SF0133 - Prescription drug assistance program.

 

2001

State of Wyoming

01LSO-0370.E1

ENGROSSED

 

 

 

SENATE FILE NO.  SF0133

 

 

Prescription drug assistance program.

 

Sponsored by:

 

 

A BILL

 

for

 

 1  AN ACT relating to Wyoming Medical Assistance and Services
 2  Act; creating the prescription drug program under the
 3  Wyoming Medical Assistance and Services Act; specifying
 4  eligibility criteria; specifying which drugs qualify for
 5  payment under the program; establishing procedures;
 6  limiting benefits as specified; providing an appropriation;
 7  authorizing posititions; and providing for an effective
 8  date.

 9 

10  Be It Enacted by the Legislature of the State of Wyoming:

11 

12         Section 1.  W.S. 42-4-117 is created to read:

13 

14         42-4-117.  Prescription drug assistance program
15  created; eligibility criteria; benefits provided; coverage
16  of medications.

 

Page  1

 

 

 

 1 

 2         (a)  There is created a prescription drug assistance
 3  program to assist residents of the state. The program shall
 4  be a state funded program to provide prescription drug
 5  assistance, effective July 1, 2001, in addition to the
 6  services provided under the Wyoming Medical Assistance and
 7  Services Act. Effective July 1, 2001, the prescription drug
 8  assistance program shall replace the minimum medical
 9  program. Eligibility for assistance under the program
10  created by this section shall not constitute an entitlement
11  and services shall be provided under this section only to
12  the extent funds are available.

13 

14         (b)  Residents of the state may apply for the
15  prescription drug assistance program in the manner provided
16  in W.S. 42-4-106. Upon a determination of eligibility, the
17  applicant remains eligible for assistance under the
18  prescription drug assistance program as provided in this
19  section. If a recipient ceases to be a resident of the
20  state, his eligibility under the program shall terminate.
21  The department shall by rule and regulation establish
22  income eligibility guidelines on a sliding scale no later
23  than July 1 of each year based on the federal poverty
24  levels in effect on January 1 of such calendar year. The

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 1  rules shall take into consideration family size up to four
 2  (4) individuals. Eligibility for families consisting of
 3  more than four (4) individuals shall be determined on the
 4  basis of the income of a family of four (4) individuals.
 5  Persons eligible for prescription drug assistance under
 6  other state or federal programs, except the state high risk
 7  health insurance pool, shall be ineligible for assistance
 8  under the prescription drug assistance program. Four (4)
 9  categories of eligibility shall be established as follows:

10 

11              (i)  One hundred percent (100%) of the federal
12  poverty level or less;

13 

14              (ii)  Greater than one hundred percent (100%) but
15  not more than one hundred fifty percent (150%) of the
16  federal poverty level;

17 

18              (iii)  Greater than one hundred fifty percent
19  (150%) but not more than two hundred percent (200%) of the
20  federal poverty level;

21 

22              (iv)  Greater than two hundred percent (200%) but
23  not more than two hundred fifty percent (250%) of the
24  federal poverty level.

 

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 1 

 2         (c)  Except as provided by this subsection, an
 3  eligibility determination made under subsection (b) of this
 4  section shall be valid for one (1) year. A recipient whose
 5  monthly income changes by more than one-third (1/3), shall
 6  report the change in income to the department. Such
 7  recipient is entitled to a redetermination if his income
 8  has declined and may, at the option of the department, be
 9  subject to a redetermination if his income has increased.

10 

11         (d)  Upon a determination of income eligibility, an
12  eligible family shall pay an initial enrollment fee of
13  twenty dollars ($20.00) per recipient and a continuing
14  enrollment fee of twenty dollars ($20.00) per recipient
15  annually thereafter as long as the recipient remains
16  eligible for services under this section. The fee shall be
17  collected by the department of family services and shall be
18  deposited in the general fund. In addition, for the first
19  three (3) full calendar months of eligibility each
20  recipient shall be required to pay a deductible of one
21  thousand dollars ($1,000.00) before receiving any benefits
22  under the program. No person shall be subject to this
23  initial high deductible requirement more than one (1) time
24  unless he has not participated in the prescription drug

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 1  assistance program for five (5) years or more. Person
 2  qualifying pursuant to paragraph (b)(i) of this section
 3  shall not pay the initial enrollment fee or continuing
 4  enrollment fees or the deductible. After the first three
 5  (3) months of eligibility, the following recipients shall
 6  be subject to the following monthly deductibles and
 7  copayment for prescription drugs, with the program paying
 8  the balance:

 9 

10              (i)  For a person found eligible under paragraph
11  (b)(i) of this section, the recipient shall not be required
12  to pay a deductible, but shall be required to pay a
13  copayment per prescription of ten dollars ($10.00) for
14  generic drugs and twenty-five dollars ($25.00) for brand
15  name drugs;

16 

17              (ii)  For a recipient found eligible under
18  paragraph (b)(ii) of this section, the recipient shall be
19  required to pay a deductible of one hundred dollars
20  ($100.00) each month, and a copayment per prescription of
21  ten dollars ($10.00) for generic drugs and twenty-five
22  dollars ($25.00) for brand name drugs;

23 

 

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 1              (iii)  For a recipient found eligible under
 2  paragraph (b)(iii) of this section, the recipient shall be
 3  required to pay a deductible of three hundred dollars
 4  ($300.00) each month, and a copayment per prescription of
 5  ten dollars ($10.00) for generic drugs and twenty-five
 6  dollars ($25.00) for brand name drugs;

 7 

 8              (iv)  For a recipient found eligible under
 9  paragraph (b)(iv) of this section, the recipient shall be
10  required to pay a deductible of six hundred dollars
11  ($600.00) each month, and a copayment per prescription of
12  ten dollars ($10.00) for generic drugs and twenty-five
13  dollars ($25.00) for brand name drugs.

14 

15         (e)  The department shall project costs of the program
16  created by this section at least quarterly and compare
17  those projected costs against the funds appropriated for
18  the program. If the funds available to the program are
19  insufficient to meet the projected costs of the program,
20  the department shall take action to prevent the program
21  from incurring costs beyond available funds, including
22  taking any of the following actions:

23 

 

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 1              (i)  Imposing a moratorium on new enrollments in
 2  the program;

 3 

 4              (ii)  Reducing the gross family income 
 5  eligibility levels specified in subsection (b) of this
 6  section;

 7 

 8              (iii)  Increasing the deductibles specified in
 9  subsection (c) of this section;

10 

11              (iv)  Imposing higher prescription drug
12  copayments;

13 

14              (v)  Eliminate individual drugs from eligibility
15  if the cost of the drug is not justified by its benefit;

16 

17              (vi)  Carry claims for payment into the next
18  biennium if the amount of claims are less than one
19  twenty-fourth (1/24) of the appropriation that has been
20  enacted for the next biennium.

21 

22         (f)  Only prescription drugs that are medically
23  necessary and cost effective are reimbursable under the
24  program created by this section. In determining which drugs

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 1  are reimbursable the department shall consult with the drug
 2  utilization review board for Wyoming established pursuant
 3  to Title XIX of the federal Social Security Act.

 4 

 5         Section 2.  There is appropriated three million two
 6  hundred thousand dollars ($3,200,000.00) from the general
 7  fund to the department of health for the fiscal year
 8  beginning July 1, 2001, to implement the purposes of this
 9  act. The department of health is authorized one (1) full-
10  time employee. There is appropriated three hundred twenty
11  thousand dollars ($320,000.00) from the general fund to the
12  department of family services for fiscal year beginning
13  July 1, 2001, to implement purposes of this act. The
14  department of family services is authorized four (4) full-
15  time and five (5) part-time employees.

16 

17         Section 3.  This act is effective immediately upon
18  completion of all acts necessary for a bill to become law
19  as provided by Article 4, Section 8 of the Wyoming
20  Constitution.

21 

22                         (END)

 

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