HB 0083A 2003
1	A bill to be entitled
2	An act relating to prescription drugs; amending s.
3	409.9065, F.S.; revising the pharmaceutical expense
4	assistance program for low-income elderly individuals;
5	adding eligibility groups; providing benefits; requiring
6	the Agency for Health Care Administration, in
7	administering the program, to collaborate with both the
8	Department of Elderly Affairs and the Department of
9	Children and Family Services; requiring federal approval
10	of benefits; creating s. 430.83, F.S.; providing a popular
11	name; providing definitions; providing legislative
12	findings and intent; creating the Sunshine for Seniors
13	Program to assist low-income seniors with obtaining
14	prescription drugs from manufacturers’ pharmaceutical
15	assistance programs; providing implementation and
16	oversight duties of the Department of Elderly Affairs;
17	providing for community partnerships; providing for
18	contracts; requiring annual evaluation reports on the
19	program; specifying that the program is not an
20	entitlement; providing for construction of the act in pari
21	materia with laws enacted during the 2003 Regular Session
22	of the Legislature; providing an effective date.
23
24	Be It Enacted by the Legislature of the State of Florida:
25
26	Section 1. Section 409.9065, Florida Statutes, is amended
27	to read:
28	409.9065 Pharmaceutical expense assistance.--
29	(1) PROGRAM ESTABLISHED.--There is established a program
30	to provide pharmaceutical expense assistance to eligiblecertain
31	low-income elderly individuals, which shall be known as the "Ron
32	Silver Senior Drug Program" and may be referred to as the
33	"Silver Lifesaver Program."
34	(2) ELIGIBILITY.--Eligibility for the program is limited
35	to those individuals who qualify for limited assistance under
36	the Florida Medicaid program as a result of being dually
37	eligible for both Medicare and Medicaid, but whose limited
38	assistance or Medicare coverage does not include any pharmacy
39	benefit. To the extent funds are appropriated, specifically
40	eligible individuals are individuals who:
41	(a) Are Florida residents age 65 and over;
42	(b) Have an income equal to or less than 200 percent of
43	the federal poverty level;:
44	1. Between 88 and 120 percent of the federal poverty
45	level;
46	2. Between 88 and 150 percent of the federal poverty level
47	if the Federal Government increases the federal Medicaid match
48	for persons between 100 and 150 percent of the federal poverty
49	level; or
50	3. Between 88 percent of the federal poverty level and a
51	level that can be supported with funds provided in the General
52	Appropriations Act for the program offered under this section
53	along with federal matching funds approved by the Federal
54	Government under a s. 1115 waiver. The agency is authorized to
55	submit and implement a federal waiver pursuant to this
56	subparagraph. The agency shall design a pharmacy benefit that
57	includes annual per-member benefit limits and cost-sharing
58	provisions and limits enrollment to available appropriations and
59	matching federal funds. Prior to implementing this program, the
60	agency must submit a budget amendment pursuant to chapter 216;
61	(c) Are eligible for both Medicare and Medicaid;
62	(d) Have exhausted pharmacy benefits under Medicare,
63	Medicaid, or any other insurance planAre not enrolled in a
64	Medicare health maintenance organization that provides a
65	pharmacy benefit; and
66	(e) Request to be enrolled in the program.
67	(3) BENEFITS.--Eligible individuals shall receive a
68	discount for prescription drugsMedications covered under the
69	pharmaceutical expense assistance program are those covered
70	under the Medicaid program in s. 409.906(20)(19). Monthly
71	benefit payments shall be limited to $80 per program
72	participant. Participants are required to make a 10-percent
73	coinsurance payment for each prescription purchased through this
74	program.
75	(a) Eligible individuals with incomes equal to or less
76	than 120 percent of the federal poverty level shall receive a
77	discount of 100 percent for the first $160 worth of prescription
78	drugs they receive each month, subject to copayments that the
79	agency requires on these benefits. For all other prescription
80	drugs received each month, eligible individuals shall receive a
81	discount of 50 percent.
82	(b) Eligible individuals with incomes of more than 120
83	percent but not more than 150 percent of the federal poverty
84	level shall receive a discount of 50 percent.
85	(c) Eligible individuals with incomes of more than 150
86	percent but not more than 175 percent of the federal poverty
87	level shall receive a discount of 41 percent.
88	(d) Eligible individuals with incomes of more than 175
89	percent but not more than 200 percent of the federal poverty
90	level shall receive a discount of 37 percent.
91	(4) ADMINISTRATION.--The pharmaceutical expense assistance
92	program shall be administered by the agency for Health Care
93	Administration, in collaborationconsultationwith the
94	Department of Elderly Affairs and the Department of Children and
95	Family Services.
96	(a) The Agency for Health Care Administration and the
97	Department of Elderly Affairs shall develop a single-page
98	application for the pharmaceutical expense assistance program.
99	(a)(b) The agency for Health Care Administrationshall, by
100	rule, establish for the pharmaceutical expense assistance
101	program eligibility requirements;, limits on participation;,
102	benefit limitations, including copayments;a requirement for
103	generic drug substitution;,and other program parameters
104	comparable to those of the Medicaid program. However, there
105	shall be no monetary limit on prescription drugs purchased with
106	discounts of less than 51 percent unless the agency determines
107	there is a risk of a funding shortfall in the program. If the
108	agency determines there is a risk of a funding shortfall, the
109	agency may establish monetary limits on prescription drugs which
110	shall not be less than $160 worth of prescription drugs per
111	month.
112	(b)(c) By January 1 of each year, the agency for Health
113	Care Administrationshall report to the Legislature on the
114	operation of the program. The report shall include information
115	on the number of individuals served, use rates, and expenditures
116	under the program. The report shall also address the impact of
117	the program on reducing unmet pharmaceutical drug needs among
118	the elderly and recommend programmatic changes.
119	(5) NONENTITLEMENT.--The pharmaceutical expense assistance
120	program established by this section is not an entitlement.
121	Enrollment levels are limited to those authorized by the
122	Legislature in the annual General Appropriations Act. If, after
123	establishing monetary limits as required by paragraph (4)(a),
124	funds are insufficient to serve all eligible individuals
125	eligible under subsection (2) andseeking coverage, the agency
126	may develop a waiting list based on application dates to use in
127	enrolling individuals in unfilled enrollment slots.
128	(6) PHARMACEUTICAL MANUFACTURER PARTICIPATION.--In order
129	for a drug product to be covered under Medicaid or this program,
130	the product's manufacturer shall:
131	(a) Provide a rebate to the state equal to the rebate
132	required by the Medicaid program; and
133	(b) Make the drug product available to the program for the
134	best price that the manufacturer makes the drug product
135	available in the Medicaid program.
136	(7) REIMBURSEMENT.--Totalreimbursements to pharmacies
137	participating in the pharmaceutical expense assistance program
138	established under this section shall be equivalent to
139	reimbursements under the Medicaid program.
140	(8) FEDERAL APPROVAL.--The benefits provided in this
141	section are limited to those approved by the Federal Government
142	pursuant to a Medicaid waiver or an amendment to the state
143	Medicaid plan.
144	Section 2. Section 430.83, Florida Statutes, is created to
145	read:
146	430.83 Sunshine for Seniors Program.--
147	(1) POPULAR NAME.--This section shall be known by the
148	popular name "The Sunshine for Seniors Act."
149	(2) DEFINITIONS.--As used in this section, the term:
150	(a) "Application assistance organization" means any
151	private organization that assists individuals with obtaining
152	prescription drugs through manufacturers’ pharmaceutical
153	assistance programs.
154	(b) "Eligible individual" means any individual who is 60
155	years of age or older who lacks adequate pharmaceutical
156	insurance coverage.
157	(c) "Manufacturers’ pharmaceutical assistance program"
158	means any program offered by a pharmaceutical manufacturer that
159	provides low-income individuals with prescription drugs free or
160	at reduced prices, including, but not limited to, senior
161	discount card programs and patient assistance programs.
162	(3) LEGISLATIVE FINDINGS AND INTENT.--The Legislature
163	finds that the pharmaceutical manufacturers, seeing a need, have
164	created charitable programs to aid low-income seniors with the
165	cost of prescription drugs. The Legislature also finds that many
166	low-income seniors are unaware of such programs or either do not
167	know how to apply for or need assistance in completing the
168	applications for such programs. Therefore, it is the intent of
169	the Legislature that the Department of Elderly Affairs, in
170	consultation with the Agency for Health Care Administration,
171	implement and oversee the Sunshine for Seniors Program to help
172	seniors in accessing manufacturers’ pharmaceutical assistance
173	programs.
174	(4) SUNSHINE FOR SENIORS PROGRAM.--There is established a
175	program to assist low-income seniors with obtaining prescription
176	drugs from manufacturers’ pharmaceutical assistance programs,
177	which shall be known as the "Sunshine for Seniors Program."
178	Implementation of the program is subject to the availability of
179	funding and any limitations or directions provided for by the
180	General Appropriations Act or chapter 216.
181	(5) IMPLEMENTATION AND OVERSIGHT DUTIES.--In implementing
182	and overseeing the Sunshine for Seniors Program, the Department
183	of Elderly Affairs:
184	(a) Shall promote the availability of manufacturers’
185	pharmaceutical assistance programs to eligible individuals with
186	various outreach initiatives.
187	(b) Shall, working cooperatively with pharmaceutical
188	manufacturers and consumer advocates, develop a uniform
189	application form, which shall be available in English, Spanish,
190	and Creole, to be completed by seniors who wish to participate
191	in the Sunshine for Seniors Program.
192	(c) May request proposals from application assistance
193	organizations to assist eligible individuals with obtaining
194	prescription drugs through manufacturers’ pharmaceutical
195	assistance programs.
196	(d) Shall train volunteers to help eligible individuals
197	fill out applications for the manufacturers’ pharmaceutical
198	assistance programs.
199	(e) Shall train volunteers to determine if applicants are
200	available for other state programs.
201	(f) Shall seek federal funds to help fund the Sunshine for
202	Seniors Program.
203	(g) May seek federal waivers to help fund the Sunshine for
204	Seniors Program.
205	(6) COMMUNITY PARTNERSHIPS.--The Department of Elderly
206	Affairs may build private-sector and public-sector partnerships
207	with corporations, hospitals, physicians, pharmacists,
208	foundations, volunteers, state agencies, community groups, area
209	agencies on aging, and any other entities that will further the
210	intent of this section. These community partnerships may also be
211	used to facilitate other pro bono benefits for eligible
212	individuals, including, but not limited to, medical, dental, and
213	prescription services.
214	(7) CONTRACTS.--The Department of Elderly Affairs may
215	select and contract with application assistance organizations to
216	assist eligible individuals in obtaining their prescription
217	drugs through the manufacturers’ pharmaceutical assistance
218	programs. If the department contracts with an application
219	assistance organization, the department shall evaluate quarterly
220	the performance of the application assistance organization to
221	ensure compliance with the contract and the quality of service
222	provided to eligible individuals.
223	(8) REPORTS AND EVALUATIONS.--By January 1 of each year,
224	while the Sunshine for Seniors Program is operating, the
225	Department of Elderly Affairs shall report to the Legislature
226	regarding the implementation and operation of the Sunshine for
227	Seniors Program.
228	(9) NONENTITLEMENT.--The Sunshine for Seniors Program
229	established by this section is not an entitlement. If funds are
230	insufficient to assist all eligible individuals, the Department
231	of Elderly Affairs may develop a waiting list prioritized by
232	application date.
233	Section 3. If any law amended by this act was also amended
234	by a law enacted at the 2003 Regular Session of the Legislature,
235	such laws shall be construed as if they had been enacted at the
236	same session of the Legislature, and full effect shall be given
237	to each if possible.
238	Section 4. This act shall take effect upon becoming a law.