The Florida Senate

409.9065  Pharmaceutical expense assistance.--

(1)  PROGRAM ESTABLISHED.--There is established a program to provide pharmaceutical expense assistance to certain low-income elderly individuals, which shall be known as the "Ron Silver Senior Drug Program."

(2)  ELIGIBILITY.--Eligibility for the program is limited to those individuals who qualify for limited assistance under the Florida Medicaid program as a result of being dually eligible for both Medicare and Medicaid, but whose limited assistance or Medicare coverage does not include any pharmacy benefit. To the extent funds are appropriated, specifically eligible individuals are individuals who:

(a)  Are Florida residents age 65 and over;

(b)  Have an income:

1.  Between 88 and 120 percent of the federal poverty level;

2.  Between 88 and 150 percent of the federal poverty level if the Federal Government increases the federal Medicaid match for persons between 100 and 150 percent of the federal poverty level; or

3.  Between 88 percent of the federal poverty level and a level that can be supported with funds provided in the General Appropriations Act for the program offered under this section along with federal matching funds approved by the Federal Government under a s. 1115 waiver. The agency is authorized to submit and implement a federal waiver pursuant to this subparagraph. The agency shall design a pharmacy benefit that includes annual per-member benefit limits and cost-sharing provisions and limits enrollment to available appropriations and matching federal funds. Prior to implementing this program, the agency must submit a budget amendment pursuant to chapter 216;

(c)  Are eligible for both Medicare and Medicaid;

(d)  Are not enrolled in a Medicare health maintenance organization that provides a pharmacy benefit; and

(e)  Request to be enrolled in the program.

(3)  BENEFITS.--Medications covered under the pharmaceutical expense assistance program are those covered under the Medicaid program in s. 409.906(19). Monthly benefit payments shall be limited to $80 per program participant. Participants are required to make a 10-percent coinsurance payment for each prescription purchased through this program.

(4)  ADMINISTRATION.--The pharmaceutical expense assistance program shall be administered by the Agency for Health Care Administration, in consultation with the Department of Elderly Affairs.

(a)  The Agency for Health Care Administration and the Department of Elderly Affairs shall develop a single-page application for the pharmaceutical expense assistance program.

(b)  The Agency for Health Care Administration shall, by rule, establish for the pharmaceutical expense assistance program eligibility requirements, limits on participation, benefit limitations, a requirement for generic drug substitution, and other program parameters comparable to those of the Medicaid program.

(c)  By January 1 of each year, the Agency for Health Care Administration shall report to the Legislature on the operation of the program. The report shall include information on the number of individuals served, use rates, and expenditures under the program. The report shall also address the impact of the program on reducing unmet pharmaceutical drug needs among the elderly and recommend programmatic changes.

(5)  NONENTITLEMENT.--The pharmaceutical expense assistance program established by this section is not an entitlement. Enrollment levels are limited to those authorized by the Legislature in the annual General Appropriations Act. If funds are insufficient to serve all individuals eligible under subsection (2) and seeking coverage, the agency may develop a waiting list based on application dates to use in enrolling individuals in unfilled enrollment slots.

(6)  PHARMACEUTICAL MANUFACTURER PARTICIPATION.--In order for a drug product to be covered under Medicaid or this program, the product's manufacturer shall:

(a)  Provide a rebate to the state equal to the rebate required by the Medicaid program; and

(b)  Make the drug product available to the program for the best price that the manufacturer makes the drug product available in the Medicaid program.

(7)  REIMBURSEMENT.--Reimbursements to pharmacies participating in the pharmaceutical expense assistance program established under this section shall be equivalent to reimbursements under the Medicaid program.

History.--s. 2, ch. 2000-254; s. 5, ch. 2001-377; s. 20, ch. 2002-400.