HCS/HB 1711 - This act makes various changes regarding prescription drugs and the Medicaid program.

MEDICAID PHARMACY PARTICIPATION PROGRAM - This act requires pharmacies participating in the Medicaid program to charge Medicare recipients an amount equal to the current Medicaid reimbursement rate plus an amount to be determined by the Division of Medical Services. The additional amount charged shall include pharmacy transmission costs, adjudication costs incurred by the division and an additional pharmacy administration charge. The division is required to collect the cost of adjudication from the reimbursement paid to enrolled Title XIX providers through the Medicaid remittance advices. The administrative charge shall be determined by consulting the most recent publication of NCPA-Searle Digest or its successor publication. The division shall use the same reimbursement rate for all pharmacies participating in the Medicaid program on a fee-for-service basis. The act does not apply to over-the-counter medications or over-the-counter medications which are written as prescriptions.

Under this act, pharmacies are prohibited from charging a patient an aggregate amount greater than the usual and customary rate for cash paying patients. The division is required to submit an annual report to the General Assembly by January 1st including information about participation rates, the number of pharmacies terminating their participation in the Medicaid program, and the reasons given for such termination.

The act also provides that the health care utilization review process existing under current law does not apply to this program. If a prescription drug benefit is added to the federal Medicare program, the appropriate committees of the General Assembly are required to evaluate whether to continue providing Medicare prescriptions at the Medicaid rate. The provisions of the Medicaid program are effective January 1, 2001.

MAIL ORDER PHARMACY - The act prohibits policies, contracts, and plans from mandating differences in coverages or imposing different conditions concerning co-payments, deductibles, co-insurance, or the number of days for the supply of medications when a patient submits a prescription for medications at a pharmacy or the medications are obtained from a mail order pharmacy. The provider is required to be a participant in the plan involved.

OBESITY PRESCRIPTION DRUG COVERAGE - Under this act, eligible persons who receive medical assistance under Section 208.151, RSMo, are authorized to receive prescription drug coverage of non-systemic drugs for the treatment of obesity which are approved by the FDA. Eligibility requirements will be developed by the Department of Health. The drug coverage may be subject to a prior authorization and a retrospective drug utilization process. The eligibility criteria must include a body mass index and the presence of a specified risk factor which include diabetes, hypertension, stroke, dyslipidemia or cardiovascular disease.

HEALTH INSURANCE COMPANIES PHARMACY REIMBURSEMENT RATES - The act also prohibits individual or group health insurance policies providing coverage for pharmaceutical benefits from reimbursing pharmacies at a rate lower than the rate paid by the Department of Social Services if the pharmacy is a Medicaid provider in Missouri.
STEPHEN WITTE