Report Title:
Rx Plus; Prescription Drug Program
Description:
Changes the name of the Rx program to Rx plus; adds new definitions of "covered drugs", "participating retail pharmacy", and "qualified resident"; establishes requirements to determine qualified residents; requires department of human services to conduct ongoing quality assurance activities; clarifies consequences applicable to nonparticipating manufacturers.
HOUSE OF REPRESENTATIVES |
H.B. NO. |
2005 |
TWENTY-SECOND LEGISLATURE, 2004 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to prescription drugs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Section 346-311, Hawaii Revised Statutes, is amended by adding three new definitions to be appropriately inserted and to read as follows:
""Covered drugs" means drugs that are on Hawaii's medicaid preferred drug list established and revised from time to time by the department pursuant to its authority to operate the State's medicaid program.
"Participating retail pharmacy" or "retail pharmacy" means a retail pharmacy located in this State, or another business licensed to dispense prescription drugs in this State, that participates in the program.
"Qualified resident" means a resident of the State who has a family income equal to or less than three hundred fifty per cent of the federal poverty level and who is enrolled in the program. This includes a resident of the State whose family incurs unreimbursed expenses for prescription drugs that equal five per cent or more of family income or whose total unreimbursed medical expenses equal fifteen per cent or more of family income. For purposes of this definition, the cost of drugs provided under this part is considered an expense incurred by the family for eligibility determination purposes."
SECTION 2. Section 346-311, Hawaii Revised Statutes, is amended by amending the definition of "program" to read as follows:
""Program" means the Rx plus program except as otherwise provided."
SECTION 3. Section 346-312, Hawaii Revised Statutes, is amended to read as follows:
"[[]§346-312[]] Rx plus program. (a) There is established within the department, the Rx plus program. The program will combine the purchasing power of all [persons] qualified residents to enable the State to take steps to reduce prescription drug costs and to improve the quality of health care for [those in the group] qualified Hawaii residents in the program, thereby increasing the overall health of Hawaii residents, promoting healthy communities, and protecting the public health and welfare, and to integrate the program as part of any statewide or federal program for the uninsured.
(b) The program shall utilize manufacturer rebates and pharmacy discounts to reduce prescription drug prices.
(c) The department may administer the program or contract with a third party or third parties in accordance with chapter 103F to administer any single component, or combination of components of the program including outreach, eligibility, claims, administration, rebate negotiations and recovery, and redistribution.
(d) The department shall conduct ongoing quality assurance activities similar to those used in the medicaid program."
SECTION 4. Section 346-313, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:
"(a) All qualified residents of the State shall be eligible to participate in the Rx plus program.
(b) The department:
(1) Shall establish procedures [for determining] to verify eligibility and shall issue program enrollment cards to eligible qualified residents;
(2) Shall undertake outreach efforts to build public awareness of the program and maximize the enrollment of eligible qualified residents; and
(3) May adjust the requirements and terms of the program by rule to accommodate any federally funded or authorized prescription drug program."
SECTION 5. Section 346-314, Hawaii Revised Statutes, is amended to read as follows:
"[[]§346-314[]] Rebate agreement. (a) Any prescription drug manufacturer that sells prescription drugs in the State may enter into a rebate agreement with the department for the Rx [access] plus program. The rebate agreement shall require the manufacturer to make rebate payments to the State each calendar quarter or according to a schedule established by the department.
(b) The administrator shall negotiate the amount of the rebate required from a manufacturer[.] in accordance with this part.
(c) The administrator shall take into consideration the rebate calculated under the medicaid rebate program pursuant to 42 United States Code section 1369r-8, the average wholesale price of prescription drugs, and any other information on prescription drug prices and price discounts.
(d) The administrator of the Rx plus program shall use the administrator's best efforts to obtain an initial rebate amount equal to or greater than the rebate calculated under the medicaid program pursuant to 42 United States Code section 1369r-8.
(e) With respect to rebates effective January 1, 2005, the administrator shall use the administrator's best efforts to obtain a rebate amount equal to or greater than the amount of any discount, rebate, or price reduction for prescription drugs provided to the federal government."
SECTION 6. Section 346-315, Hawaii Revised Statutes, is amended to read as follows:
"[[]§346-315[]] Nonparticipating manufacturers. [If the department and a drug manufacturer fail to reach agreement on the terms of a rebate, the department shall conduct a review of whether to place that manufacturer's products on the prior authorization list or formularies for the state Medicaid program in accordance with this chapter.] (a) The [department may release the] names of manufacturers [that] who do not enter into rebate agreements[. This information shall be deemed] pursuant to this part are public information.
(b) The department or administrator may also provide to [doctors, pharmacists, and other health professionals] health care providers information about the relative cost of drugs produced by manufacturers that enter into rebate agreements compared to the cost of drugs produced by those that do not enter into rebate agreements. The department shall adopt rules under chapter 91 creating procedures for the implementation of this section."
SECTION 7. Section 346-316, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:
"(a) Each retail pharmacy participating in the Rx plus program shall [discount the price of] sell drugs covered [by the program and sold] to [program participants.] qualified residents at such discounted prices as are determined by the department pursuant to this part.
(b) The department shall establish discounts for drugs covered by a rebate agreement and shall promote the use of efficacious and reduced-cost drugs, taking into consideration:
(1) Reduced prices for state and federally capped drug programs;
(2) [Dispensing] Differential dispensing fees; and
(3) Administrative costs of the department[; and
(4) The average of all rebates provided pursuant to section 346-314, weighted by sales of drugs subject to those rebates over the most recent twelve-month period for which the information is available]."
SECTION 8. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 9. This Act shall take effect upon its approval.
INTRODUCED BY: |
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