- Truly Agreed To and Finally Passed -

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

The current tax credit, under Section 135.095, sunsets as of December 31, 2001.

A three-year increase in Medicaid income limits is phased in. As of July 1, 2002, the income limits will be phased in at 80 percent; at 90 percent in 2003; and at 100 percent in 2004. The Department may apply for federal waivers (Sections 208.151).

The Commission for the Missouri Senior Rx Program is established, consisting of fifteen members. Members will serve staggered terms and may be reappointed. The Commission will establish guidelines and procedures for the Missouri Senior Rx Program. The Commission will have flexibility to redefine certain terms, such as "generic drugs" (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. The coverage of certain drugs is prohibited. Eligible individuals must be:

- Sixty-five or older without access to health insurance with a pharmacy benefit for at least six months prior to application (except for retirees);

- With household income at or below $12,000 for individuals and $17,000 for couples; or

- With household income between $12,001 and $17,000 for individuals and between $17,001 and $23,000 for couples.

The Commission may restrict income eligibility and must set and adjust coinsurance, deductibles, and enrollment fees at different amounts as cost control measures.

Medicaid participants are not eligible for this Program. This Program is a payer of last resort and is not an entitlement. If a senior carries coverage through another plan, then the senior may only receive certain benefits after meeting the deductible. Applicants must apply annually with certain proof provided. Participants will pay a forty percent coinsurance. Total annual expenditures for each participant may not exceed $5,000. The following minimum deductibles and enrollment fees apply for the initial year:

- 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;

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

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

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 operational by July 1, 2002. Open enrollment will be April 1 - May 30, 2002. As of 2004, open enrollment will be held January 1 through February twenty-eighth. 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).

The Division must negotiate with manufacturers for participation in the program. Certificates will be issued to participating pharmacists and will be in effect for at least one year and may be automatically renewed. Cancellation must be with sixty days notice. The Division will negotiate the amount of rebates annually. Rebates for all drugs will be fifteen percent of the average manufacturers' price. All rebates will be used toward refunding the program. 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 public or private agency created to assist and educate Missouri residents in accessing prescription drugs and serve as a pharmaceutical benefit resource. Purposes include providing one-stop shopping for information, targeting outreach, maintain a toll-free phone number, provide data to the state regarding the program (Section 208.568).

This act contains an emergency clause. This act will be reauthorized every four years.

This act is identical to CCS/SS/SCS/HS/HCS/HB 3 (2001 - Special).

ERIN MOTLEY