Report Title:

State Pharmacy Assistance Program

Description:

Extends income eligibility requirement to two hundred per cent of the federal poverty level.  Requires the department to provide enrollees with counseling about prescription drug plans.  Repeals prescription drug rebate funding limitations.

THE SENATE	S.B. NO.	1729
TWENTY-FOURTH LEGISLATURE, 2007
STATE OF HAWAII

A BILL FOR AN ACT

relating to the state pharmacy assistance program.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  Section 346-341, Hawaii Revised Statutes, is amended by repealing the definition of "full coverage prescription drug benefit".

     [""Full coverage prescription drug benefit" means a federally approved prescription drug plan that offers a zero co-payment benefit for medicaid dual eligibles under the medicare part D drug benefit."]

     SECTION 2.  Section 346-342, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

     "(b)  The department [may] shall provide enrollment assistance to eligible individuals [into the state pharmacy assistance program.  Enrollment for medicaid dual eligible persons shall begin no later than October 1, 2005.] by:

(1) Identifying the medicare prescription drug plans that best meet the needs of the enrollee at the lowest cost, based on the enrollee's medication, pharmacy, and overall costs; and

(2) Assisting the enrollee in joining or changing plans."

     SECTION 3.  Section 346-343, Hawaii Revised Statutes, is amended to read as follows:

     "§346-343  Eligibility.  (a)  All residents of the State shall be eligible to participate in the state pharmacy assistance program; provided that the applicant:

     (1)  Is a resident of Hawaii;

     (2)  Is sixty-five years or older, or is disabled and receiving a social security benefit;

     (3)  Has a household income at or below [one] two hundred fifty per cent of the federal poverty level;

     (4)  Meets the asset test; and

     (5)  Is not a member of a retirement plan who is receiving a benefit from the Medicare Modernization Act.

     (b)  State pharmacy assistance program applicants who are enrolled in any other public assistance program providing pharmaceutical benefits, other than the Medicare Modernization Act and medicaid, shall be ineligible for the state pharmacy assistance program as long as they receive pharmaceutical benefits from that other public assistance program, unless the applicant is eligible for medicare.  Residents who qualify for, or are enrolled in, the Rx plus program shall be eligible for the state pharmacy assistance program; provided that they meet all other state pharmacy assistance program requirements.

     (c)  State pharmacy assistance program applicants who are enrolled in a private sector plan or insurance providing payments for prescription drugs shall be ineligible to receive benefits from the state pharmacy assistance program.

(d)  State pharmacy assistance program applicants must:

(1) Apply for the federal medicare part D pharmacy benefit program;

(2) Apply for and accept all subsidies available under the medicare part D pharmacy drug benefit; and

(3) Authorize the department on behalf of the applicant, to:

(A) Request eligibility, coverage, and formulary exceptions; and

(B) Appeal adverse determinations relating to medicare prescription drug plan enrollment, eligibility, subsidy eligibility, subsidy benefit levels, coverage, and formulary exceptions."

     SECTION 4.  Section 346-344, Hawaii Revised Statutes, is amended to read as follows:

     "§346-344  Benefits.  (a)  For persons [meeting] with household incomes of not more than two hundred fifty per cent of the federal poverty level, who meet the eligibility requirements in section 346-343, the state pharmacy assistance program [may] shall pay: [all or some of the co-payments required under the federal medicare part D pharmacy benefit program, subject to the sufficiency of funds in the state pharmacy assistance program special fund, as determined by the department.]

(1) The medicare prescription drug premium or a portion thereof, up to one hundred twenty-five per cent of the average premium charged by the part D plans available in the state;

(2) As to prescriptions covered by the medicare prescription drug benefit, all enrollee costs, including deductibles and copayments;

(3) As to classes of medication excluded from coverage by the medicare prescription drug benefit, all enrollee costs; and

(4) As to a prescription that has been denied for coverage by the medicare prescription drug plan because the pharmaceutical is not on the plan's formulary, all enrollee costs if the department determines that alternative medications available from the medicare prescription drug plan would be less effective than the prescribed medication or unsafe.  The department may seek reimbursement from the medicare prescription drug plan and request and appeal a part D formulary exception on behalf of the department and the beneficiary.

(b)  For persons meeting the eligibility requirements in section 346-343 with household incomes between one hundred fifty and two hundred fifty per cent of the federal poverty level, the state pharmacy assistance program shall pay a portion of the payment of medicare part D on a sliding scale of between twenty-five per cent and one hundred per cent of the average premium charged by the medicare prescription drug plans available in the state.

     [(b)](c)  The state pharmacy assistance program is the payor of last resort [subject to the sufficiency of funds in the state pharmacy assistance program special fund, as determined by the department].

     [(c)](d)  The state pharmacy assistance program shall be funded with state appropriations [, including funds derived from revenues to the State from rebates paid by pharmaceutical manufacturers pursuant to section 346 342(g),], and with savings resulting from medicare prescription drug coverage for the medicaid dual eligible population."

     SECTION 5.  Section 346-345, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

     "(b)  Moneys in the state pharmacy assistance program special fund may be used for:

     [(1) Reimbursement payments to participating pharmacies for co-payments required under the federal medicare part D pharmacy benefit program as provided to state pharmacy assistance program participants;]

(1) Payment of benefits under section 346-344;

     (2)  The costs of administering the state pharmacy assistance program, including salary and benefits of employees, computer costs, and contracted services as provided in section 346-342(d); and

     (3)  Any other purpose deemed necessary by the department for the purpose of operating and administering the state pharmacy [assistance] program.

     All interest on special fund balances shall accrue to the special fund.  Upon dissolution of the state pharmacy assistance program special fund, any unencumbered moneys in the fund shall lapse to the general fund."

     SECTION 6.  Act 264, Session Laws of Hawaii 2006, is amended by amending section 6 to read as follows:

     "SECTION 6.  This Act shall take effect on July 1, 2006; provided that section 3 shall take effect on [July 1,] June 30, 2007."

     SECTION 7.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 8.  This Act shall take effect on July 1, 2007.

INTRODUCED BY:

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