LD 1325
pg. 5
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LR 1609
Item 1

 
drugs and medications furnished under the program, including
covered prescription and nonprescription drugs, medications
and medical supplies, under the following terms.

 
(1)__For the basic component of the program, the total
cost to an enrollee for the purchase of any covered
drug or medication may not exceed the sum of $2 plus
20% of the price allowed for that drug or medication
under program rules.

 
(2)__For the supplemental component of the program, the
total cost to an enrollee for the purchase of any
covered drug or medication may not exceed:

 
(a)__For a brand name drug or medication, the cost
to the program for that drug or medication minus
the $2 paid by the program; and

 
(b)__For a generic drug or medication, the sum of
$2 plus 20% of the price allowed for that drug or
medication under program rules.

 
(3)__For the catastrophic component of the program, the
commissioner shall establish annual limits on the costs
incurred by enrollees for drugs and medications covered
under the program on or prior to May 31, 2001.__After
the limit is reached, the program must pay 80% of the
cost of each drug and medication covered by the
supplemental component of the program on May 31, 2001
minus $2.__Any remaining amount is paid by the
enrollee.__The limits must be set by the commissioner
by rule as necessary to operate the program within the
program budget.

 
H.__Payment must be denied for drugs from manufacturers that
do not enter into a rebate agreement with the department.

 
(1)__Each agreement must provide that the manufacturer
make rebate payments for both the basic and
supplemental components of the program to the
department according to the following schedule.

 
(a)__From October 1, 1992 to October 1, 1998, the rebate
percentage is equal to the percentage recommended by the federal
Center for Medicare and Medicaid Services of the manufacturer's
wholesale price for the total number of dosage units of each form
and strength of a prescription drug that the department reports
as reimbursed to providers of prescription drugs, provided
payments are not due


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