BILL REQ. #:  S-1637.3 

Read first time 02/19/2003.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to prescription drug assistance programs for seniors; adding new sections to chapter 74.09 RCW; adding new sections to chapter 41.05 RCW; and creating new sections.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   The legislature finds that prescription drugs are an effective and important part of efforts to maintain and improve the health of Washington state residents. However, their increased cost and utilization is straining the resources of many people, particularly low-income elderly people who lack insurance coverage for such drugs. Furthermore, inappropriate use of prescription drugs can result in unnecessary expenditures and lead to serious health consequences. It is therefore the intent of the legislature to develop programs to provide prescription drugs at an affordable price to those in need, and increase public awareness regarding their safe and cost-effective use.

NEW SECTION.  Sec. 2   A new section is added to chapter 74.09 RCW to read as follows:
     (1) There is established a program to be known as the medicaid senior prescription drug program. Neither the benefits of, nor the eligibility for, the program is considered to be an entitlement. To the extent funds are appropriated specifically for this purpose, and subject to any conditions placed on appropriations made for this purpose, the department shall design and administer the medicaid senior prescription drug program.
     (2) The department is directed to obtain necessary federal waivers to implement the medicaid senior prescription drug program. Consistent with federal waiver conditions, the department may charge enrollment fees, premiums, or point-of-service cost-sharing to enrollees of the program.
     (3) Eligibility for this program is limited to persons: (a) Who are age sixty-five and older; (b) whose family income does not exceed one hundred fifty percent of the federal poverty level as adjusted for family size and determined annually by the federal department of health and human services; (c) who do not otherwise have insurance that provides prescription drug coverage; and (d) who otherwise are eligible under Title XIX and the state's federal prescription drug waiver program.
     (4) The department may use a cost-effective prescription drug benefit design. Consistent with federal waiver conditions, this benefit design can be different than the benefit design offered under the medical assistance program. The benefit design may include a deductible benefit that provides coverage when enrollees incur higher prescription drug costs as defined by the department. The department also may offer more than one benefit design.
     (5) The department may limit enrollment of persons who qualify for the program so as to prevent an overexpenditure of appropriations for this program or to assure necessary compliance with federal waiver budget neutrality requirements.
     (6) This program will be terminated within twelve months after implementation of a prescription drug benefit under Title XVIII of the social security act, or by June 30, 2009.

NEW SECTION.  Sec. 3   A new section is added to chapter 41.05 RCW to read as follows:
     (1) The health care authority shall implement a program whereby it negotiates with prescription drug manufacturers for price discounts, comparable to those negotiated for its preferred prescription drugs, to be available to any Washington resident:
     (a) Whose family income does not exceed two hundred fifty percent of the federal poverty level as adjusted for family size and determined annually by the federal department of health and human services;
     (b) Who does not otherwise have insurance that provides prescription drug coverage; and
     (c) Who is: (i) At least fifty-five years old; or (ii) between the ages of nineteen and fifty-four and otherwise eligible for benefits under Title II of the social security act, federal old age, survivors, and disability insurance benefits.
     (2) The administrator may charge participants in this program a reasonable annual enrollment fee to help offset the cost of program administration.
     (3) The price discounts available pursuant to this section shall not be at the expense of retail pharmacies.
     (4) This program will be terminated within twelve months after implementation of a prescription drug benefit under Title XVIII of the social security act, or by June 30, 2009.

NEW SECTION.  Sec. 4   A new section is added to chapter 41.05 RCW to read as follows:
     (1) The administrator shall establish and advertise a pharmacy connection program through which health care providers and members of the public can obtain information about manufacturer-sponsored prescription drug assistance programs. The administrator shall ensure that the program has staff available who can assist persons in procuring free or discounted medications from manufacturer-sponsored prescription drug assistance programs by:
     (a) Determining whether an assistance program is offered for the needed drug or drugs;
     (b) Evaluating the likelihood of a person obtaining drugs from an assistance program under the guidelines formulated;
     (c) Assisting persons with the application and enrollment in an assistance program;
     (d) Coordinating and assisting physicians and others authorized to prescribe medications with communications, including applications, made on behalf of a person to a participating manufacturer to obtain approval of the person in an assistance program; and
     (e) Working with participating manufacturers to simplify the system whereby eligible persons access drug assistance programs, including development of a single application form and uniform enrollment process.
     (2) Notice regarding the pharmacy connection program shall initially target senior citizens, but the program shall be available to anyone, and shall include a toll-free telephone number, available during regular business hours, that may be used to obtain information.
     (3) The administrator may apply for and accept grants or gifts and may enter into interagency agreements or contracts with other state agencies or private organizations to assist with the implementation of this program including, but not limited to, contracts, gifts, or grants from pharmaceutical manufacturers to assist with the direct costs of the program.
     (4) The administrator shall notify pharmaceutical companies doing business in Washington of the pharmacy connection program. Any pharmaceutical company that does business in this state and that offers a pharmaceutical assistance program shall notify the administrator of the existence of the program, the drugs covered by the program, and all information necessary to apply for assistance under the program.
     (5) For purposes of this section, "manufacturer-sponsored prescription drug assistance program" means a program offered by a pharmaceutical company through which the company provides a drug or drugs to eligible persons at no charge or at a reduced cost. The term does not include the provision of a drug as part of a clinical trial.

NEW SECTION.  Sec. 5   A new section is added to chapter 74.09 RCW to read as follows:
     Each of the state's area agencies on aging shall implement a program intended to inform and train persons sixty-five years and older in the safe and appropriate use of prescription and nonprescription medications. To further this purpose, the department shall award a development grant of no more than five thousand dollars to each of the agencies upon a showing that:
     (1) The agency has the ability to effectively administer such a program, including an understanding of the relevant issues and appropriate outreach and follow-up;
     (2) The agency can bring resources to the program in addition to those funded by the grant; and
     (3) The program will be a collaborative effort between the agency and other health care providers and programs in the location to be served, including doctors, pharmacists, and long-term care providers.

NEW SECTION.  Sec. 6   A new section is added to chapter 41.05 RCW to read as follows:
     The authority may adopt rules to implement this act.

NEW SECTION.  Sec. 7   By January 1, 2005, the administrator of the health care authority and the director of the department of social and health services shall submit to the governor and the legislature a progress report regarding the implementation of the programs created in this act.