Missouri Senate

Introduced

SECTION 208.568 - Moneys in the Missouri Senior Rx Fund shall be credited to the Missouri Senior Prescription Drug Plan Fund after notice is provided to the Revisor that Medicare Act of 2003 has been fully implemented.

SECTION 208.574 - The provisions of the Missouri Senior Rx Program shall terminate after notice is provided to the Revisor that the Medicare Act of 2003 has been fully implemented.

SECTION 208.575(1) - This subsection provides definitions for "eligible senior", "2006 standard drug coverage gap", and "prescription drug plan sponsors (PDP)".

SECTION 208.575(2) - The "Missouri Senior Prescription Drug Plan" is created within the Department of Health and Senior Services. The plan shall be effective upon notice to the Revisor by the Commission that the Medicare Act of 2003 has been fully implemented.

SECTION 208.575(3) - This plan is not an entitlement and is only a payer of last resort. The benefits shall be limited to the amounts appropriated for the plan. If the costs of the plan exceed the amounts appropriated, the Commission may request a supplemental appropriation to fund the plan or may direct PDP sponsors to implement cost control measures.

SECTION 208.575(4) - Subject to appropriations and other available funds, the plan shall pay seventy-five percent of the 2006 standard drug benefit coverage gap of up to $2850, which shall not exceed $2138, for each eligible senior each year.

SECTION 208.575(5) - Applications for the program 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.

SECTION 208.575(6), (7), & (8) - 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;

- prescription vitamins;

- nonprescription drugs;

- barbiturates; and

- benzodiazepines.

The plan shall also exclude any drugs that are not "reasonable and necessary" as defined pursuant to Section 1862(a) of P.L. 108-173.

SECTION 208.575(9) - For the covered prescription drugs, the state plan shall not be charged an amount in excess of the price charged pursuant to the federal program.

SECTION 208.577(1) & (2) - The "Missouri Senior Prescription Plan Commission" is created and shall be composed of 12 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.

SECTION 208.577(3) & (4) - 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.

SECTION 208.577(5) - The Commission shall have the authority to contract with PDP sponsors for implementing and administering the plan and for determining the eligibility of applicants. The Commission shall also have the authority to adjust the fee payments with PDP sponsors, coordinate with the Missouri Senior Rx Commission to avoid any duplication in coverage and to ensure a smooth transition between the two programs, and perform any other function necessary for the implementation and administration of the plan.

SECTION 208.577(6) & (7) - The Commission may apply for any federal waivers or grants. The Commission shall have rule-making authority for the implementation of sections 208.575 and 208.583.

SECTION 208.579(1) & (2) - The "Missouri Senior Prescription Plan Clearinghouse" is established within the Commission. The Commission may submit proposals for the third-party administration of the Clearinghouse. 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 provide information on eligibility, enrollment, and benefits for the plan on the Department's website.

SECTION 208.581 - The "Missouri Senior Prescription Drug Plan Fund" is created within the State Treasury. The fund will consist of appropriations by the General Assembly, federal moneys, or moneys from other sources. Moneys in the fund shall be used solely by the Commission and the Department of Health and Senior Services for the implementation of the plan.

SECTION 208.583 - This new section provides that sections 208.575 to 208.583 shall be subject to reauthorization every four years.

This act is similar to the perfected version of SB 1371 (2004).

ADRIANE CROUSE