- Committee -

SCS/SBs 4, 1, 5, & 6 - This act creates the Missouri Senior Rx Program to provide pharmaceutical assistance for seniors.

A revised prescription drug tax credit it contingently reenacted if the Missouri Senior Rx Program is not fully operational by December 31, 2002. The term "fully operational" will be defined by the Commission established in 208.553.

The current tax credit, under section 135.095, sunsets as of December 31, 2001. Section 135.094 maintains the $200 credit and defines "claimant" and "income" with the definition for Missouri's current circuit breaker law (Section 135.010). The income limits remain at $15,000 and the phase-out is removed. Claimant couples must be Missouri residents and must apply for their own credit. No claimant who meets Medicaid eligibility requirements or who has pharmaceutical benefits through another policy may be eligible for the tax credit. However, if a person's pharmaceutical expenses exceed coverage limits, then that person may qualify for the credit for the additional expenses. A provision is added for each claim to be accompanied by proof of pharmaceutical expenses. The Department of Social Services must develop methods for verification. This credit may not be claimed after the 2002 tax year or any tax year during which an equivalent pharmaceutical benefits program is implemented (Section 135.094).

The Commission for the Missouri Senior Rx Program is established, consisting of thirteen members. The Commission will establish guidelines and procedures for the Missouri Senior Rx Program (Sections 208.550 - 208.553).

The Missouri Senior Rx Program is established within the Division of Aging. The Commission must solicit requests for proposal from private contractors for administration of the Program and for an insurance-based program to provide prescription drug coverage to eligible seniors. Eligible individuals must be:

- 65 or older without access to health insurance with a pharmacy benefit for at least six months prior to application;

- with household income at or below $12,000 for individuals and $17,000 for couples.

- a second tier of income levels at or below $17,000 for individuals and $23,000 for couples is allowed, but it is subject to appropriations and must be fully funded. The first tier income levels must be given priority.

Medicaid participants are not eligible for this Program. This Program is a payer of last resort. If a senior carries coverage through another plan, then the senior may only receive certain benefits after meeting the deductible. Applicants must apply annually and prove age, residence, and household income.

Participants will pay a forty percent coinsurance and the following deductibles and enrollment fees:

FIRST TIER:

- Individual with income at or below $12,000 will pay a $250 deductible and a $25 enrollment fee;

- Couples with income at or below $17,000 will pay a $250 deductible and a $25 enrollment fee per person;

SECOND TIER, IF FUNDS ALLOW:

- Individual with income between $12,001 and $17,000 will pay a $500 deductible and a $35 enrollment;

- Couples with income between $17,001 and $23,000 will pay a $500 deductible and a $35 enrollment fee per person.

Total expenditures for an enrollee may be up to $5000.

The Commission must submit quarterly reports to the General Assembly, the Governor, and the Division. If program costs exceed funds, then the Commission may implement cost control measures. If a federal program is established, the state program will cover additional costs only (Section 208.556).

The Program must be fully operational by July 1, 2002. Open enrollment will be April 1 - May 30, 2002. As of 2004, open enrollment will be held November 1 through December 15. Other enrollment periods may apply for some (Section 208.559).

Generic drugs must be used when available, unless requested otherwise. Pharmacists in the Program will be reimbursed at specific levels based on whether the drug is generic or brand (Section 208.562).

Certificates will be issued to participating pharmacists. The Division will negotiate the amount of rebates annually. Rebates for brand name drugs will be fifteen percent of the average manufacturers' price (AMP) and generic drugs will be eleven percent of the AMP. A pharmaceutical manufacturer's refusal to participate will not affect its Medicaid status. A prohibition on drug formulary restrictions is included. False information and confidentiality provisions are also included (Section 208.565).

The "Missouri Senior Rx Fund" is established to receive all moneys received by the Program (Section 208.568).

The "Missouri Senior Rx Clearinghouse" is established within the Commission. The Commission must submit requests for proposal for the private administration of the Clearinghouse. This may be the same administrator of the Program. The Clearinghouse will be a quasi-public agency created to assist and educate Missouri residents in accessing prescription drugs and serve as a pharmaceutical benefit resource. Purposes include promoting competition, scaling existing programs, providing meaningful assistance through discounts and subsidies, and integrating subsidy programs into the mainstream (Section 208.568).

This act contains an emergency clause and a contingent effective date for a certain section.

Portions of this act are similar to HB 3 (2001 - Special).

ERIN MOTLEY