Chapter 416
2004 -- S 2864
SUBSTITUTE A AS AMENDED
Enacted 07/05/04
A N A C T
RELATING
TO STATE AFFAIRS AND GOVERNMENT -- GENERIC DRUGS
Introduced
By: Senators Paiva-Weed, Badeau, Pichardo, and Felag
Date
Introduced: February 11, 2004
It
is enacted by the General Assembly as follows:
SECTION
1. Section 40-8-24 of the General Laws in Chapter 40-8 entitled "Medical
Assistance"
is hereby amended to read as follows:
40-8-24.
Purpose. – Less expensive alternative medications. --
For pharmaceutical
purchases
eligible for reimbursement under the Medicaid state plan, the department shall
encourage
the substitution of generic drugs which are therapeutically equivalent and
interchangeable
with specific brand name drugs in accordance with section 21-31-16.1 and
related
regulations of the department of health, except in the event that a brand name
is
determined
by the director to be less costly to the state than the equivalent generic.
Calculation
of comparative drug costs shall include consideration of the amount paid by the
state
to
the pharmacy for a drug under the current retail pharmacy reimbursement
formula, less any
discounts
or rebates, including those paid pursuant to federal Medicaid law during the
previous
calendar
quarter, and inclusive of all dispensing fees.
(a)
The department of human services is directed to seek any waivers as described
by
section
40-8-24 required by the United States department of health and human services
to
establish,
subject to appropriation, a pharmacy assistance program, to be known as the
Healthy
Rhode
Island Pharmacy Program, for the purposes of providing prescription and
nonprescription
pharmaceuticals
at low cost to certain Rhode Island residents who are elderly or living with a
disabling
condition, as provided in this section.
(b) To enable the state of Rhode Island to maximize claims for federal
financial
participation
and pharmaceutical manufacturer rebates for the Healthy Rhode Island Pharmacy
Program,
the department is directed and authorized to seek the following waivers:
(1) The department shall submit to the United States department of health and
human
services
a waiver of otherwise applicable requirements of title XIX of the Federal
Social Security
Act
in order to claim federal financial participation for a pharmacy assistance
program for
residents
of the state who are sixty-five (65) years of age and over with incomes no
greater than
two
hundred percent (200%) of the federal poverty level. The Healthy Rhode Island
Pharmacy
Program
shall provide pharmacy assistance for any persons deemed eligible under the
waiver that
is
comparable to the pharmacy benefit provided to individuals eligible under the
Rhode Island
Medicaid
State Plan, to the extent that the cost-sharing and enrollment limitations
provided for in
subsection
(c) allow.
(2) The department shall submit to the United States department of health and
human
services
a waiver of otherwise applicable requirements of title XIX of the Federal
Social Security
Act
in order to claim federal financial participation for a pharmacy assistance
program for adult
residents
of the state who are either incapacitated and with incomes no greater than two
hundred
percent
(200%) of the federal poverty level; or severely and persistently mentally ill
and eligible
for
community support services through the department of mental health, retardation
and
hospitals;
and are deemed by the department to be ineligible for pharmacy assistance under
subdivision
(b)(1) of this section or under any other applicable sections of chapter 66.2
of title 42
and
otherwise unable to pay the costs for medically necessary prescription drugs
and medications.
The
Healthy Rhode Island Pharmacy Program shall provide pharmacy assistance for any
persons
deemed
eligible under the waiver that is comparable to the pharmacy benefits provided
to
individuals
eligible under the Medicaid State Plan to the extent any program requirements
established
by rule in accordance with subsection (c) allow.
(c) The department shall provide by rule for all other requirements of the
program,
including
cost-sharing and any enrollment limitations deemed necessary, as permitted by
an
approved
waiver. The department shall consult with the department of elderly affairs in
developing
the requests for the waivers as authorized and, to the greatest extent
practicable, shall
coordinate
implementation of the Health Rhode Island Pharmacy Program with the
administration
and
application process for determining eligibility and enrollment in the
pharmaceutical
assistance
program for the elderly set forth in chapter 66.2 of title 42.
(d) The caseloads and expenditures for the Healthy Rhode Island Pharmacy
Program
waivers
shall be determined by the caseload estimating conference in accordance with
the
provisions
of chapter 17 of title 35 for determining official estimates of medical
assistance
caseloads.
(e) Upon receipt of these waiver(s) from the United States department of health
and
human
services, the department of human services shall file with the house and senate
finance
committees
a report of the terms and conditions of these approved waiver(s) together with
a
detailed
plan for the implementation of them within the aggregate general revenue
appropriations
for
pharmacy benefits and administrative costs provided for in the enacted budget
for state fiscal
year
2003; and provided further that any reallocations of these general revenue
appropriations
between
or among departments and/or appropriation line items necessary to implement the
approved
waiver(s), and/or adjustments to federal revenue appropriations consistent with
these
wavier
approval(s), shall be submitted to the general assembly by the Governor in the
supplemental
appropriations act for state fiscal year 2003 in accordance with section
35-3-8.
SECTION
2. This act shall take effect upon passage.
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LC02647/SUB
A
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