Chapter 499

2007 -- S 0593 SUBSTITUTE A

Enacted 10/30/07

A N A C T

RELATING TO INSURANCE - THE RHODE ISLAND BEST RX PROGRAM

Introduced By: Senators Moura, Perry, Paiva-Weed, and Maselli

Date Introduced: February 15, 2007

It is enacted by the General Assembly as follows:

     SECTION 1. The title of Chapter 66.2.1 of the General Laws entitled “PRESCRIPTION

DRUG DISCOUNT PROGRAM FOR THE UNINSURED” is hereby amended to read as

follows: RHODE ISLAND BEST RX PRESCRIPTION DRUG DISCOUNT PROGRAM FOR

THE UNINSURED

     SECTION 2. Sections 42-66.2.1-1, 42-66.2.1-2, 42-66.2.1-3 and 42-66.2.1-5 of the

General Laws in Chapter 42-66.2.1 entitled "Prescription Drug Discount Program for the

Uninsured" are hereby amended to read as follows:

42-66.2.1-1. Short title. -- This act shall be called the "Rhode Island Best Rx

Prescription Drug Discount Program for the Uninsured."

42-66.2.1-2. Discount drug program. -- The departments of human services and elderly

affairs shall develop a prescription drug discount program for the uninsured to be implemented on

or before March 15, 2005, and the department of elderly affairs shall issue a request for proposal

to entities for the management of the discount program. Once the bid has been awarded to a

contractor, the contract may be modified as necessary and appropriate to achieve the purpose of

the program at any time, with the agreement of all parties.

42-66.2.1-3. Program eligibility. -- (a) Persons who are residents of this state between

nineteen (19) and sixty-five (65) years of age and have an annual family income at or below two

hundred percent (200%) of the federal poverty level, and are uninsured for prescription drugs

shall be eligible for the prescription drug discount program offered under the provisions of this

chapter. Persons who are residents of this state and:

(i) are over the age of sixty (60) and are ineligible for Medicare Part D; or

(ii) receive Social Security Disability Insurance benefits; or

(iii) subject to subsection (b), are uninsured for prescription drugs and have an annual

family income at or below three hundred percent (300%) of the federal poverty level, shall be

eligible for the prescription drug discount program offered under the provisions of this chapter.

      (b) Persons eligible shall not include an individual who is eligible, or has been eligible

for the four (4) months prior to the application for the drug discount program offered under the

provisions of this chapter, for outpatient prescription drug coverage under a health benefits

program, other than a worker’s compensation program, paid for in whole or in part by an

employer, Medicaid, Medicare, or another state or federal health plan or pharmaceutical

assistance program that uses state or federal funds to pay part or all of the individual's

prescription drug costs. This provision shall not apply to individuals who become uninsured due

to a layoff or sponsored health plan bankruptcy.

(c) An individual or a household member acting on behalf of an individual may establish

eligibility by self-certification of the criteria established in subsections (a) and (b), and

prospective enrollees shall be informed of the penalties for making false statements on a

government application. The contractor shall facilitate distribution of information needed to

make self-certification application and may provide for enrollment using telephone, Internet and

such other means as are likely to reach prospective enrollees, including use of volunteers and

community based outreach.

42-66.2.1-5. Reporting requirements. -- The departments of human services and elderly

affairs shall issue a report on April 15, 2005 to the joint legislative committee on health care

oversight on the status of the prescription drug discount program design and implementation.

regularly publish information on the number of enrollees, and the number of prescriptions filled

under the program, and ensure timely availability to the public of the drug prices payable by

enrollees and the percentage savings off the usual and customary charge reflected by such prices.

     SECTION 3. Chapter 42-66.2.1 entitled "Prescription Drug Discount Program for the

Uninsured" is hereby amended by adding thereto the following sections:

42-66.2.1-4. 1 Annual enrollment fee Discount agreements. – (a) The contractor shall

be authorized to negotiate and enter into agreements with manufacturers and pharmacies to

provide discounts on prescription drugs. In general, the contractor shall seek discounts from

pharmacies and manufacturers that are comparable to those available under health plans that

provide pharmacy benefits to employees of state and local government entities.

(b) The departments of human services and elderly affairs, in consultation with the

contractor, shall establish maximum prices to be charged an enrollee, and the contractor shall

establish and publicize special value prices where it has established a significant discount on a

generic drug or where a drug’s manufacturer has agreed to subsidize discounts by making

quarterly rebate payments. The contractor shall establish any arrangements for compensating

pharmacies where the prices payable by enrollees have been reduced using manufacturer rebates,

and for collecting administrative fees paid by enrollees to pharmacies. The contractor shall

establish arrangements for facilitating application by Best Rx enrollees to patient assistance

programs offered by participating manufacturers.

(c) Pharmacy dispensing fees shall be uniformly established in advance at an amount that

shall not exceed two dollars and fifty cents ($2.50) per prescription, and shall be paid directly to

the pharmacy by the program beneficiaries.

42-66.2.1-6. Administrative fees. – The departments of human services and elderly

affairs shall ensure that administrative fees imposed by means of subsection (a) or (b), are

sufficient to cover all expenses related to the management of the discount program, and shall

periodically revise any arrangements under this section in order to maximize enrollment and to

minimize the price paid by enrollees for prescriptions.

(a) Per prescription administrative fees paid by the enrollee shall be established as follows:

(i) for the first twenty thousand (20,000) prescriptions filled for program beneficiaries, two

dollars ($2.00) per prescription; (ii) for the next twenty thousand (20,000) prescriptions filled

for program beneficiaries, one dollar and fifty cents ($1.50) per prescription; (iii) for the next

twenty thousand (20,000) prescriptions filled for program beneficiaries, one dollar ($1.00)

per prescription; (iv) after the initial sixty thousand (60,000) prescriptions are filled, the

Rhode Island Best Rx Program Advisory commission, established in section 42-66.2.1-6

below, shall advise the departments regarding an appropriate per prescription administrative

fee, which shall not exceed one dollar ($1.00} per prescription.

(b)Any authority for the contractor to retain a share of manufacturer rebates to defray

administrative expenses shall be subject to a quarterly review and revision based on reconciliation

of aggregate rebates received and administrative costs in excess of fees established under

subsection (a).

(c) The departments of human services and elderly affairs shall seek to minimize the

diversion of rebates to pay administrative costs, and shall phase out all such use of rebates as soon

as feasible, in order to ensure that rebates are passed through to enrollees for whom a drug is

prescribed.

(d) Department of Human Services—Powers—The department of human services is

authorized to promulgate rules and regulations for the administration of this chapter and to further

its purposes.

42-66.2.1-7. Advisory Commission. – (a) There is hereby established the Rhode Island

Best Rx Program Advisory Commission. The Commission shall be responsible for the

marketing, education and promotion of the Rhode Island Best Rx Discount Program for the

Uninsured and shall set administrative fees as required under section 42-66.2.1-5 and otherwise

advise the General Assembly on the operation of the Rhode Island Best Rx Discount Program for

the Uninsured.

(b) The advisory commission shall have the following composition: (i) a representative of

organized labor appointed by the president of the Rhode Island AFL-CIO; (ii) a representative of

the Alliance for Retired Americans appointed by the executive director; (iii) a representative of

the American Association of Retired Persons appointed by the executive director; (iv) a

representative of retail pharmacists licensed and operating in the state of Rhode Island, as

appointed by the Rhode Island Pharmacists Association; (v) three (3) representatives of the

research-based pharmaceutical manufacturers; (vi) the speaker of the house or his or her

designee; (vii) the president of the senate or his or her designee; (viii) the Director of the

Department of Human Services, or his or her designee; and (ix) the Director of the Department of

Elderly Affairs, or his or her designee.

(c) The speaker of the house or his or her designee, and the president of the senate or his

or her designee, shall co-chair the advisory commission, and the commission shall meet at the call

of the chair, but no less frequently than once per year.

(d) Commission members in subsections (i) through (iv) herein shall be appointed as

above and shall serve such terms as may be designated by their respective constituencies and

shall receive no compensation for their service.

(e) The director or designated representative of the department of human services and the

department of elderly affairs shall be non-voting ex-officio members of the advisory commission.

(f) A quorum for consideration of business is no fewer than five (5) voting members

present. Recommendations and action of the council shall be adopted by a two-thirds (2/3)

majority, and no minority action shall be authorized.

     SECTION 4. Section 42-66.2.1-4 of the General Laws in Chapter 42-66.2.1 entitled

"Prescription Drug Discount Program for the Uninsured" is hereby repealed.

42-66.2.1-4. Annual enrollment fee. -- There shall be an annual enrollment fee sufficient

to cover all expenses related to the management of the discount program and shall not exceed

thirty dollars ($30.00) per year. Pharmacy dispensing fees shall be uniformly established in

advance, and paid directly to the pharmacy by the program beneficiaries.

     SECTION 5. This act shall take effect on July 1, 2007.

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LC02106/SUB A

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