- Introduced -
SB 6 - This act creates the Pharmaceutical Investment Program for Seniors (PIPS).
The current prescription drug tax credit (Section 135.095, RSMo) will sunset on December 31, 2001.
The Medicaid income limit is increased to 100 percent of the federal poverty level and resource limits are increased to $1,500 for individuals and $2,500 for couples (Sections 208.010, 208.151).
The Commission for the Pharmaceutical Investment Program for Seniors is established, consisting of eleven members. The Commission will establish guidelines and procedures for PIPS (Sections 208.550 - 208.553).
The PIPS is established within the Division of Aging. The Commission must solicit requests for proposal from private contractors for administration of PIPS. Eligible individuals must be:
- 65 or older without access to health insurance with a pharmacy benefit for at least six months prior to application;
- with household income at or below $17,000 for individuals and $23,000 for couples;
Medicaid participants are not eligible for this program. This program is a payer of last resort. If a senior carries coverage through another plan, then the senior may only receive certain benefits after meeting the deductible. Applicants must apply annually and prove age, residence, and household income. Certain deductibles and coinsurance amounts apply based on income level.
Income levels will be adjusted annually based on the cost-of-living adjustment to the federal poverty levels. Participants will also pay a forty percent coinsurance. Total expenditures for an enrollee may be up to $5,000. The Commission must submit quarterly reports including specific data. If program costs exceed funds, then the Commission may implement cost control measures. If a federal program is established, the state program will cover additional costs only (Section 208.556).
The Program must be fully operational by July 1, 2002. Open enrollment will be April 1 - May 30, 2002. As of 2004, open enrollment will be held November 1 through December 15. Other enrollment periods may apply for some (Section 208.559).
Generic drugs must be used when available, unless requested otherwise. Pharmacists in the Program will be reimbursed at specified levels based on whether the drug is generic or brand (Section 208.562).
Certificates will be issued to participating pharmacists. Participating pharmaceutical manufacturers may agree to provide rebates under PIPS. The Division will negotiate the amount annually with at least a fifteen percent rebate for brand and an eleven percent rebate for generic. Rebate payments must be made quarterly. All rebates will be used toward refunding the Program. A pharmaceutical manufacturer's refusal to participate will not affect its Medicaid status (Section 208.565).
The "Pharmaceutical Investment Program for Seniors Fund" is established to receive all moneys received by the PIPS. (Section 208.568).
This act contains an emergency clause.