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.

(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. Specifically eligible are low-income senior citizens who:

(a)  Are Florida residents age 65 and over;

(b)  Have an income between 90 and 120 percent of the federal poverty level;

(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(20). 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.

(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.