24the federal poverty line for a family the size of the person's eligible family.
SB204,6,2525 b. Seven hundred fifty dollars.
SB204,7,2
1(c) After payment of any applicable deductible under par. (b), all of the
2following:
SB204,7,63 1. For each prescription drug that bears only a generic name, a copayment of
4$10, except that, for a person whose annual household income, as determined by the
5department, is 125% or less of the federal poverty line for a family the size of the
6person's eligible family, a copayment of $5.
SB204,7,107 2. For each prescription drug that does not bear only a generic name, a
8copayment of $20, except that, for a person whose annual household income, as
9determined by the department, is 125% or less of the federal poverty line for a family
10the size of the person's eligible family, a copayment of $10.
SB204,7,1411 (d) Notwithstanding s. 49.002, if a person who is eligible under this section has
12other available coverage for payment of a prescription drug, this section applies only
13to costs for prescription drugs for the person that are not covered under the person's
14other available coverage.
SB204,7,20 15(4) The department shall devise and distribute a form for application for the
16program under sub. (2), shall determine eligibility for each 12-month benefit period
17of applicants, and shall issue to eligible persons a prescription drug card for use in
18purchasing prescription drugs, as specified in sub. (5). The department shall
19promulgate rules that specify the criteria to be used to determine annual household
20income under sub. (2) (a) 4. and (b) and (3) (b) 1. and (c) 1. and 2.
SB204,7,25 21(5) (a) Beginning July 1, 2002, as a condition of participation by a pharmacy
22or pharmacist in the program under s. 49.45, 49.46, or 49.47, the pharmacy or
23pharmacist may not charge a person who presents a valid prescription order and a
24card indicating that he or she meets eligibility requirements under sub. (2) an
25amount for a prescription drug under the order that exceeds the following:
SB204,8,2
11. For a deductible, as specified in sub. (3) (b) 1. and 2. b., the program payment
2rate.
SB204,8,53 2. After any applicable deductible under subd. 1. is charged, the copayment, as
4applicable, that is specified in sub. (3) (c) 1. or 2. No dispensing fee may be charged
5to a person under this subdivision.
SB204,8,66 3. For a deductible, as specified in sub. (3) (b) 2. a., the retail price.
SB204,8,97 4. After the deductible under subd. 3. is charged, the copayment, as applicable,
8that is specified in sub. (3) (c) 1. or 2. No dispensing fee may be charged to a person
9under this subdivision.
SB204,8,1310 (b) The department shall calculate and transmit to pharmacies and
11pharmacists that are certified providers of medical assistance amounts that may be
12used in calculating charges under par. (a). The department shall periodically update
13this information and transmit the updated amounts to pharmacies and pharmacists.
SB204,8,19 14(6) The department or an entity with which the department contracts shall
15provide to a drug manufacturer that sells drugs for prescribed use in this state
16material designed for use by the manufacturer in entering into a rebate agreement
17with the department or entity that is modeled on the rebate agreement specified
18under 42 USC 1396r-8. A rebate agreement under this subsection shall include all
19of the following as requirements:
SB204,8,2520 (a) That the manufacturer shall make rebate payments for each prescription
21drug of the manufacturer that is prescribed for and purchased by persons who meet
22criteria under sub. (2) (a) and by persons who meet criteria under sub. (2) (b) and
23have paid the deductible under sub. (3) (b) 2. a., to the state treasurer to be credited
24to the appropriation under s. 20.435 (4) (j), each calendar quarter or according to a
25schedule established by the department.
SB204,9,2
1(b) That the amount of the rebate payment shall be determined by a method
2specified in 42 USC 1396r-8 (c).
SB204,9,18 3(7) From the appropriation accounts under s. 20.435 (4) (bv), (j), and (jb),
4beginning July 1, 2002, the department shall, under a schedule that is identical to
5that used by the department for payment of pharmacy provider claims under medical
6assistance, provide to pharmacies and pharmacists payments for prescription drugs
7sold by the pharmacies or pharmacists to persons eligible under sub. (2) who have
8paid the deductible specified under sub. (3) (b) 1. or 2. or who, under sub. (3) (b) 1.,
9are not required to pay a deductible. The payment for each prescription drug under
10this subsection shall be at the program payment rate, minus any copayment paid by
11the person under sub. (5) (a) 2. or 4., plus, if applicable, incentive payments that are
12similar to those provided under s. 49.45 (8v). The department shall devise and
13distribute a claim form for reports by pharmacies and pharmacists under this
14subsection and may limit payment under this subsection to those prescription drugs
15for which payment claims are submitted by pharmacies or pharmacists directly to
16the department. The department may apply to the program under this section the
17same utilization and cost control procedures that apply under rules promulgated by
18the department to medical assistance under subch. IV.
SB204,9,25 19(8) The department shall, under methods promulgated by the department by
20rule, monitor compliance by pharmacies and pharmacists that are certified providers
21of medical assistance with the requirements of sub. (5) and shall annually report to
22the legislature under s. 13.172 (2) concerning the compliance. The report shall
23include information on any pharmacies or pharmacists that discontinue
24participation as certified providers of medical assistance and the reasons given for
25the discontinuance.
SB204,10,2
1(9) (a) The department shall promulgate rules relating to prohibitions on fraud
2that are substantially similar to applicable provisions under s. 49.49 (1) (a).
SB204,10,63 (b) A person who is convicted of violating a rule promulgated by the department
4under par. (a) in connection with that person's furnishing of prescription drugs under
5this section may be fined not more than $25,000, or imprisoned for not more than 7
6years and 6 months, or both.
SB204,10,97 (c) A person other than a person specified in par. (b) who is convicted of violating
8a rule promulgated by the department under par. (a) may be fined not more than
9$10,000, or imprisoned for not more than one year, or both.
SB204,10,15 10(10) If federal law is amended to provide coverage for prescription drugs for
11outpatient care as a benefit under medicare or to provide similar coverage under
12another program, the department shall submit to appropriate standing committees
13of the legislature under s. 13.172 (3) a report that contains an analysis of the
14differences between such a federal program and the program under this section and
15that provides recommendations concerning alignment, if any, of the differences.
SB204,10,20 16(11) Beginning October 1, 2002, the department shall by October 1, January
171, April 1, and July 1 annually submit to appropriate standing committees of the
18legislature under s. 13.172 (3) a report concerning expenditures of general purpose
19revenues, receipt of revenues from manufacturers under rebate agreements, and
20program participant case loads under the program under this section.
SB204,10,24 21(12) Except as provided in subs. (8) to (11), and except for the department's
22rule-making requirements and authority, the department may enter into a contract
23with an entity to perform the duties and exercise the powers of the department under
24this section.
SB204, s. 7 25Section 7. Nonstatutory provisions.
SB204,12,2
1(1) Prescription drug assistance for elderly; administration. Before the first
2day of the 2nd month following publication of the biennial budget act, the
3department of health and family services may develop and submit to the department
4of administration a proposal for expenditure of the funds appropriated under section
520.865 (4) (a) of the statutes for administration of the prescription drug assistance
6for low-income elderly program under section 49.688 of the statutes, as created by
7this act. The department of administration may approve, disapprove, or modify and
8approve any proposal it receives under this subsection. If the department of
9administration approves the proposal, the department shall submit the proposal,
10together with any modifications, to the cochairpersons of the joint committee on
11finance. If the cochairpersons of the committee do not notify the secretaries of
12administration and health and family services within 14 working days after
13receiving the proposal that the cochairpersons have scheduled a meeting for the
14purpose of reviewing the proposal, the secretary of administration may transfer from
15the appropriation under section 20.865 (4) (a) of the statutes to the appropriation
16under section 20.435 (4) (a) of the statutes the amount specified in the proposal or
17any proposed modifications of the proposal for expenditure as specified in the
18proposal or any proposed modifications of the proposal and may approve any position
19authority specified in the proposal or any proposed modifications of the proposal. If,
20within 14 working days after receiving the proposal, the cochairpersons notify the
21secretaries of administration and health and family services that the cochairpersons
22have scheduled a meeting for the purpose of reviewing the proposal, the secretary of
23administration may not transfer any amount specified in the proposal or any
24proposed modifications of the proposal from the appropriation under section 20.865
25(4) (a) of the statutes and may not approve any position authority specified in the

1proposal or any proposed modifications of the proposal, except as approved by the
2committee.
SB204, s. 8 3Section 8. Appropriation changes.
SB204,12,94 (1) Prescription drug assistance for low-income elderly; administration. In
5the schedule under section 20.005 (3) of the statutes for the appropriation to the joint
6committee on finance under section 20.435 (4) (a) of the statutes, as affected by the
7acts of 1999, the dollar amount is increased by $1,000,000 for fiscal year 2001-02 to
8increase funding for administration of the prescription drug assistance for elderly
9program under section 49.688 of the statutes, as created by this act.
SB204,12,1610 (2) Prescription drug assistance for low-income elderly; additional
11administration.
In the schedule under section 20.005 (3) of the statutes for the
12appropriation to the joint committee on finance under section 20.865 (4) (a) of the
13statutes, as affected by the acts of 2001, the dollar amount is increased by $1,000,000
14for fiscal year 2001-02 to increase funding for administration of the prescription
15drug assistance for elderly program under section 49.688 of the statutes, as created
16by this act.
SB204, s. 9 17Section 9. Effective dates. This act takes effect on the 2nd day after
18publication of the 2001-03 biennial budget bill, except as follows:
SB204,12,2019 (1) Prescription drug assistance for low-income elderly. The treatment of
20section 20.435 (4) (bv) of the statutes takes effect on July 1, 2002.
SB204,12,2121 (End)
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