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Sponsors: Senators J. Verne Smith and Cromer
Document Path: l:\council\bills\nbd\11533ac05.doc
Introduced in the Senate on March 3, 2005
Currently residing in the Senate Committee on Finance
Summary: Pharmacy Assistance Act
HISTORY OF LEGISLATIVE ACTIONS
Date Body Action Description with journal page number ------------------------------------------------------------------------------- 3/3/2005 Senate Introduced and read first time SJ-5 3/3/2005 Senate Referred to Committee on Finance SJ-5 3/3/2005 Senate Referred to Subcommittee: Hayes (ch), Alexander, Land, Matthews, Grooms, Richardson
View the latest legislative information at the LPITS web site
VERSIONS OF THIS BILL
TO AMEND ARTICLE 5, CHAPTER 6, TITLE 44, OF THE CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO THE SOUTH CAROLINA RETIREES AND INDIVIDUALS POOLING TOGETHER FOR SAVINGS ACT (SCRIPTS), SO AS TO CHANGE THE NAME OF THIS ACT TO THE SOUTH CAROLINA PHARMACY ASSISTANCE ACT AND TO PROVIDE THAT THE SOUTH CAROLINA ASSISTANCE PROGRAM IS CREATED IN THE DEPARTMENT OF HEALTH AND HUMAN SERVICES; TO PROVIDE THAT THE PURPOSE OF THE PROGRAM IS TO COORDINATE WITH MEDICARE PART D TO PROVIDE TO LOW INCOME MEDICARE-ELIGIBLE STATE RESIDENTS ASSISTANCE WITH THE COST OF PRESCRIPTION DRUGS UNDER MEDICARE PART D; TO SPECIFY THAT AN ENROLLEE IS ENTITLED TO BENEFITS WHEN THE ENROLLEE'S ANNUAL DRUG EXPENSES REACH THE MEDICARE PART D ANNUAL COVERAGE LIMIT, THAT BENEFITS ARE LIMITED TO WHAT AN ENROLLEE'S MEDICARE PART D PLAN WOULD HAVE COVERED IF THE LIMIT HAD NOT BEEN REACHED, AND THAT BENEFITS TERMINATE WHEN THE ENROLLEE'S ANNUAL DRUG EXPENSES REACH THE MEDICARE PART D ANNUAL OUT-OF-POCKET THRESHOLD; TO PROVIDE THAT IF REVENUE IS GENERATED FOR THE PROGRAM FROM OTHER SOURCES, THIS ADDITIONAL REVENUE MUST BE USED TO MAKE PAYMENTS REQUIRED UNDER THE FEDERAL MEDICARE PRESCRIPTION DRUG IMPROVEMENT AND MODERNIZATION ACT OF 2003 AND TO FUND EXPANDED PROGRAM BENEFITS; TO AUTHORIZE THE DEPARTMENT TO MODIFY PROGRAM ELIGIBILITY CRITERIA AND BENEFIT LEVELS IF NECESSARY; TO AUTHORIZE THE DEPARTMENT TO AUTOMATICALLY ENROLL MEDICAID RECIPIENTS IN THE PROGRAM AND TO REQUIRE THE DEPARTMENT TO INFORM THESE ENROLLEES AS TO HOW THEY MAY WITHDRAW FROM THE PROGRAM; AND TO REPEAL CHAPTER 130, TITLE 44, RELATING TO THE SOUTH CAROLINA SENIORS' PRESCRIPTION DRUG PROGRAM ACT.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Article 5, Chapter 6, Title 44 of the 1976 Code is amended to read:
Section 44-6-610. This article may be cited as the 'South Carolina
Retirees and Individuals Pooling for Savings Pharmacy Assistance Act'.
Section 44-6-620. For purposes of this article:
(1) 'Department' means the Department of Health and Human Services.
(2) 'Prescription drugs' means outpatient prescription drugs
(a) have been approved
as safe and effective by the United States Food and Drug Administration; including insulin syringes, insulin needles, and insulin. 'Prescription drugs' do not include experimental drugs and over- the-counter pharmaceutical products
(b) are included in the enrollee's selected Medicare Part D Plan formulary; and
(c) are rebated to the department by the manufacturer at an amount equal to the rebate amount received by the department for the same drug when reimbursed through the Medicaid program.
(3) 'Program' means the South Carolina
Retirees and Individuals Pooling Together for Savings(SCRIPTS) Pharmacy Assistance program created pursuant to this article.
Section 44-6-630. There is created within the Department of Health and Human Services the South Carolina
Retirees and Individuals Pooling Together for Savings (SCRIPTS) Pharmacy Assistance Program. The program must combine the purchasing power of all South Carolina citizens sixty-five years of age and older who enroll in the program to reduce their prescription drug costs. Where possible, without violation of federal law, the department shall combine negotiating power for the program with negotiating power for pharmaceutical pricing and rebates which may exist now or in the future. The purpose of this program is to coordinate, beginning January 1, 2006, with Medicare Part D to provide to low-income, Medicare-eligible South Carolinians assistance with their prescription drug costs under Medicare Part D.
(A) This program must be administered by the Department of Health and Human Services. The department may designate, or enter into contracts with, other entities including, but not limited to, other states, other governmental purchasing pools, and nonprofit organizations to assist in the administration of this program.
(B) By December 30, 2003, the department must submit a program implementation and administration plan for review by the State Budget and Control Board. The plan must include:
(1) procedures for program enrollment;
(2) requirements for program participation; and
(3) annual program enrollment fees that must be calculated to pay all additional costs incurred by the department in the administration of the program.
(C) Upon review of the State Budget and Control Board, the program may be implemented as soon as practicable
(D) When requested by the department, other state agencies shall provide assistance or information necessary for the administration of this program.
To be eligible to receive benefits in this program a person must:
(1) be eligible for Medicare;
(2) reside in this State; and
(3) satisfy annual income and resource criteria established by the department.
A person eligible to participate in this program must:
(1) have attained the age of sixty-five years;
(2) have resided in South Carolina at least six consecutive months before enrolling in the program; and ;
(3) not be eligible for Medicaid prescription benefits.
(A) Program benefits may only be provided on prescription drugs as defined in this article.
(B) Beginning with the 2006 Calendar year, the department annually shall establish program benefits that, at a minimum:
(1) initiate when an enrollee's annual prescription drug expenses have reached the Medicare Part D annual coverage limit;
(2) are limited to the amount the enrollee's Medicare Part D plan would have covered if the annual coverage limit had not been reached; and
(3) terminate when the enrollee's annual prescription drug expenses have reached the Medicare Part D annual out-of-pocket threshold.
(C) Benefits may be tiered based on enrollee income.
(D) If a federally-approved South Carolina Medicare Part D plan offers prescription drug coverage that does not include an annual coverage limit, the department may expand program benefits to include an alternative benefit plan that functions in an economically equivalent manner as subsection (B).
(A) The department shall maintain data to allow evaluation of the cost effectiveness of the program.
(B) Beginning with the 2005 regular session of the General Assembly, no later than thirty days before the convening of each regular session, the department shall submit an annual report to the Governor, the chairman of the House Ways and Means Committee, and the Chairman of the Senate Finance Committee summarizing enrollment, financial information, and any other information needed to evaluate the costs and benefits of the program.
(A)(1) The department may explore all possibilities for the program to generate additional revenue. The department shall use all additional revenue to first, fund any payment required by the federal government pursuant to the Medicare Prescription Drug Improvement and Modernization Act of 2003, and second, to fund expanded program benefits. If the department determines that revenue may be generated, the department may modify the program eligibility criteria and benefit levels as necessary.
(2) The department may develop an expanded program if the department determines that:
(a) additional revenue may be generated through a contractual relationship with a federally-approved Medicare Part D plan;
(b) additional revenue projections are actuarially sound; and
(c) no federal or state law, regulation, or directive prohibits any action necessary to generate the additional revenue.
(3) If, at any time, the department is not able to generate additional revenue for the program, the department may restrict program eligibility criteria and benefit levels if the provisions of Section 44-6-650 continue to be met.
(B) The department automatically may enroll in the program individuals who are also enrolled in Medicaid or a Medicaid waiver program.
Section 44-6-670. (A) The department may seek waivers of any federal laws, regulations, or rules necessary to implement this program
(B) The department may promulgate regulations necessary for the administration of this program.
Section 44-6-680. The program must be funded entirely from annual enrollment fees collected from program participants."
SECTION 2. Chapter 130, Title 44 of the 1976 Code is repealed.
SECTION 3. This act takes effect upon approval by the Governor.
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