2008 Legislation
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HOUSE BILL NO. 509<br /> – Idaho Prescription Drug Program

HOUSE BILL NO. 509

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Bill Status



H0509.................................................by HEALTH AND WELFARE
PRESCRIPTION DRUG PROGRAM - Adds to existing law relating to prescription
drugs to provide a short title; to define terms; to create the Idaho
Prescription Drug Program; to provide a purpose; to provide for the
appointment of an administrator and to set forth duties; to provide for
program participants; to provide for terms of the program; to provide for
different reimbursement rates or prescription drug prices; to provide for
pharmacy enrollment in the program; to provide certain restrictions and
certain duties of the administrator; to provide for application and
participation in the program; to provide for program prescription drug
prices and identification cards; to provide for a best choice drug guide;
to create the Prescription Drug Purchasing Fund; to provide for
appropriations; to authorize the adoption of rules; and to provide for a
report.

02/11    House intro - 1st rdg - to printing
02/12    Rpt prt - to Health/Wel

Bill Text




                                                                       
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-ninth Legislature                   Second Regular Session - 2008

                                                                       

                              IN THE HOUSE OF REPRESENTATIVES

                                     HOUSE BILL NO. 509

                              BY HEALTH AND WELFARE COMMITTEE

  1                                        AN ACT
  2    RELATING TO PUBLIC ASSISTANCE AND THE IDAHO PRESCRIPTION DRUG PROGRAM;  AMEND-
  3        ING  TITLE  56, IDAHO CODE, BY THE ADDITION OF A NEW CHAPTER 14, TITLE 56,
  4        IDAHO CODE, TO PROVIDE A SHORT TITLE, TO DEFINE TERMS, TO CREATE THE IDAHO
  5        PRESCRIPTION DRUG PROGRAM AND  PROVIDE  A  PURPOSE,  TO  PROVIDE  FOR  THE
  6        APPOINTMENT  OF  AN  ADMINISTRATOR AND TO SET FORTH DUTIES, TO PROVIDE FOR
  7        PROGRAM  PARTICIPANTS, TO PROVIDE FOR TERMS OF THE PROGRAM, TO PROVIDE FOR
  8        DIFFERENT REIMBURSEMENT RATES OR PRESCRIPTION DRUG PRICES, TO PROVIDE  FOR
  9        PHARMACY  ENROLLMENT  IN  THE PROGRAM, TO PROVIDE CERTAIN RESTRICTIONS AND
 10        CERTAIN DUTIES OF THE ADMINISTRATOR, TO PROVIDE FOR APPLICATION  AND  PAR-
 11        TICIPATION IN THE PROGRAM, TO PROVIDE FOR PROGRAM PRESCRIPTION DRUG PRICES
 12        AND IDENTIFICATION CARDS, TO PROVIDE FOR A BEST CHOICE DRUG GUIDE, TO CRE-
 13        ATE  THE PRESCRIPTION DRUG PURCHASING FUND, TO PROVIDE FOR APPROPRIATIONS,
 14        TO AUTHORIZE THE ADOPTION OF RULES AND TO PROVIDE FOR A REPORT.

 15    Be It Enacted by the Legislature of the State of Idaho:

 16        SECTION 1.  That Title 56, Idaho Code, be, and the same is hereby  amended
 17    by  the addition thereto of a NEW CHAPTER, to be known and designated as Chap-
 18    ter 14, Title 56, Idaho Code, and to read as follows:

 19                                      CHAPTER 14
 20                           IDAHO PRESCRIPTION DRUG PROGRAM

 21        56-1401.  SHORT TITLE. This chapter shall be known and may be cited as the
 22    "Idaho Prescription Drug Program."

 23        56-1402.  DEFINITIONS. As used in this chapter:
 24        (1)  "Pharmacy benefit manager" means an entity that, in addition to being
 25    a prescription drug claims processor, negotiates and executes  contracts  with
 26    pharmacies, manages preferred drug lists, negotiates rebates with prescription
 27    drug  manufacturers  and serves as an intermediary between the Idaho prescrip-
 28    tion drug program, prescription drug manufacturers and pharmacies.
 29        (2)  "Prescription drug claims processor" means an entity  that  processes
 30    and pays prescription drug claims, adjudicates pharmacy claims, transmits pre-
 31    scription  drug  prices  and claims data between pharmacies and the Idaho pre-
 32    scription drug program and processes related payments to pharmacies.
 33        (3)  "Program price" means the  reimbursement rates and prescription  drug
 34    prices  established  by  the administrator of the Idaho prescription drug pro-
 35    gram.

 36        56-1403.  PROGRAM CREATED -- PURPOSE. The Idaho prescription drug  program
 37    is  hereby established in the Idaho department of health and welfare. The pur-
 38    pose of the program is to:
 39        (1)  Purchase prescription drugs or reimburse pharmacies for  prescription
 40    drugs in order to receive discounted prices and rebates;

                                       2

  1        (2)  Make prescription drugs available at the lowest possible cost to par-
  2    ticipants in the program; and
  3        (3)  Maintain  a list of prescription drugs recommended as the most effec-
  4    tive prescription drugs available at the best possible prices.

  5        56-1404.  APPOINTMENT OF ADMINISTRATOR --  DUTIES.  The  director  of  the
  6    department  of  health and welfare shall appoint an administrator of the Idaho
  7    prescription drug program. The administrator shall:
  8        (1)  Negotiate price discounts and rebates on prescription drugs with pre-
  9    scription drug manufacturers;
 10        (2)  Contract with a prescription drug claims processor or pharmacy  bene-
 11    fit manager to adjudicate pharmacy claims and transmit program prices to phar-
 12    macies;
 13        (3)  Determine  program  prices  and reimburse pharmacies for prescription
 14    drugs;
 15        (4)  Adopt and implement a best choice drug guide;
 16        (5)  Develop a system for  allocating  and  distributing  the  operational
 17    costs  of the program and any rebates obtained to participants of the program;
 18    and
 19        (6)  Cooperate with other states or regional consortia in  the  bulk  pur-
 20    chase of prescription drugs.

 21        56-1405.  PARTICIPANTS. The following individuals or entities may partici-
 22    pate in the program:
 23        (1)  Any city government or county government of this state;
 24        (2)  State  agencies  that  directly  or  indirectly purchase prescription
 25    drugs, including agencies that dispense prescription drugs directly to persons
 26    in state operated facilities;
 27        (3)  Residents of this state who are either uninsured or underinsured  for
 28    prescription drug coverage;
 29        (4)  Private entities;
 30        (5)  The state program that receives federal medicaid funds and is respon-
 31    sible for implementing the state's medical assistance program may not partici-
 32    pate in the program;
 33        (6)  Notwithstanding  the  provisions  of  subsection (3) of this section,
 34    individuals who are eligible for medicare part D  prescription  drug  coverage
 35    may participate in the program.

 36        56-1406.  TERMS  OF  THE PROGRAM. (1) The administrator may establish dif-
 37    ferent reimbursement rates or prescription drug prices for pharmacies in rural
 38    areas to maintain statewide access to the program.
 39        (2)  The administrator shall establish the  terms  and  conditions  for  a
 40    pharmacy  to  enroll  in  the  program. A licensed pharmacy that is willing to
 41    accept the terms and conditions established by the administrator may apply  to
 42    enroll in the program.
 43        (3)  Except as provided in subsection (4) of this section, the administra-
 44    tor may not:
 45        (a)  Establish  a  state  managed wholesale or retail drug distribution or
 46        dispensing system; or
 47        (b)  Require pharmacies to maintain or allocate separate  inventories  for
 48        prescription drugs dispensed through the program.
 49        (4)  The  administrator  shall  contract  with one (1) or more entities to
 50    provide the functions of a prescription drug claims processor. The administra-
 51    tor may also contract with one (1) or more of such entities or a pharmacy ben-
 52    efit manager to negotiate with prescription drug manufacturers  on  behalf  of

                                       3

  1    the administrator.

  2        56-1407.  APPLICATION AND PARTICIPATION IN IDAHO PRESCRIPTION DRUG PROGRAM
  3    -- PRESCRIPTION DRUG CHARGES. (1) An individual or entity described in section
  4    56-1405,  Idaho  Code, may apply to participate in the Idaho prescription drug
  5    program. Participants shall apply on an application provided by the department
  6    of health and welfare. Such application may be provided either  electronically
  7    through  the department's internet website, via telephone or on a paper appli-
  8    cation. The department may charge participants a nominal fee to participate in
  9    the program. The department shall issue  a  prescription  drug  identification
 10    card to participants of the program.
 11        (2)  The  department  of  health  and welfare shall provide a mechanism to
 12    calculate and transmit the program prices for prescription drugs  to  a  phar-
 13    macy.  The  pharmacy shall charge the participant the program price for a pre-
 14    scription drug.
 15        (3)  Prescription drug identification cards issued under this section must
 16    contain the information necessary for proper claims adjudication or  transmis-
 17    sion of price data.

 18        56-1408.  BEST  CHOICE DRUG GUIDE. The Idaho department of health and wel-
 19    fare shall develop and recommend a best  choice  drug  guide  that  identifies
 20    choices  of  prescription drugs within therapeutic classes for particular dis-
 21    eases and conditions, including generic alternatives, for  use  in  the  Idaho
 22    prescription  drug  program.  Recommendations  will be based on evidence-based
 23    evaluations on the effectiveness and safety of similar prescription drugs  and
 24    will include public testimony.

 25        56-1409.  PRESCRIPTION  DRUG  PURCHASING  FUND. The prescription drug pur-
 26    chasing fund is hereby established in the  state  treasury.  The  prescription
 27    drug  purchasing  fund shall consist of moneys appropriated to the fund by the
 28    legislature, moneys received by the department of health and welfare  for  the
 29    purposes  established  in this section in the form of gifts, grants, bequests,
 30    endowments or donations or as otherwise provided by law.  The  moneys  in  the
 31    prescription drug purchasing fund are continuously appropriated to the depart-
 32    ment  of  health  and welfare and shall be used to purchase prescription drugs
 33    and reimburse the department for the costs of  administering  the  Idaho  pre-
 34    scription  drug  program, including contracted services costs, computer costs,
 35    professional dispensing fees paid to retail pharmacies  and  other  reasonable
 36    program  costs. Moneys in the fund shall be invested by the state treasurer in
 37    the same manner as provided under section 67-1210, Idaho Code, with respect to
 38    other surplus or idle moneys in the state treasury.  Interest  earned  on  the
 39    investments shall be credited to the fund.

 40        56-1410.  RULES.  The  department  of  health and welfare shall promulgate
 41    rules to implement and administer this chapter. The rules shall  include,  but
 42    are not limited to, establishing procedures for:
 43        (1)  Issuing  prescription  drug  identification  cards to individuals and
 44    entities that participate in the Idaho prescription drug program; and
 45        (2)  Enrolling pharmacies in the program.

 46        56-1411.  REPORT. (1) Not later than October 30, 2008, the  department  of
 47    health  and welfare shall report to the joint finance-appropriations committee
 48    during the 2008 legislative interim regarding the department's preparations to
 49    implement the Idaho prescription drug program. Such report shall include,  but
 50    not be limited to:

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  1        (a)  The number of individuals and entities that the department expects to
  2        enroll  in  the  program and the number of persons for whom the department
  3        expects to purchase prescription drugs;
  4        (b)  How the department expects the program to  affect  prescription  drug
  5        prices for participants;
  6        (c)  The rules proposed or adopted by the department to implement the pro-
  7        gram;
  8        (d)  The feasibility and advisability of expanding the program; and
  9        (e)  A plan to expand the program if the department determines that expan-
 10        sion is feasible and advisable.
 11        (2)  Subject to available funding for the program, not later than November
 12    1, 2008, the department shall begin implementation of the program.

Statement of Purpose / Fiscal Impact



                       STATEMENT OF PURPOSE

                            RS 17847

This Act will establish the Idaho Prescription Drug Program
within the Idaho Department of Health and Welfare. Its purpose is
to provide those uninsured and underinsured with rates not
available to them but available to those in group plans to
purchase medications.  This program is expected to save an
average of 40-60 percent.



                          FISCAL IMPACT

We estimate that this program would cost $150,000 to pay for one
FTP and marketing. Funding would be from the recovery of monies
received from the Medicaid Fraud Unit specifically recovered from
pharmaceutical company charges found to be fraudulent. 




Contact
Name: Representative Sue Chew 
Phone: 208-332-1000
Representative Margaret Henbest


STATEMENT OF PURPOSE/FISCAL NOTE                      H 509