FIRST REGULAR SESSION
93RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVES JOHNSON (47) (Sponsor) AND KRAUS (Co-sponsor).
Pre-filed December 3, 2004 and copies ordered printed.
STEPHEN S. DAVIS, Chief Clerk
AN ACT
To amend chapter 208, RSMo, by adding thereto seven new sections relating to the Missouri Rx card program, with an emergency clause.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 208, RSMo, is amended by adding thereto seven new sections, to be known as sections 208.585, 208.587, 208.589, 208.591, 208.593, 208.595, and 208.597, to read as follows:
208.585. 1. As used in sections 208.585 to 208.597, the following terms shall mean:
(1) "Department", the Missouri department of social services;
(2) "Director", the director of the Missouri department of social services;
(3) "Manufacturer", a manufacturer of prescription drugs, as defined in 42 U.S.C. Section 1396r-8(k)(5), including a subsidiary or affiliate of a manufacturer;
(4) "Participating retail pharmacy", a retail pharmacy or other business licensed to dispense prescription drugs in this state that participates in the state Medicaid program or voluntarily agrees to participate in the Missouri Rx card program;
(5) "Third-party administrator", a private party contracted to administer the Missouri Rx card program established in section 208.587 and whose duties may include, but are not limited to, devising applications, enrolling members, and administration of prescription drug benefits;
(6) "Wholesaler", a business licensed pursuant to chapter 338, RSMo, to distribute prescription drugs in this state.
208.587. 1. There is hereby established within the department of social services the "Missouri Rx Card Program" as a state pharmaceutical assistance program under 42 U.S.C. Section 1396r-8(c)(1)(C)(i)(III) to provide discounts to participants for drugs covered by a rebate agreement established in section 208.589. Using sums from negotiated rebates, the department shall contract with wholesalers or participating retail pharmacies to deliver discounted prices to the Missouri Rx card participants.
2. The drug discounts received by Missouri Rx card participants shall be calculated by the director on a quarterly basis. Such calculation shall provide discounts approximately equal to the amount of the negotiated drug rebate minus an amount to cover the reasonable administrative costs of the Missouri Rx card program.
3. Except as otherwise provided for in subsection 4 of this section, any person who is a resident of this state and is eligible for participation in the Medicare program or has a net family income below three hundred percent of the federal poverty level is eligible to participate in the Missouri Rx card program.
4. A person shall be ineligible to participate in the Missouri Rx card program if such person is eligible for assistance under the state's Medicaid program or is covered by an insurance policy that provides benefits for prescription drugs equal to or greater than the benefits provided under the Missouri Rx card program, as delineated by rules promulgated by the department.
5. The department shall establish simple procedures for enrolling Missouri Rx card participants and shall implement outreach efforts to increase public awareness of the program and maximize enrollment by eligible residents.
6. The department shall solicit requests for proposals from private contractors for the third-party administration of the program.
7. Administration of the program shall include, but not be limited to, devising program applications, enrolling participants, and administration of prescription drug benefits. The department shall select a responsive cost-effective bid from the requests for proposals; except that, if no responsive cost-effective bids are received, the program shall be administered by the department of social services.
208.589. 1. The director shall negotiate discount prices or rebates for prescription drugs from drug manufacturers and labelers. A drug manufacturer or labeler that sells prescription drugs in this state may voluntarily elect to negotiate:
(1) Rebates for the Medicaid program over and above those required under 42 U.S.C. Section 1396r-8;
(2) Discount prices or rebates for the Missouri Rx card program; and
(3) Discount prices or rebates for any other state program that pays for or acquires prescription drugs.
2. In negotiating rebate terms, the director shall take into consideration:
(1) The rebate calculated under the Medicaid rebate program pursuant to 42 U.S.C. Section 1396r-8;
(2) The price provided to eligible entities under 42 U.S.C. Section 256b; and
(3) Any other available information on prescription drug prices, discounts, and rebates.
3. (1) The director shall initiate a review of whether to place a manufacturer's or labeler's products on the prior authorization list for the state Medicaid program and take similar actions involving prior authorization or formularies for any other state-funded or operated prescription drug program if:
(a) The director and a drug manufacturer or labeler fail to reach agreement on the terms of a supplemental Medicaid rebate or a discount or rebate for the Missouri Rx card program; and
(b) The discounts or rebates offered by the manufacturer or labeler are not as favorable to the state as the prices provided to eligible entities under 42 U.S.C. Section 256b.
(2) Any prior authorization shall meet the requirements of 42 U.S.C. Section 1396r-8(d)(5) and this chapter. The director shall promulgate rules establishing clear procedures for the implementation of this section.
(3) The names of manufacturers and labelers that do not enter into rebate agreements are public information. The department shall release such information to the public and actively distribute such information to its physicians, pharmacists, and other health care professionals.
208.591. The department may require prior authorization of pharmaceutical products. Any such restriction may be based on medical and clinical criteria, Missouri-specific data, or the manufacturer's refusal to participate in the Missouri Rx card program.
208.593. 1. The department shall adopt rules requiring disclosure by participating retail pharmacies to the Missouri Rx card program participants of the amount of savings provided as a result of the program. Such rules shall protect information that is proprietary in nature.
2. A participating retail pharmacy shall verify to the department the amounts charged to Missouri Rx card program participants, and shall provide the department with utilization data necessary to calculate rebates from manufacturers and labelers. The department shall protect the confidentiality of all information subject to confidentiality protection under state or federal law, rule, or regulation. The department shall not impose transaction charges on wholesalers or participating retail pharmacies that submit claims or receive payments under the program.
3. Participating retail pharmacies shall be reimbursed by the department on a bimonthly basis, including a dispensing fee that does not exceed seventy-five percent of the Medicaid dispensing fee.
208.595. 1. The department shall report the enrollment and financial status of the Missouri Rx card program to the general assembly by February first of each year.
2. The director may combine drug pricing negotiations to maximize drug rebates if the director finds that it is beneficial to both the Missouri Rx card program and another state program, including the state Medicaid program.
3. The department shall adopt rules to implement the provisions of sections 208.585 to 208.597. No rule or portion of a rule shall become effective unless it has been promulgated pursuant to the provisions of chapter 536, RSMo.
4. The department may seek waivers of federal law, rule, or regulation necessary to implement the provisions of sections 208.585 to 208.597.
208.597. Discounts to participants in the Missouri Rx card program shall begin by July 1, 2005.
Section B. Because immediate action is necessary to provide adequate pharmaceutical treatment for the residents of this state section A of this act is deemed necessary for the immediate preservation of the public health, welfare, peace, and safety, and is hereby declared to be an emergency act within the meaning of the constitution, and section A of this act shall be in full force and effect upon its passage and approval.