90TH GENERAL ASSEMBLY
Taken up for Perfection April 11, 2000. House Committee Substitute for House Bill No. 1711 ordered Perfected and printed, as amended.
ANNE C. WALKER, Chief Clerk
To amend chapter 376, RSMo, relating to health insurance by adding thereto three new sections relating to the same subject, with an effective date.
Section A. Chapter 376, RSMo, is amended by adding thereto three new sections, to be known as section 376.845, 1 and 2, to read as follows:
376.845. 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 division of medical services (DMS) shall collect costs of adjudication by the division from the reimbursement to be paid to the enrolled Title XIX provider through the Medicaid remittance advices. 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 use the same reimbursement rate for all pharmacies participating in the Medicaid program on a fee-for-services basis. 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 nor medications available over-the-counter and written as a prescription.
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.
6. No policy, contract or plan shall permit or mandate any difference in coverage or impose any different conditions, including, but not limited to, copayments, deductibles or coinsurance or the number of days for the supply of the drug, whether the prescription benefits are provided through direct contact with a pharmacy or by use of a mail order pharmacy so long as the provider selected is a participant in the plan involved.
Section 1. The medical assistance program established in section 208.151, RSMo, shall provide prescription drug coverage of nonsystemic drugs for the treatment of obesity, which are approved by the federal Food and Drug Administration, for eligible persons according to appropriate criteria established by the department. Such criteria shall include coverage for eligible patients that have a body mass index equal to or greater than twenty-seven kg/m2 with the presence of another risk factor including diabetes, cardiovascular disease, hypertension, stroke or dyslipidemia. Such coverage may be subject to prior authorization or to a retrospective drug utilitzation review process.
Section 2. No individual or group health insurance policy providing coverage on an expense incurred basis, no
individual or group service or indemnity type contract issued by a not for profit corporation, no individual or group
service contract issued by a health maintenance organization, no self-insured group arrangement, to the extent not
preempted by law, and no managed health care entity plan of any type or description, that are delivered, issued for
delivery, continued or renewed on or after August 28, 2000, which provide coverage for pharmaceutical benefits or
services shall reimburse any pharmacy or pharmacist for dispensing any prescription or providing any service at
less than the rate paid by the department of social services for the same fees or services pursuant to section 1 of this
act so long as the pharmacy or pharmacist is a Medicaid provider in this state.
Missouri House of Representatives