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Check current prescription coverage and price, including out-of-pocket prescription costs for UnitedHealthcare members at their selected pharmacy with the PreCheck MyScript tool on Link. Specifies that when annual limits on the costs incurred for eligible household members' prescription or non-prescription medications have been reached, and program pays 80% of the cost of all prescriptions (minus $2), any remaining amount will be paid by the member.” Removes requirement that the department seek to achieve an aggregate rebate amount from all agreements that is at least 6 percentage points higher than the percentage of the total Medicaid drug expenditures that the rebates would otherwise be under Section 1927 of the federal Social Security Act.
Prohibits a provider from prescribing, a pharmacy from billing, and the agency from reimbursing for brand name drugs if there are "equally effective generic equivalents available and if the generic equivalents are the least expensive." Establishes a Pharmacy and Therapeutics Committee to review recommendations regarding prior approval of prescription drugs.
Also requires the state to submit a Medicaid state plan amendment to allow pharmacies to refuse to fill Medicaid prescriptions for "beneficiaries who demonstrate a documented and continuous failure to pay co-payments in spite of their ability to make these payments", described as unpaid for six prescriptions or six months.
Authorizes the Department of Health and Social Services to create a PDL and to use other cost containment strategies including use of supplemental rebates from pharmaceutical manufacturers Drugs approved for the PDL will be selected based on clinical effectiveness, safety and costs.
Establishes a multi-agency bulk purchasing council; requires the creation and implementation of a Medicaid PDL; provides that "drugs not included on the preferred drug list shall be subject to prior authorization", with exceptions for mental health, HIV and cancer; mandates the state to "maximize expansion of prior authorization of prescription drugs under the medical assistance program beyond the 25 current categories of medications"; authorizes supplemental rebates from manufacturers; reduces dispensing fees from $5.17 to $4.26; increases co-pays to a sliding scale from $.50 (for Rx under $10) to $3.00 (for Rx over $50); sets ingredient reimbursement at AWP -12%, and makes other changes in pharmacy reimbursements for Medicaid.
Requires an annual report beginning in October 2003, on "costs incurred by pharmacies in the provision of prescription medications to Medicaid eligible recipients including, but not limited to, dispensing fee costs and drug acquisition costs." The study is to include an analysis of factors such as urban versus rural location, chain versus independent affiliation, total prescription volume, and Medicaid volume as a percent of the total volume.
Deletes a provision requiring that each report to the governor and the Legislative Research Commission by the cabinet include a research study on costs incurred by pharmacies in the provision of prescription medications to Medicaid-eligible recipients.
Authorizes the Department of Health and Human Resources "to negotiate and enter into agreements with pharmaceutical manufacturers for supplemental rebates for Medicaid reimbursable drugs." Authorizes the department to develop a preferred drug list and to implement a drug utilization review program to achieve "the most rational cost-effective medication therapy." Also affirms that "trade secrets, rebate amounts, percentage of rebate, manufacturer's pricing and supplemental rebates" remain confidential and not subject to public release.
This law requires the state, beginning on January 12, 2006, and concluding 15 calendar days later, to provide drug benefits to a Medicare-eligible person who is also ED Medication Less Than $2 A Pill in Wisconsin eligible for Medi-Cal prescription drug benefits and who is not able to obtain drug benefits from his or her prescription drug plan under the Medicare Program.
Under this interpretation of the law, any supplemental rebate negotiated by a state Medicaid program is a rebate "under this section" so that manufacturers do not have to extend such a rebate negotiated with one state Medicaid program to all Medicaid programs.
Also requires the state to enter "into a multistate purchasing pool, negotiate directly with manufacturers or labelers or contract with a pharmacy benefit manager for negotiated discounts or rebates for all prescription drugs under the medical assistance program in order to achieve the lowest available price for such drugs under such program." Includes proposed $1 million for start-up costs, to be effective January 2009.