- Committee -
SCS/SB 1371 - This act closes the standard drug benefit coverage gap for certain seniors that was created due to the enactment of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.
MISSOURI SENIOR PRESCRIPTION DRUG PLAN - The "Missouri Senior Prescription Drug Plan" is created within the Department of Health and Senior Services. Beginning January 1, 2006 and subject to appropriations, the state shall pay 75% of the standard drug benefit coverage gap of $2850 for eligible individuals.
Beginning November 15, 2005, applications for the Missouri Senior Prescription Drug Plan will be conducted jointly with applications for the Medicare Part D benefit. The enrollment period for the state plan shall correspond with the enrollment period for the federal program.
This plan is not an entitlement and is only a payer of last resort. Benefits are limited to the amounts appropriated for the plan. If the costs exceed the amounts appropriated, then the Commission may direct the prescription drug plan (PDP) sponsors to implement cost-control measures, such as increasing the amount of co-insurance.
The Missouri Senior Prescription Drug Plan shall be reauthorized every four years.
ELIGIBILITY - Individuals who are 65 and older and are a participant in the Medicare Part D benefit will be eligible for the plan if their income is:
-within 150% to 200% of the federal poverty level; or
-below 150% of the federal poverty level and they fail the asset test.
COVERAGE - The plan shall provide coverage for only the prescription drugs covered in the PDP sponsors' formulary under the federal program. The plan shall not include coverage for any of the following drugs:
-those used for anorexia and weight gain;
-those used to promote fertility;
-those used for cosmetic purposes or hair growth;
-those used for coughs or colds;
The plan shall also exclude any drugs that are not "reasonable and necessary" as defined pursuant to the federal program. For covered prescription drugs, the state plan shall not be charged an amount in excess of the price charged pursuant to the federal program.
MISSOURI SENIOR PRESCRIPTION DRUG PLAN COMMISSION - The "Missouri Senior Prescription Drug Plan Commission" is created and will be composed of twelve members. Members appointed by the Governor shall serve for three years, legislative members shall serve for their current term of office, and all other members shall serve for as long as they hold the position which made them eligible for appointment.
Members of the Commission shall receive no compensation, but may be reimbursed for any expenses incurred. The Commission may also employ administrative staff as necessary to assist the Commission.
AUTHORITY OF THE COMMISSION - The Commission shall have the authority to:
-contract with PDP sponsors for implementing and administering the plan and determining eligibility;
-adjust the fee payments with PDP sponsors;
-set and adjust co-insurance at different amounts;
-apply for federal waivers and grants;
-promulgate rules; and
-perform any other function necessary for the implementation of the plan.
MISSOURI SENIOR PRESCRIPTION DRUG PLAN CLEARINGHOUSE - The "Missouri Senior Prescription Drug Plan Clearinghouse" is created within the Commission. The purpose of the Clearinghouse is to assist all Missourians in accessing prescription drugs programs, to educate the public on quality drug programs, to maintain a toll-free number, and to provide information on eligibility, enrollment, and benefits for the plan on the Department's website.
TERMINATION OF THE MISSOURI SENIOR RX PROGRAM - The Missouri Senior Rx Program shall terminate thirty days after notice is provided to the Revisor of Statutes that the Medicare Prescription Drug, Improvement and Modernization Act of 2003 has been fully implemented.