A N A C T
RELATING TO THE PHARMACEUTICAL ASSISTANCE TO THE ELDERLY ACT
It is enacted by the General Assembly as follows:
SECTION 1. Section 42-66.2-3 of the General Laws in Chapter 42-66.2 entitled "Pharmaceutical Assistance to the Elderly Act" is hereby amended to read as follows:
42-66.2-3. Definitions -- As used in this chapter, unless the context requires otherwise:
(1) "Consumer" means any full-time resident of the state who fulfills the eligibility requirements set forth in section 42-66.2-5. Residence for purposes of this chapter shall be in accordance with the definitions and evidence standards set forth in section 17-1-3.1.
(2) "Contractor" means a third party or private vendor capable of administering a program of reimbursement for prescription drugs, and drug program eligibility administrative support as required by the director, the vendor to be determined through a competitive bid process in which the director awards a three (3) year contract for services.
(3) "Department" means the department of elderly affairs.
(4) "Director" means the director of the department of elderly affairs.
(5) "Drugs" and "eligible drugs" means insulin and shall mean noninjectable drugs which require a physician's prescription according to federal law and which are contained in the following American hospital formulary service pharmacologic-therapeutic classifications categories that have not been determined by the federal "drug efficacy and safety implementation (DESI) commission" to lack substantial evidence of effectiveness. Drugs and eligible drugs are limited to the following classification categories: cardiac drugs, hypotensive drugs, diuretics, anti-diabetic agents, insulin, disposable insulin syringes, vasodilators (cardiac indications only), anticoagulants, hemorreolgic agents, glaucoma drugs, drugs for the treatment of Parkinson's disease, antilipemic drugs and oral antineoplastic drugs and drugs for the treatment of asthma and other chronic respiratory diseases and prescription vitamin and mineral supplements for renal patients and drugs approved for the treatment of alzheimer's disease, drugs used for the treatment of depression, and those drugs approved for the treatment of urinary incontinence. ,anti-infectives, drugs used for the treatment of arthritis, and neuraminidase inhibiting drugs indicated for the treatment of influenza A and B.
(6) "Income" for the purposes of this chapter means the sum of federal adjusted gross income as defined in the Internal Revenue Code of the United States, and all nontaxable income including but not limited to, the amount of capital gains excluded from adjusted gross income, alimony, support money, nontaxable strike benefits, cash public assistance and relief (not including relief granted under this chapter), the gross amount of any pension or annuity (including Railroad Retirement Act benefits, all payments received under the federal Social Security Act, state unemployment insurance laws, and veterans' disability pensions), nontaxable interest received from the federal government or any of its instrumentalities, workers' compensation, and the gross amount of "loss of time" insurance. It does not include gifts from nongovernmental sources, or surplus foods or other relief in kind supplied by a public or private agency.
(7) "Pharmaceutical manufacturer" means any entity holding legal title to or possession of a national drug code number issued by the federal food and drug administration.
(8) "Pharmacy" means a pharmacy licensed by the state of Rhode Island and whose place of business is physically located within the state.
(9) "Pilot program contractor" means Blue Cross and Blue Shield of Rhode Island.
SECTION 2. Sections 42-66.2-4 and 42-66.2-5 of the General Laws in Chapter 42-66.2 entitled "Pharmaceutical Assistance to the Elderly Act" are hereby amended to read as follows:
42-66.2-4. Amount of payment. -- The state shall pay sixty percent (60%) the percentage rate of the maximum allowable amount per prescription as formulated in the contract, as of the date of purchase of the drug, between the contractor and participating pharmacies in accordance with the income eligibility and co-payment shares set forth in section 42-66.2-5. The pharmacy shall collect from the consumer forty percent (40%) the percentage rate of the maximum allowable amount per prescription as formulated in the contract, as of the date of the purchase of the drug, between the contractor and participating pharmacies in accordance with the income eligibility and co-payment shares set forth in section 42-66.2-5. Payment for eligible drugs pursuant to this chapter shall only apply to purchases made on or after October 1, 1985.
42-66.2-5. Persons eligible. -- (a) Persons eligible for assistance under the provisions of this section include: (1) any unmarried resident or married resident living separate and apart, of the state who is at least sixty-five (65) years of age. whose income for the calendar year immediately preceding the year in which assistance is sought does not exceed twelve thousand dollars ($12,000); and (2) any married resident of the state who is at least sixty-five (65) years of age and whose income for the calendar year immediately preceding the year in which assistance is sought hereunder when combined with any income of the person's spouse in the same year does not exceed fifteen thousand dollars ($15,000). State and consumer co-payment shares shall be determined as follows:
(1) for unmarried persons or married persons living separate and apart whose income for the calendar year immediately preceding the year in which assistance is sought is:
(i) less than fifteen thousand nine hundred and thirty-two dollars ($15,932) the state shall pay sixty percent (60%) of the cost of the prescriptions and the consumer shall pay forty percent (40%) of the cost of the prescriptions;
(ii) more than fifteen thousand nine hundred and thirty-two dollars ($15,932) and less than twenty thousand dollars ($20,000), the state shall pay thirty percent (30%) of the cost of prescription and the consumer shall pay seventy percent of the cost of prescriptions; and
(iii) more than twenty thousand dollars ($20,000) and less than thirty-five thousand dollars ($35,000), the state shall pay fifteen percent (15%) of the cost of prescriptions and the consumer shall pay eighty-five percent (85%) of the cost of prescriptions.
(2) for married persons whose income for the calendar year immediately preceding the year in which assistance is sought hereunder when combined with any income of the person's spouse in the same year is:
(i) nineteen thousand nine hundred and sixteen dollars ($19,916) or less, the state shall pay sixty percent (60%) of the cost of the prescriptions and the consumer shall pay forty percent (40%) of the cost of the prescriptions;
(ii) more than nineteen thousand nine hundred and sixteen dollars ($19,916) and less than twenty-five thousand dollars ($25,000), the state shall pay thirty percent (30%) of the cost of prescriptions and the consumer shall pay seventy percent of the cost of prescriptions; and
(iii) more than twenty-five thousand dollars ($25,000) and less than forty thousand dollars ($40,000), the state shall pay fifteen percent (15%) of the cost of prescriptions and the consumer shall pay eighty-five percent (85%) of the cost of prescriptions.
Eligibility may also be determined by using income data for the ninety (90) days prior to application for benefits and projecting that income on an annual basis. The income levels shall not include those sums of money expended for medical and pharmaceutical that exceed three percent (3%) of the applicant's annual income or three percent (3%) of the applicant's preceding ninety (90) day income computed on an annual basis.
(b) On July 1 of each year commencing in 1991, the maximum amount of allowable income for both unmarried and married residents set forth in subsection (a) shall be increased by a percentage equal to the percentage of the cost of living adjustment provided for social security recipients.
(c) Notwithstanding the foregoing provisions of this section, no person whose prescription drug expenses are paid or reimbursable, either in whole or in part, by any other plan of assistance or insurance is eligible for assistance under this section, until the person's prescription drug coverage is exhausted during a benefit year, and as provided in subsection (d).
(d) The fact that some of a person's prescription drug expenses are paid or reimbursable under the provisions of medicare, part B, shall not disqualify that person, if he or she is otherwise eligible, to receive assistance under this chapter. In those cases, the state shall pay sixty percent (60%) of the cost of those prescriptions for qualified drugs for which no payment or reimbursement is made by the federal government.
(e) Eligibility for receipt of any other benefit under any other provisions on the Rhode Island General Laws as a result of eligibility for the pharmaceutical assistance program authorized under this section shall be limited to those persons whose income qualify them for a sixty percent (60%) state co-payment share of the cost of prescriptions.
SECTION 3. This act shall take effect upon passage.