Report Title:

Drug Assistance for Seniors

Description:

Creates a state pharmaceutical assistance program pilot program for residents 62 years and older, in counties having a population density of less than 75 per square mile, with incomes up to 300% of the federal poverty level, and who do not qualify for Medicaid.

THE SENATE

S.B. NO.

2010

TWENTY-FIRST LEGISLATURE, 2002

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to prescription drugs.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. There is established within the executive office on aging of the department of health the Hawaii Senior RX program to help reduce the costs of prescription drugs for Hawaii residents age sixty-two and older. The program shall operate in all counties having an average population density of less than seventy-five persons per square mile. Prescription drugs have the same meaning as defined in section 328-1, Hawaii Revised Statutes.

This program shall not include:

(1) Experimental drugs and over the counter pharmaceutical products;

(2) Drugs used:

(A) For anorexia or weight gain;

(B) To promote fertility;

(C) For cosmetic purposes or hair growth;

(D) For symptomatic relief of cough and colds;

(E) To promote smoking cessation;

(F) As vitamins and mineral products, except prenatal vitamins;

(G) Barbiturates; and

(H) Benzodiazepines.

SECTION 2. (a) There is established within the executive office on aging for administrative purposes the Hawaii Senior RX commission to govern the operation of the program. The executive office on aging shall provide technical assistance to the commission for the administration and implementation of the program, if requested.

(b) Members of the commission shall include:

(1) The executive director of the executive office on aging, the administrator of the state health planning and development agency, and the administrator of the medquest division of the department of human services, as ex-officio members;

(2) Four members appointed by the governor, one each appointed from lists of nominees submitted by the president of the senate, the minority party leader of the senate, the speaker of the house of representatives, and the minority party leader of the house of representatives, respectively;

(3) A representative of the pharmaceutical manufacturing industry, and two public members appointed by the governor from lists of nominees submitted jointly by the president of the senate and the speaker of the house of representatives; and

(4) Four members appointed by the governor, one from each of the following groups in the State:

(A) Licensed pharmacists;

(B) Licensed physicians;

(C) Senior advocacy groups; and

(D) Area agencies on aging.

(c) The commission shall establish guidelines, policies, and procedures necessary to implement the Hawaii Senior RX program. The commission shall also:

(1) Establish a prospective and retrospective drug utilization component to reduce drug interactions, overutilizations, therapeutic duplications, or early refills; and

(2) Establish guidelines and collect information and data to promote and facilitate the program and to allow evaluation of the program's cost effectiveness.

The commission may enter into contracts with other organizations to administer the program to perform duties that may include devising applications, enrolling members, administration of prescription drug benefits, and implementation of cost-control measures.

(d) The members of the commission shall serve without compensation, but shall be reimbursed for expenses, including travel expenses, necessary for the performance of their duties.

SECTION 3. A person is eligible to participate in the Hawaii Senior RX program if the person:

(1) Is at least sixty-two years old;

(2) Does not qualify for Medicaid prescription drug benefits;

(3) Has an annual income of not more than three hundred per cent of the federal poverty level;

(4) Has resided in Hawaii for at least six consecutive months; and

(5) Has no public or private health care insurance that provides prescription drug benefits.

SECTION 4. The Hawaii Senior RX program is not an entitlement. Benefits shall be limited to the level supported by the revenues appropriated by this Act.

The following deductibles shall apply to program participants:

(1) For an individual with an annual income at or below three hundred per cent of the federal poverty level, the deductible shall be not less than $250 in the initial year; and

(2) For a married couple with an annual household income at or below three hundred per cent of the federal poverty level, the deductible shall be not less than $250 for each person in the initial year.

For each prescription drug dispensed, participants shall pay a forty per cent coinsurance payment. The commission may recommend a higher coinsurance payment and shall adjust the coinsurance amount annually. Coinsurance payments shall be used to reduce the State's cost for the program.

The commission may require participants to pay an enrollment fee of not more than $25, based on income. The total annual expenditures for each Hawaii Senior RX participant shall not exceed $5,000.

The executive office on aging shall utilize area agencies on aging, senior citizens centers, and other senior focused entities to provide outreach, enrollment referral assistance, and education services to potentially eligible residents for the Hawaii Senior RX program.

The department of health shall negotiate with drug manufacturers for participation in the program. The rebate amount for each prescription drug covered shall be fifteen per cent of the average manufacturers' price as defined pursuant to 42 U.S.C. 139964-8(k)(1). Rebates shall be used toward refunding the program. A manufacturer's refusal to participate shall not affect the manufacturer's statute under the current Medicaid program. There shall be no drug formulary, prior approval system, or any similar restriction imposed on the coverage of outpatient prescription drugs made by pharmaceutical manufacturers who have entered into rebate agreements for prescription drugs covered under the Hawaii Senior RX program.

SECTION 5. The commission may adopt rules under chapter 91 to implement this Act; provided that the rules shall be exempt from the public notice and public hearing requirements of chapter 91.

SECTION 6. The Hawaii Senior RX program shall be operational no later than July 1, 2003, and shall cease to operate on June 30, 2005.

If the federal government establishes a pharmaceutical assistance program that covers program eligible seniors under Medicare or another program, the Hawaii Senior RX program shall cover only eligible costs not covered by the federal program. The Hawaii Senior RX program is the payer of last resort.

SECTION 7. There is appropriated out of the general revenues of the State of Hawaii the sum of $       , or so much thereof as may be necessary for fiscal year 2002-2003, to carry out the purposes of this Act. The sums appropriated shall be expended by the department of health.

SECTION 8. This Act shall take effect on July 1, 2002.

INTRODUCED BY:

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