|SB 0004||Creates the Missouri Senior Rx Program to provide pharmaceutical assistance for seniors|
|LR Number:||2418L.16C||Fiscal Note:||2418-16|
|Committee:||Public Health and Welfare|
|Last Action:||09/12/01 - H Third Read and Passed - EC adopted||Journal page:|
|Title:||HCS SCS SBs 4, 1, 5 & 6|
SCS/SBs 4, 1, 5, & 6 - This act creates the Missouri Senior Rx Program to provide pharmaceutical assistance for seniors.
The current tax credit, under Section 135.095, sunsets as of December 31, 2001.
As of July 1, 2002, Medicaid asset limits are expanded for those sixty-five and older to $1,500 for an individual and $2,500 for a couple. Income limits are expanded to 100 percent of the federal poverty level for those sixty-five and older (Sections 208.010, 208.151).
The Commission for the Missouri Senior Rx Program is established, consisting of thirteen members. Members will serve staggered terms and may be reappointed. The Commission will establish guidelines and procedures for the Missouri Senior Rx Program. The Commission will have flexibility to redefine certain terms, such as "generic drugs" (Sections 208.550 - 208.553).
The Missouri Senior Rx Program is established within the Division of Aging. The Commission must solicit requests for proposal from private contractors for administration of the Program. Eligible individuals must be:
- Sixty-five or older without access to health insurance with a pharmacy benefit for at least six months prior to application;
- With household income at or below $12,000 for individuals and $17,000 for couples;
- Any other senior may enroll in the program after spending 25 percent of annual household income as a deductible, if the amount expended minus household income is equal to or less than the qualifying income limits for the program.
Medicaid participants are not eligible for this Program. This Program is a payer of last resort. If a senior carries coverage through another plan, then the senior may only receive certain benefits after meeting the deductible. Applicants must apply annually and prove age, residence, and household income. Participants will pay a forty percent coinsurance and the following deductibles and enrollment fees:
- Individual with income at or below $12,000 will pay a $250 deductible and a $25 enrollment fee;
- Couples with income at or below $17,000 will pay a $250 deductible and a $25 enrollment fee per person.
Participants shall pay 40% of the cost of each prescription and total expenditures for each participant may not exceed $5,000.
The Commission must submit quarterly reports to the General Assembly, the Governor, and the Division. If program costs exceed funds, then the Commission may implement cost control measures. If a federal program is established, the state program will cover additional costs only (Section 208.556).
The Program must be fully operational by July 1, 2002. Open enrollment will be April 1 - May 30, 2002. As of 2004, open enrollment will be held November 1 through December 15. Other enrollment periods may apply for some (Section 208.559).
Generic drugs must be used when available, unless requested otherwise. Pharmacists in the Program will be reimbursed at specific levels based on whether the drug is generic or brand (Section 208.562).
Certificates will be issued to participating pharmacists. Certificates will be in effect for at least one year and may be automatically renewed. Cancellation must be with sixty days notice. The Division will negotiate the amount of rebates annually. Rebates for brand name drugs will be fifteen percent of the average manufacturers' price (AMP) and generic drugs will be eleven percent of the AMP. A pharmaceutical manufacturer's refusal to participate will not affect its Medicaid status. A prohibition on drug formulary restrictions is included. False information and confidentiality provisions are also included (Section 208.565).
The "Missouri Senior Rx Fund" is established to receive all moneys received by the Program (Section 208.568).
The "Missouri Senior Rx Clearinghouse" is established within the Commission. The Commission must submit requests for proposal for the private administration of the Clearinghouse. This may be the same administrator of the Program. The Clearinghouse will be a public or private agency created to assist and educate Missouri residents in accessing prescription drugs and serve as a pharmaceutical benefit resource. Purposes include providing one- stop shopping for information, targeting outreach, maintain a toll-free phone number, provide data to the state regarding the program (Section 208.568).
This act contains a severability clause, an emergency clause, and will expire on July 1, 2005.
Portions of this act are similar to HB 3 (2001 - Special).