ANNE C. WALKER, Chief Clerk
AN ACT
To amend chapter 376, RSMo, relating to health insurance by adding thereto one new section relating to the same subject, with an effective date.
Section A. Chapter 376, RSMo, is amended by adding thereto one new section, to be known as section 376.891, to read as follows:
376.891. 1. Upon presentation of a prescription and Medicare card by a patient who is a resident of the state of Missouri, any pharmacy participating in the Medicaid program shall charge a Medicare recipient an amount equal to the current Medicaid reimbursement rate for such prescription medicine plus an amount to be established by the division of medical services in the department of social services. Such amount charged in addition to the Medicaid reimbursement rate shall include the cost of claim transmission by the pharmacy, any cost of adjudication by the division and an additional pharmacy administrative charge, when added to the Medicaid fee, approximates the pharmacies cost to dispense a prescription. The administrative charge shall be determined from calculations performed on operating cost of community pharmacies as it appears in the most recent publication of NCPA-Searle Digest or its successor publication. If the NCPA-Searle Digest is no longer published and no successor publication exists, the division of medical services shall conduct a cost of dispensing survey no less than once every two years to determine the cost to fill a prescription in a community pharmacy. The division of medical services shall determine the manner in which to transmit information and the rate to be charged for a prescription to the pharmacy over commonly available electronic systems. In no case shall the pharmacies charge a patient an aggregate rate greater than the usual and customary rate for cash paying patients. The provisions of this section shall only apply to legend drug prescription and shall not cover any over-the-counter medications.
2. The utilization and review process established in sections 376.1350 to 376.1389 shall not apply to this section.
3. The division of medical services shall monitor participation by Medicare recipients and submit an annual report to the general assembly by January first. Such report shall include information regarding participation rates and the number of pharmacies that terminate their participation in the Medicaid program and any reasons given for such termination.
4. If a new prescription drug benefit is added pursuant to the federal Medicare program, the appropriate committees of the general assembly shall evaluate the need to continue to provide Medicare prescriptions at the Medicaid rate pursuant to this section.
5. The provisions of this section shall become effective January 1, 2001, and shall terminate on December 31,
2002.
Missouri House of
Representatives