SB 32/FN (BR 170) - R. Roeding, C. Borders, A. Robinson, D. Seum, J. Westwood
AN ACT relating to the Kentucky Senior Citizen Prescription Drug Assistance Act of 2002.
Create new sections of Subtitle 17B of KRS Chapter 304 to define "department," "eligible consumer," "eligible drug," "maintenance drug," "program," and "third-party administrator"; create the Kentucky Senior Citizen Prescription Drug Assistance Program, to be administered by the Department of Insurance with the services of a third-party administrator; provide that implementation will occur when funds are available; permit use of federal or appropriated Kentucky funds; provide that program may be superseded by federal law, and may otherwise be changed to conform to federal requirements for a senior prescription drug program; provide that certain Medicaid drug rebate funds not otherwise returned to the federal government or used for the Medicaid match may be used to fund the program; require the department to promulgate administrative regulations to implement the program and to work with the Revenue Cabinet on an income verification process; allow for use of electronic or "Smart Card" technology for tracking of copayments, electronic benefits transfer between the program and the pharmacy, and require compatibility with similar technology used by other state programs; provide for annual premium of $150 for gross family income of $20,000 or less, and for annual premium of $300 for gross family income of $20,001 to $30,000; provide for a copayment of 20%, or a maximum of $50, for each prescription filled or refilled; direct reimbursement to be made to a pharmacy or consumer for up to a 60 day supply of drugs; provide that a reimbursement shall be the usual and customary fee charged by the pharmacy, minus the copayment; permit the pharmacy to retain the copayment; require the copayment to be collected prior to dispensing the drug; require the department or third-party administrator to market the program; provide for enrollment during an annual 30 day period; allow persons turning 65 to have 6 months to enroll; require the department to consult with the Department for Medicaid Services or other state agencies for assistance with determining the most effective marketing approach and application and open enrollment processes; require the department to review data submitted by the third-party administrator to and project expenditures, make recommendations for inclusion of other drugs in the program, with priority given to cancer drugs, review and recommend changes, if appropriate to premiums, copayments, or eligibility criteria, and submit a report to the Governor and LRC summarizing demographics, utilization, and recommendations; establish standards for selection of a third-party administrator; require that the third-party administrator be selected through a competitive bidding process; provide that the contract period shall be for 4 years with an option for a 2 year extension; require the third-party administrator to develop policies for enrollment, eligibility determination, pharmacy benefits management, drug utilization, premium billing and collection, data reporting, and agent referral fees; require the third-party administrator to submit reports on the operating condition of the program to the department; require the third-party administrator to submit an annual report to the department on earned premium, administrative expenses, incurred and paid claims, and number of eligible consumers; and permit the third-party administrator to contract with a pharmacy benefits manager.
(Prefiled by the sponsor(s))
Jan 8-introduced in Senate
Jan 10-to Health and Welfare (S)