B.__Prescription drugs and medicines that are not designated for benefits under the program, nonprescription drugs and medicines and other health products are not qualifying prescription drugs and do not count toward expenditure of the qualifying amount.__Premiums paid for coverage under a health, medical or prescription drug program, insurance or benefit do not count toward expenditure of the qualifying amount.

4.__Program benefits; copayments.__Program benefits apply to all prescription drugs and medications provided under the Medicaid program, referred to in this subsection as "drugs," subject to adjustment by the department pursuant to subsection 8.__ The following provisions apply to benefits under the program.

A.__The program benefit pays the cost of drugs in excess of the copayment of 20% paid by the enrollee.

B.__The program must allow prescriptions for a 15-day time period on newly issued drugs for chronic condiions or diseases.

C.__The program must encourage for prescription drugs to be filled for 90-day time periods, subject to a maximum copayment of twice the amount applicable to a 30-day prescription.

5.__Program terms.__The terms of this subsection apply to the program.

A.__The department shall designate some prescription drugs and medicines as generic drugs.__In making a designation under this paragraph, the department shall conduct a cost- benefit analysis and shall consider the most current medical and pharmacological information and research.__When a generic drug is available that is the pharmacological equivalent of a brand name drug, the terms of the program must require the purchase of a generic drug in substitution for a prescribed brand name drug or must limit program benefits to the amount of benefit for the generic drug.

B.__The terms of the program must deny program benefits for a prescribed drug for which there is an over-the-counter pharmacological equivalent.

C.__The terms of the program must designate the program as the payor of last resort, requiring payment from private

insurance and health maintenance organizations and from other sources, private and public, prior to payment from the program to the extent allowable by law.

6.__Program coordination.__The commissioner shall administer this program in coordination with the elderly low-cost drug program under section 254, Medicaid prescription drug waiver program and any other program providing prescription drug benefits in order to maximize federal funding, increase program benefits and decrease total administrative expenses and the prices paid for prescription drugs by residents of this State.

7.__Contracts.__The department may enter into contracts for the administration of the program or any of its necessary functions, including, but not limited to, mail order service for maintenance prescriptions and the use of a pharmaceutical benefits manager.__A pharmaceutical manufacturer, wholesaler or distributor is disqualified from entering into a contract for pharmaceutical benefits management services under the program.

8.__Limitation.__The program must operate within the constraints of the funding appropriated and allocated for its operation.__On a quarterly basis the commissioner shall review the operation and fiscal status of the program.__If the commissioner determines that the program can not operate within its fiscal limits, the commissioner shall take action to bring the program within its budget, including increasing income eligibility requirements or increasing copayments.

9.__Rulemaking.__The department shall adopt rules to implement the program.__Rules adopted pursuant to this section are routine technical rules as defined by Title 5, chapter 375, subchapter II-A.

I.

SUMMARY

This bill establishes the prescription assistance program to provide help to residents of this State of all ages who have unusually high prescription drug costs whose family incomes are below 300% of the nonfarm income official poverty line. The program will require enrollees to pay the first $1,000 of prescription drug expenses. After paying that amount, the enrollee will receive program benefits that pay 80% of the cost of the drugs. The enrollee pays 20%. The program will encourage the use of generic drugs and will not pay benefits toward prescribed drugs for which there is an over-the-counter pharmacological equivalent. The program must be administered in coordination with the elderly low-cost drug program and the Medicaid program. In administering the program, the Department

of Human Services may enter into contracts, may use mail order service and may use a pharmaceutical benefits manager. The program must operate within its budget and the Commissioner of Human Services may alter program terms to do so. The Department of Human Services is required to adopt rules to implement the program.