HB 433

1	A bill to be entitled
2	An act relating to the purchasing of Medicaid prescribed
3	drugs; amending s. 409.908, F.S.; requiring providers of
4	Medicaid prescribed drugs to give purchasing preference to
5	drugs manufactured or repackaged at certain facilities;
6	creating s. 499.01205, F.S.; defining the term "qualifying
7	facility"; providing for the Department of Health's
8	recognition of a qualifying facility; requiring the
9	department to adopt procedures and criteria for the
10	recognition of a qualifying facility; providing an
11	effective date.
12
13	Be It Enacted by the Legislature of the State of Florida:
14
15	Section 1.  Subsection (14) of section 409.908, Florida
16	Statutes, is amended to read:
17	409.908  Reimbursement of Medicaid providers.--Subject to
18	specific appropriations, the agency shall reimburse Medicaid
19	providers, in accordance with state and federal law, according
20	to methodologies set forth in the rules of the agency and in
21	policy manuals and handbooks incorporated by reference therein.
22	These methodologies may include fee schedules, reimbursement
23	methods based on cost reporting, negotiated fees, competitive
24	bidding pursuant to s. 287.057, and other mechanisms the agency
25	considers efficient and effective for purchasing services or
26	goods on behalf of recipients. If a provider is reimbursed based
27	on cost reporting and submits a cost report late and that cost
28	report would have been used to set a lower reimbursement rate
29	for a rate semester, then the provider's rate for that semester
30	shall be retroactively calculated using the new cost report, and
31	full payment at the recalculated rate shall be effected
32	retroactively. Medicare-granted extensions for filing cost
33	reports, if applicable, shall also apply to Medicaid cost
34	reports. Payment for Medicaid compensable services made on
35	behalf of Medicaid eligible persons is subject to the
36	availability of moneys and any limitations or directions
37	provided for in the General Appropriations Act or chapter 216.
38	Further, nothing in this section shall be construed to prevent
39	or limit the agency from adjusting fees, reimbursement rates,
40	lengths of stay, number of visits, or number of services, or
41	making any other adjustments necessary to comply with the
42	availability of moneys and any limitations or directions
43	provided for in the General Appropriations Act, provided the
44	adjustment is consistent with legislative intent.
45	(14)  A provider of prescribed drugs shall be reimbursed
46	the least of the amount billed by the provider, the provider's
47	usual and customary charge, or the Medicaid maximum allowable
48	fee established by the agency, plus a dispensing fee. The
49	Medicaid maximum allowable fee for ingredient cost will be based
50	on the lower of: average wholesale price (AWP) minus 16.4
51	percent, wholesaler acquisition cost (WAC) plus 4.75 percent,
52	the federal upper limit (FUL), the state maximum allowable cost
53	(SMAC), or the usual and customary (UAC) charge billed by the
54	provider. Medicaid providers are required to dispense generic
55	drugs if available at lower cost and the agency has not
56	determined that the branded product is more cost-effective,
57	unless the prescriber has requested and received approval to
58	require the branded product. The agency is directed to implement
59	a variable dispensing fee for payments for prescribed medicines
60	while ensuring continued access for Medicaid recipients. The
61	variable dispensing fee may be based upon, but not limited to,
62	either or both the volume of prescriptions dispensed by a
63	specific pharmacy provider, the volume of prescriptions
64	dispensed to an individual recipient, and dispensing of
65	preferred-drug-list products. The agency may increase the
66	pharmacy dispensing fee authorized by statute and in the annual
67	General Appropriations Act by $0.50 for the dispensing of a
68	Medicaid preferred-drug-list product and reduce the pharmacy
69	dispensing fee by $0.50 for the dispensing of a Medicaid product
70	that is not included on the preferred drug list. The agency may
71	establish a supplemental pharmaceutical dispensing fee to be
72	paid to providers returning unused unit-dose packaged
73	medications to stock and crediting the Medicaid program for the
74	ingredient cost of those medications if the ingredient costs to
75	be credited exceed the value of the supplemental dispensing fee.
76	The agency is authorized to limit reimbursement for prescribed
77	medicine in order to comply with any limitations or directions
78	provided for in the General Appropriations Act, which may
79	include implementing a prospective or concurrent utilization
80	review program. A provider of prescribed drugs must give
81	preference in the purchasing of Medicaid prescribed drugs,
82	including generic drugs, to those manufactured or repackaged at
83	a qualifying facility located in this state and recognized by
84	the Department of Health under s. 499.01205.
85	Section 2.  Section 499.01205, Florida Statutes, is created
86	to read:
87	499.01205  Recognition of qualifying facility for Medicaid
88	purchasing preference.--
89	(1)  As used in this section, the term "qualifying
90	facility" means a new or expanding facility located in this
91	state at which prescription drugs are manufactured or
92	repackaged.
93	(2)  A permittee that manufactures or repackages
94	prescription drugs at a qualifying facility may apply to the
95	department for recognition of the facility. The department shall
96	adopt rules prescribing the application form, procedures, and
97	criteria for recognition of a qualifying facility. A permittee,
98	upon the department's recognition of the qualifying facility, is
99	eligible for the Medicaid purchasing preference provided in s.
100	409.908(14).
101	Section 3.  This act shall take effect July 1, 2009.

CODING: Words stricken are deletions; words underlined are additions.