HCS HB 3 -- PHARMACEUTICAL INVESTMENT PROGRAM FOR SENIORS CO-SPONSORS: Barry (Abel, Naeger) COMMITTEE ACTION: Voted "do pass" by the Committee on Children, Families and Health by a vote of 15 to 0. This substitute establishes a Pharmaceutical Investment Program for eligible seniors who reside in Missouri. In its main provisions, the substitute: (1) Repeals the current $200 prescription tax credit for eligible seniors; (2) Revises the current resource limit used to determine eligibility for persons who apply for public assistance. The resource limit for an individual is increased from $1,000 to $1,500; for a married couple, the resource limit is increased from $2,000 to $2,500; (3) Increases the income limit to 100% of the federal poverty level for persons eligible to receive Medicaid; (4) Establishes an 11-member Commission for the Pharmaceutical Investment Program for Seniors within the Division of Aging in the Department of Health and Senior Services. The composition and selection of members and duties of the commission are contained in the substitute; (5) Establishes the Pharmaceutical Investment Program for Seniors within the Division of Aging in the Department of Health and Senior Services. Various terms are defined; (6) Requires the commission to govern the program and to solicit requests for proposals to administer the program from private contractors; (7) Requires the commission to select a bid from the submitted proposals. If no bids are received, the program will be jointly administered by the Department of Health and Senior Services and the Department of Social Services; (8) Sets eligibility criteria for participation in the program. Residents are eligible to apply to the program if they are 65 years of age, have not received pharmaceutical benefits for at least 6 months prior to applying to the program, have not received Medicaid benefits, and meet income eligibility guidelines; (9) Establishes income eligibility limits of $17,000 for individuals and $23,000 for married couples; (10) Makes the program the payer of last resort and not an entitlement; (11) Requires that seniors submit an annual application to the Division of Aging or the division's designee. The commission will develop and implement a means test requiring applicants to meet the income requirement of the program; (12) Prohibits requiring applicants to accept Medicaid benefits in lieu of participating in the program; (13) Requires that participants pay a deductible to participate in the program. Deductible amounts are $250 or $500 per participant, depending on marital status and household income; (14) Requires that all household income levels established for participation in the program be adjusted annually by an amount equal to the cost-of-living adjustment for the federal poverty level established by the federal Department of Health and Human Services; (15) Requires that enrollees pay 40% of the purchase price of prescription drugs. In addition, eligible enrollees are required to pay an annual co-insurance amount of $25 or $35 based on marital status and income level; (16) Establishes an annual program benefit limit of $5,000 per enrollee; (17) Allows the Department of Health and Senior Services to enter into a contract with any private individual, corporation, or agency to implement the program; (18) Requires the division to utilize Area Agencies on Aging, senior citizen centers, and related entities to provide outreach, enrollment assistance, and education relating to the program; (19) Requires the commission to submit quarterly reports to the Governor, Senate Appropriations Committee, House of Representatives Budget Committee, Speaker of the House of Representatives, and President Pro Tem of the Senate; (20) Requires that program benefits be supported by moneys appropriated by the General Assembly; (21) Requires the commission to implement cost control measures if projected costs exceed the current program appropriation; (22) Allows the division to request a supplemental appropriation to meet additional costs and requires implementation of cost control measures; (23) Requires the program to cover eligible costs not covered by a federal pharmaceutical assistance program if established; (24) Requires the commission to develop rules to implement the program; (25) Makes any person who engages in fraudulent activities in order to participate in the program guilty of a misdemeanor and forfeits his or her rights to participate in the program; (26) Requires the program to be fully operational by July 1, 2002. An initial enrollment period will be from April 1, 2002, through May 30, 2002. A second initial enrollment period will be from November 1, 2002, through December 15, 2002, for persons who did not enroll during the first initial enrollment period for the 2003 calendar year. Current enrollees do not have to re-enroll during the second initial enrollment period for the 2003 calendar year. Beginning with calendar year 2004, open enrollment periods will be held from November 1 through December 15 of the preceding calendar year; (27) Allows an individual a 30-day enrollment period outside the established enrollment periods; (28) Requires that the program use generic prescription drugs when available. Enrollees may receive brand name prescription drugs when a generic prescription drug is available only if both the prescribing physician and the enrollee request the brand name prescription drug, the enrollee pays the co-insurance on the generic drug, and the enrollee pays the difference in price between the brand name drug and the generic drug; (29) Requires that pharmacists participating in the program be reimbursed for costs resulting from obtaining and dispensing medications. Reimbursement formulas for brand name and generic medications are contained in the substitute; (30) Requires the division to issue a certificate of participation to pharmaceutical manufacturers who participate in the program. A manufacturer can apply for participation in the program by submitting an application approved by the commission; (31) Requires pharmaceutical manufacturers to provide quarterly rebates under the program. The division is required to negotiate annually with manufacturers for the rebate amounts. Rebates for brand name prescription drugs may not be less than 15% and rebates for generic prescriptions may not be less than 11%. Rebates will be used to fund the program; (32) Prohibits a pharmaceutical manufacturer's status under the current Medicaid program from being affected if the manufacturer refuses to participate in the program; and (33) Creates a Pharmaceutical Investment Program for Seniors Fund which will be administered by the State Treasurer. The revenue sources for the fund are specified in the substitute, and funds will not revert to the General Revenue Fund. The substitute contains an emergency clause. FISCAL NOTE: Not available at time of printing. PROPONENTS: Supporters say that the current pharmaceutical tax credit is not meeting the needs of Missouri seniors and that a fiscally responsible pharmaceutical assistance program is needed for seniors who are on fixed incomes and are confronted with choosing between paying for the increased costs of prescription drugs, health care, and other household expenses. Supporters also state that revising the income and asset levels for persons applying for public assistance will help ease the financial burden experienced by individuals meeting the Medicaid "spend-- down" requirement. Creating a pharmaceutical assistance program is an initial phase of state government action responding to the needs of Missouri seniors who need assistance paying for the increased costs of prescribed medication. Testifying for the bill were Lieutenant Governor Maxwell; Representatives Abel, Naeger, Portwood, and Hollingsworth; Silver Haired Legislature of Missouri; Missouri Coalition of Community Mental Health Centers; National Alliance for the Mentally Ill; AARP; Coalition for Affordable Prescriptions for Seniors; and Cindy Eckstein. OPPONENTS: Those who oppose the bill say that the two-tiered benefit contained in the pharmaceutical assistance program will lead to difficulty estimating the actual number of program participants and the actual costs of the program. Due to these uncertainties, a pharmaceutical assistance program should contain a single benefit tier. Testifying against the bill was Cathy Carroll. Joseph Deering, Legislative AnalystCopyright (c) Missouri House of Representatives