Source: http://www.ncsl.org/research/health/archive-notes-history-for-state-pharmaceutical.aspx
Timestamp: 2014-03-08 11:43:54
Document Index: 349528274

Matched Legal Cases: ['art 2', '§15', 'Art 4', '§256', '§25', 'art 1', '§ 271', '§ 11', '§ 19', '§ 42', '§ 409', '§38', '§2693', '§ 7', '§ 7', '§173']

Archive: Notes+History for State Pharmaceutical Assistance Programs
Back Archive Notes History for State Pharmaceutical
NCSL Health Program State Pharmaceutical Assistance Programs, part 2 - APPENDIX: Historical Notes and Archives Updated June 2011
NCSL's published online report, State Pharmaceutical Assistance Programs, 2010 edition, describes current state programs and laws designed to assist residents in buying or obtaining their prescription drugs. It includes state-by-state listings and descriptions of both state subsidy programs (often called "SPAPs") and state pharmaceutical discount programs. For the latest information, use the online edition at: www.ncsl.org/programs/health/drugaid.htm.
This APPENDIX to State Pharmaceutical Assistance Programs includes only:
1. Archive listings of former programs and enacted programs that never became operational. The laws creating the listed programs may or may not remain in state statute.
2. Legislative and statistical notes on state programs, including laws that changed program designs and examples of funding and eligibility from recent years.
Program data is detailed within two Tables:
Table #1H: HISTORY: Non-operational State Subsidy Programs - provides brief details on each of the individual state programs, including citations and web links to state laws where available, year of creation, basic eligibility requirements and contact telephone numbers within each state for further details. Also see further explanations and notes in Recent Major State Actions, below.
Table #2H: HISTORY: Non-operational State Discount Programs - Includes state-negotiated price reductions, discount cards and multi-agency purchase arrangements affecting segments of the public. Note that several states have more than one program.
NON-OPERATIONAL & FORMER STATE SUBSIDY PROGRAMS - Table 1H
* = incl. disabled
age & maximum income (year) See note below about FPL
Year / law citation
dates of operation **
Alaska "SeniorCare Rx" Pharmaceutical Assistance Program
(4/30/04)
Income: Single:
$16,815 a year.
Couple: $23,419
(150% of AK federal poverty, '04)
signed by governor as Act 3, 3/5/04
Began 5/04; closed 12/31/05 & replaced by Senior Care benefit, [See Main Report]
Prescription Medication Coverage Pilot Program
(on-line description) also see Discounts, Table 2H
Minimum age: Medicare eligible only
Income: $17,720
(must reside in a county without HMO prescription drug coverage available)
(no funds appropriated for 2002-03; statute expired 10/1/03)
Medicare Co-payment Program
Estimated eligible: 87,000 (9/2006)
State resident Medicaid-Medicare dual-eligibles; Annual income up to 200% FPL; individual = $20,800; 2-persons = $28,000 (2008 rate). Medicare Part D enrollment is required but separate state enrollment in the co-payment plan is not required.
HB 2863 of 2006, signed as Chapter 344, 6/21/06 - FY 2006-2007 budget bill includes $1.5 million appropriations
Program was terminated February 1, 2009 due to budget shortfalls.
Arizona Health Care Cost Containment System (AHCCCS) Toll-free: 1-800-654-8713
http://azahcccs.gov
Prescription Drug Access Improvement Act (Medicaid waiver for prescription drug coverage)
Income: 90% of FPL ($7,974 in 2002), increasing to 100% FPL ($9,310 for 2004) after 6/30/03. (would provide benefit of 2 Rx per month, only after federal approval is received)
2001: S.932
(signed by Governor 4/16/01)
Not operational; not funded
Silver SaveRx Formally, Ron Silver Senior Drug Program/ Prescription Affordability Act
(Also see discounts, Table 2H below)
46,312 (2005)
Minimum age: 65 and
Dually-Eligible Medicare-Medicaid
Law: Individual: $18,620
Married: $24,980 (88%-200% of FPL, 2/2004)
Operational '05:
120% of FPL
Subsidy program began 1/1/01; (Ended 12/31/05 when Medicare Part D was implemented)
Enrollment has been closed for several years.
This limited eligibility "high risk pool" served only persons denied health coverage elsewhere. It was approved by CMS as a "Qualified SPAP."
No longer qualified as of 2008.
None enrolled.
Residents age 65 and over or disabled with annual income up to 100% of FPL (Hawaii's special poverty guideline is $12,540 for individuals in 2011.) 2005: SB 802, signed on 7/8/05 as Act 209.
Program is not operational; the start date is not established.
Policy information only: (808) 692-8134
Senior Pharmacy Assistance Program
2005 final: 4,898 (6/05)
Single: 135% of poverty =$12,919 (2005)
(law allows up to 200% of poverty if funded. Expanded in '03-see notes.
Copayment: 30%; maximum reimbursement: $1,200 per person. (6/03)
(signed 5/28/03)
Program terminated 12/31/05
began 7/1/2001
785 296-4986
Medicare-Medicaid dual eligible Copayment plan
Medicaid dual-eligibles under 135% of federal poverty level. Medicaid will pay the $1 to $5 Rx copayments.
Kansas Medicaid agency
Not operational. The terms of this limited benefit were first reported by NASMD in November 2006.
Kentucky Pharmaceutical Assistance Program n/a *
Minimum age: 65, or disabled, Medicare eligible
Income: 150% FPL (single: $14,355; couple: $19,245)
Medicare wrap-around design. (2005)
SB 23 signed as
Chapter 136 3/18/05
Not yet operational -
enrollment 10/1/05
to begin 2006 but delayed
Louisiana Seniors Pharmacy Assistance Program
Income: $9,570
(100% federal poverty)
(signed 7/1/03)
Subsidy not operational- not funded for '04-06
Dept of Health & Hospitals
Maryland Maryland Pharmacy Assistance Program
(on-line description)
51,287 *
Minimum age: 19 and over
Single: $11,112 Married: $12,840 (approx 116% FPL; 10/05)
Disabled: yes No limitation by age or medical condition; asset limit is less than $4,000 for a single person
1979 Health-General §15-124 2003
HB 17 (effective 7/1/03)
Not operational; replaced by another Rx program.
Sec. Of Health & Mental Hygiene
410 767-5394
1-800-492-1974
Michigan Elder Prescription Insurance Coverage (EPIC) Program
7,600 in Medicare (10/04)
Single: $18,620 (200% FPL)
Married: $24,980
For 45 day emergency coverage (150% FPL) Single: $13,470
Married: $18,180
In operation 10/01
Program ended 12/31/06
Michigan Michigan Emergency Pharmaceutical Program for Seniors (MEPPS)
Single: $12,885/yr. (2001)
Married: $17,415/yr.
Monthly drug expenses of at least 10% of monthly income for singles.
1988 &
Program ended 9/30/01 (enrollees given priority to enter EPIC program and eligible for benefits 12/01/01)
Michigan Prescription Drug Credit Program
31,000 est.
Single: $12,885
Family: $17,415
(150% FPL) Tax credit up to $600 for prescriptions over 5% of household income
Program ended 12/31/01, (recipients were rolled over into EPIC)
7,600 (11/04)
Minimum age: 65 or disabled of any age
Single: $11,172/yr
Married: $14,988/yr ('04)
(120% FPL) liquid assets under $10,000 or $18,000 couple
1997 -chapter 225, Art 4 [statute §256.955]
651 297-5404
In effect Jan. 1999; terminated Jan, 2006
Missouri Missouri Senior Rx Program
13,787(8/26/05)
Minimum age: 65+
Single: $17,000
Couple: $23,000 Co-pay = 40% ; $250-500 deductible, depending on income. Application fee $25-35 /year.
HB 3 & SB 4
signed 10/5/01
Begun 7/1/02
Program ended; Replaced by MoRx, (see 2007 list)
on 1/1/06 Info: 866-556-9316
Medicare-Medicaid dual-eligible Copayment plan
Medicaid dual-eligibles under 135% of federal poverty.Medicaid will pay the $1 to $5 Rx copayments.
Nebraska Medicaid agency
Not operational.The terms of this limited benefit were first reported by NASMD's November 2006 report.
Minimum age: 65 or disabled.
Income: 150% FPL = $14,355 individual
Couple: $19,245
Must be enrolled in Medicare Rx plan; only Rx not covered by Medicare.
2005: SB 163, now Ch. 294 of 2005, 7/26/05
Not yet operational. NH Office of Medicaid Business and Policy is 603-271-5254
New Mexico Prescription Drug Waiver Program
Single: 185% FPL = $17,223 (2004)
Couple: $23,106 ('04)
Not operational federal waiver not approved
North Carolina N.C. Rx
Estimated 50,000 eligible
Minimum age: 65 Single: $17,150 (175% FPL)
Couple: $23,100
Medicare premium wrap around only. No direct Rx payments.
NC Rx is no longer enrolling or accepting applications (2011). Web site: www.ncrx.gov;
For consumer assistance, call 1-888-488-6279
Single: $13,290 (2002)
For persons diagnosed with heart disease (CVD) or diabetes.
1999 - H 168 [Part XI, Chapter 237 of 1999] web link
Began operation May 2000 -
919 715-3338
NC Care Line: 800-662-7030
North Carolina North Carolina Senior Care Health Plan
126,000 (7/05)
Single: $18,620
Married: $24,980 (2004)
(by law, up to 200% FPL)
For persons diagnosed with heart disease (CVD), COPD, or diabetes. $600 annual limit.
2001 Decision
Benefits began 11/02
919 733-2040; (Ended 12/31/05 when Medicare Part D began)
Senior Prescription Drug Assistance Program (Also see discounts, Table 2H below)
Max. income: 185% FPL
Single: $17,704
Couple: $23,735 (2005)
Max. assets of $2000; Annual benefit cap of $2000; max. subsidy of 50% per prescription. Cost of card: $50 annually.
(signed July 30, 2001)
Not Operational; never funded
South Carolina SilveRxCard -
Seniors' Prescription Drug Program (Also see discounts, Table 2H below)
(08/20/05)
Single: $18,620 Married: $24,980 (2/04)
Requires $500 /yr. Deductible & $10-$21 copayments
H.3699
Act 406 of 2000
(Chapter 130) 5/19/00
Began 1/1/2001
(Closed 12/31/05 replaced by GAPS)
GAPS - Gap Assistance Prescription Program For Seniors
12,000 as of 7/2007
Minimum age: 65, with annual income up to 200% FPL ($20,420 for individual). Must be enrolled in Medicare Part D plan, must select one of 17 specified PDPs that are participating in GAPS (2007).
2005: HB 3716 - Sec. 8-J02 Signed into law 6/26/05. Operational 1/1/06. 100% state funded.
Effective July 1, 2010, GAPS is no longer available. Toll-Free: 1-888-549-0820; (803) 898-2865; Office of Insurance Services (803) 734-1061
TennCare Rx program
Eligibility: "individuals lacking Rx insurance coverage" -details to be specified
(signed 6/13/03)
State Prescription Drug Program
Eligibility: Medicare dual-eligibles and others; upper limit to be determined by Commission
HB 1094 (signed 6/15/01)
Never enacted due to lack of funds.
Senior Citizens Affairs Pharmaceutical Assistance Program
listed by CMS as a qualified SPAP as of 11/8/05
Pharmacy Plus subsidy plan
(requires HHS waiver, not currently approved)
Couple: $24,980 (200% of poverty, 2004)
(signed 6/26/03)
Not yet operational; waiver withdrawn
Washington Medicare Copayment plan
Through 6/06, $1.722 million spent on 873,127 claims. Medicaid dual-eligibles under 150% of federal poverty.
2006: SB 6386 and signed by the Governor on March 31.
Funded through June 30, 2007.
* = program design includes adult disabled
** = dates of operation for new programs are based on statute; actual implementation schedules may vary based on agency administrative practices.
NON-OPERATIONAL STATE PHARMACEUTICAL DISCOUNT PROGRAMS - TABLE 2H
In almost half the states, programs created in the past ten years provide for a reduced or discounted retail price for eligible participants, but do not provide a state subsidy for the purchase of prescription drugs. In several states, discount programs have been added to or integrated with subsidy programs - see related details in chart one above. In several other states, such as Arkansas, Connecticut, Massachusetts and Texas, program features have not yet been established or implemented. This list does not include Medicare-endorsed discount cards created strictly under federal law. Other cost-related programs and proposals, including multi-state projects, inter-agency purchasing, coordination of industry charity programs, evaluating pharmaceutical advertising, and regulating commercial discount cards, are listed separately - see NCSL Pharmaceutical Reports menu page. State Discount
age & maximum income (year)
Year / law citation or authority
Arizona Drug Discount Program
15,030 *
(est. 600,000 eligible)
Medicare enrollees, 65 and over or disabled. discounts only
$9.95 enrollment fee.
EO #2003-3
Began 6/1/03.
Replaced by CoppeRx effective 1/1/2006
Arkansas Rx Program
Age 65 & over, no income limit
Under 65, up to $33,480 Medicare Part D or Medicaid are excluded.
(350% of FPL)
HB 1241; Act 538, Signed 3/3/05
Not operational;
Never implemented due to lack of interest; web site open 8/1/06; Benefit goal: open early 2007 DHHS in-state toll-free:
866-695-6508
California Discount Prescription Drug Program
An estimated 5,000,000 residents could be eligible.
All residents up to 300% of FPL or with Rx costs 10%+ of annual income.
signed as Chapter 619 of '06
Not yet operational;
Golden Bear State Pharmacy Assistance Program
(revised structure for Discount Program, above)
Medicare recipients, 65 or disabled;
(Requires negotiated manufacturer rebates to achieve larger discounts)
916-657-1280
Colorado Cares Rx
40 enrolled, 12/08. Estimated 250,000 may be eligible.
State residents of all ages; must not have health insurance and not be eligible for Medicaid or SCHIP, with maximum annual income up to 300% FPL
2007: SB 07-001, signed 2/1/2007. (CRS §25.5-2.5)
Senate Bill 132, repealed the program. It passed the Senate 2/23/09. [article]
Connecticut ConnPACE part "B"
Not specified in law
Public Act 00-2),
Not operational; never implemented
AccessRx program
None enrolled. Uninsured residents (no age restrictions) with a household income not more than 350 percent of the federal poverty level—$35,735 for an individual; $47,915 for couples. Low-income seniors with annual income up to 200 percent of the federal poverty level — $20,420 for individuals and $27,380 for couples (2007 rate). Bill 15-569 signed 3/25/2004
Enacted in 2004, it is not operational.
(also see subsidy, Table 1H, above)
n/a * enroll-ment not required
Any Medicare beneficiary, no age or income limit.
Discounts based on Average Wholesale Price minus 9% + $4.50 dispensing fee, provided by retail pharmacies
2000 S 940
Effective 7/1/00
850-487-4441
888 419-3456
Medicaid Prescription Drug Expansion Program
Eligibility: income up to $30,600 individual; couple = $41,220 (2002)
law effective 7/1/02
(Requires federal waiver - see adverse federal ruling of 12/24/02
Hawaii Rx+ Discount Program
149,460 people enrolled as of July 28, 2006.
All Hawaii residents who are uninsured or underinsured with income levels below 350% of 2004 federal poverty level. There are no age restrictions. Membership is free.
2002 HB 2834, Act took effect on July 1, 2002; 2004 HB2005
Program Discontinued (Public Notice)
Iowa Priority Prescription Savings Program
(originally Iowa Prescription Drug Purchasing Cooperative)
8,000 (Rx/mo, 12/04
was 68,000
Eligibility: any Medicare beneficiary.
($20 annual enrollment; discounts only)
Start-up via HHS federal grant
(not in state law)
Operational 1/2/02
Terminated 12/31/05
515 281-4343
toll-free 1-866-282-5817
CommunityRx Kansas
950 enrollees, since January 2006
State residents who do not have access to prescription drug coverage. Must be a resident of Kansas and meet the household annual income requirements of $29,400 for an individual, 39,600 for a couple and, 49,800 for a family of three. (approximately 287% of federal poverty). There is a $10 enrollment fee for each household. Program came as a result of Governor Kathleen Sebelius and the Office of Health Planning and Finance
Maine Maine Rx Program
(discount prices, based on Medicaid & manufacturer rebates)
estimated eligible in 2001)
All Maine residents with an Rx enrollment card
See NCSL report: Prescription Drug Laws in Maine
2000 S.1026; Chapter 786, ?2681
(signed 5/11/00)
Partly repealed by SP 560, above
Replaced by Rx Plus, above
U.S. Supreme Court favorable ruling 5/19/03
Maine Healthy Maine Prescription Program - Medicaid Waiver benefit
(discount program with subsidy)
79,000 discount only; state total 114,000 - See chart 1 above
Income limit: Medicare enrollees up to 300% of FPL.
$26,580.
HCFA granted Medicaid waiver, 1/19/2001
(signed 5/25/01)
Began 6/1/01; struck down by federal court, 12/24/02
207 287-2674
Maryland Maryland Pharmacy Discount Program
uses a Medicaid 1115 waiver.
8,078* (8/12/05)
Medicare beneficiaries 65 and over; also disabled.
Income: (175% FPL, 10/05) Single: $16,752 Couple: $22,464
Provides a state subsidy for drug purchases.
HB.6; Chapter 134 & 135 (signed 4/20/01)
Terminated 12/31/05;
1-800-226-2142
Maryland Pharmacy Discount Program
(as of 1/1/06)
n/a * Uninsured residents under age 65, but not Medicare or Medicaid.
2005: HB 1143
law effective 6/1/05
(Requires CMS waiver approval; application rejected 10/4/06)
Massachusetts Aggregate Purchasing law
State agency to coordinate combined purchasing for Senior Pharmacy Assistance enrollees, Medicare and Medicaid, state workers, uninsured and underinsured residents.
Chapter 127 of '99 § 271;
H.4900
§ 11; also (2003)H.4004, § 19
Not in operation - delayed by Executive branch
Prescription Drug Plus Program
Income: up to 250% FPL
($23,925 in 2005)
Must lack Rx coverage, or exhaust benefits.
Signed 4/19/05
Law effective 7/1/05 Montana
Prescription Drug Expansion Program
(discounts only through Medicaid)
Income: up to 200% FPL ($18,620 in 2004)
Disabled 18 & over; also mental health
signed 5/1/03; effective date of law 7/1/03
Not operational- plans halted due to MMA law & CMS delays
Prescription Drug Discount Program for Seniors
11,000 (09/05)
(not in law)
Not operational As of 1/2007
Division of Elderly and Adult Services 1-800-351-1888
Oklahoma Prescription Drug Discount Program
The program was implemented on April 1, 2007. For the months of April and May there was a total of 346 enrollees.
Any state resident who is defined as uninsured or underinsured without prescription drug coverage. There is no minimum age requirement. Enrollment is free if your income is less than 150% of federal poverty level and $9.95 per year if greater. There is no income limit. 2005:SB 547 Chapter 419, signed 6/6/05
Program ended September 2010.
Prescription Drug Discount Program for the Uninsured
20 as of 11/06 need update
State residents who are uninsured and between the ages of 19 and 65. Must also have an annual income level equal to or less than 200% of 2006 federal poverty level, for an individual it is $19,600 annually. Enrollment fee is $20.00 per year. Must have no other insurance.
2004: S.2886 RI GL § 42-66.2.1-3; 2006: Rules/Regs No longer operational
South Carolina Retirees and Individuals Pooling Together for Savings (SCRIPTS)
Fee: not specified.
No income limit; must not be on Medicaid
H 3586 (signed 6/18/03)
repealed by H3221 of 2006, (signed 2/21/06)
Never launched; repealed Feb. 2006
Senior citizen prescription drug benefit program.
(Discounts only)
Minimum age: 65 or disability
Eligibility: no income limit
Program repealed by H 1312 of 2004
Not operational; repealed as of 9/1/04
Vermont Pharmacy Discount Program (PDP) - expansion of VHAP, above
(provides for retail discount only; no state subsidy)
(est. eligible 69,000)
Medicaid benefit:
any Medicare-covered individual; others w/o coverage Single: $25,056
Couple: $33,756
H 842 section 117
HCFA waiver approved 11/00
Federal court ruling 6/8/01 halted operation
A Washington Alliance to Reduce Prescription-Drug Spending
(retail discount only)
5,000 (5/01)
$15 annual enrollment charge
Executive Order 00-04
WAC 246-30 signed 8/29/00
Began 3/19/01
Program invalidated and terminated. 6/01
enrollees transferred to private sector program, June, 2001.
(mail order discount plan)
(11/06) (est. 40,000 max. eligible)
Minimum age: 50;
Disabled 19-49
Single: $28,918
Couple: $38,490 ('05 = 300% FPL)
Operational 6/1/04
Terminated and replaced 2/1/07 by WPDP
WV Pharmaceutical Discount Program
Golden Mountaineer Discount Program
350,000 (estimate)
Pharmaceutical Discount Program has no minimum age and is for "uninsured residents". Eligibility: single: $19,140; couple: $25,660 (200% FPL)
Golden Mountaineer: State residents age 60 and older. Most beneficiaries are automatically enrolled. There is no income requirement or enrollment fee.
2004 law: HB 4084, Signed 4/7/04
West Virginia SPAN II
(retail discount only) 4,000
(7/15/01)
moved to GM card, below
Minimum age: 65 Eligibility: No income requirement as of 4/01, WV resident, no enrollment fee
Executive order 20-00 signed 10/18/00.
Began 12/00
Ended, fall 2001; replaced with
877 987-4463
or 877-987-2622
· = enrollment design included persons with disabilities under age 65.
n/a = enrollment or participation figures not available. Eligibility standards: The figures listed in these charts are based on language in state statutes or other state regulations. They are examples of the scope of individual programs; they are not intended as full descriptions of eligibility requirements for individuals. Please consult state program administrators for additional details and conditions.
State Pharmaceutical Assistance and Tobacco funds
The availability of tobacco settlement funds was a substantial factor in stimulating discussion and legislative activity relating to prescription drug subsidies. The following states appropriated tobacco settlement funds toward state Senior Pharmaceutical Assistance programs in 1999-2003. Most states continue use of these funds, appropriated annually.
Delaware (S 420 of 2000; S. 6 of 1999) $7.5 million ; also 2001 legislation
Illinois (HB 3872, HB 4437 of 2000); $35 million appropriated ; also 2001 legislation
Indiana (S 108 of 2000) $20 million; also 2001 legislation
Maine (LD 2510) $10 million for expanded coverage
Massachusetts (H5300, sec 46(b) of 2000) $10 million - original 1996 program used tobacco tax revenue Michigan - FY2001 budget - $33 million for prescription drugs for seniors (signed 7/2000)
Nevada (Ch. 538 of 1999) - 15 percent of total available revenue
New Jersey (S2000 of 2000; $29 million in FY 2000; $38 million in FY2001, of which $25 million is authorized in FY 2001 budget) ; also 2001 legislation
New York- $55.7 million for FY2001 for expansion of EPIC; funds reduce the cost of drugs and expand the program.
North Carolina - $35 million for FY 2002 for expansion from 2,000 to up to 100,000 in 2002.
Ohio earmarked up to $12 million in 2001 for a future emergency elderly prescription drug benefit. The discount program enacted in 2002 does not require direct state funding at this level.
Several other states expanded health services for seniors or low income populations, without earmarking the funds to a specific pharmaceutical assistance program.
Recent and Historical Major State Actions
In the past ten years, many states passed new or additional laws pertaining to pharmacy assistance programs. Some states have three or even four separate programs, others have changed major features over time. Examples of these include:
AL: Although the states does not have an Rx subsidy or discount plan, it does operate "SenioRx - Prescription Drug Assistance Program for Senior Citizens", as a free clearinghouse that helps seniors apply for manufacturer programs. As of Jan. 1, 2006 the program serves residents age 55 or over with income up to 200% of the federal poverty level.
AK: SB 106 (signed August 8, 2005) Establishes the Senior Care Prescription Drug Benefit Program to provide premium and deductible assistance, for seniors 65 or older with income up to $20,913 annually (175 percent of FPL). The program may pay premiums and deductibles under MMA beginning January 2006 or may pay other Rx-related costs or insurance premiums. A separate section creates a cash assistance program for seniors with individual income up to $16,133 (135 percent of FPL), with benefits set at $120 per month. Repeals conflicting parts of Senior Care Rx enacted in 2004.
AR S.932 of 2001 - Prescription Drug Access Improvement Act directs the state to apply for a Medicaid waiver for prescription drug coverage, with income eligibility maximum of 80 percent of FPL ($6872), increasing to 100 percent FPL ($8590) after 6/30/03. The program would provide benefits only after federal approval is received. The benefit is limited to two prescriptions per months, after payment of a $25 annual enrollment fee. It was signed into law by the Governor, 4/16/01. As of 11/02, the waiver had not been approved.
> HB 1241 of 2005 - Created a prescription drug discount program for AR residents without Rx coverage, age 65 or over, or under age 65 with annual income up to 350 percent of federal poverty. The “Arkansas Rx Program” will use manufacturer rebates and pharmacy discounts to reduce prescription drug prices, with participating retail drug stores to pass on savings from rebates. It requires an annual enrollment fee of $25. Those enrolled in Medicare Part D or Medicaid will not be eligible.
Pre-enrollment for prescription rebate program to begin in August - AR News Bureau, 7/25/06
AZ - For 2003, newly elected Governor Janet Napolitano issued an executive order (EO 2003-3) in January, making all of the state's Medicare eligible residents eligible for a discount on prescription drugs. The plan calls for the establishment of a network of state-contracted pharmacists to provide the discounts. Initially the program was to have a $25 annual membership fee and be offered to an estimated 570,000 enrollees; the enrollment fee was dropped to $9.95 in May. Officials state that eligible members will receive "discounts ranging from 15 to 55 percent." Enrollment began May 8, 2003 and opened June 1. The PBM RxAmerica, an affiliate of Long's Drug Stores, is running the program. > On January 7, 2004 Arizona launched a replacement discount program called CoppeRx. Cards are being mailed to about 1.1 million seniors and disabled residents automatically, with operation phased in from January 15 through March 1, 2004. There is no enrollment fee; enrollees in the 2003 program can have their '03 enrollment fee repaid. > FY 2006-2007 budget bill (HB 2863) includes $1.5 million appropriations for payment of 100% of the Part D copays for dual eligible enrollees, including acute, long-term care and behavioral health, administered by AHCCCS, the Medicaid agency. "The intent of the Legislature is that all Part D copayments will be covered as a state subsidy." The benefit became available October 1 and is funded through June 30, 2007. Signed as Chapter 344, 6/21/06. CA - SB696 of 2001 - the Golden State Pharmacy Assistance Program provides a discounted prescription drug program for Medicare beneficiaries to help reduce out-of-pocket expenses for prescription drugs for this group. The program will be funded from rebates that will be negotiated with drug manufacturers for those drugs purchased by Medicare beneficiaries. As of late May, 2002, drug manufacturer program interest meetings have been held; EDS (the State's fiscal intermediary) has completed a procurement for a vendor to operate this Program and is expected to issue a Letter of Intent to Award and contract the week of May 28, 2002; the selected contractor will then begin to conduct negotiations with drug manufacturers for rebates and determine program viability based on participation as required in the enacting legislation.
> California's Genetically Handicapped Persons Program (GHPP) pays for medical care for individuals diagnosed as Genetically Handicapped, only in case of loss of private health insurance or Medi-Cal due to change in employment status or income. GHPP often pays for services not fully covered by other plans. GHPP is not providing a "wrap around" benefit for Part D, but will continue to cover excluded categories of drugs like benzodiazepines, over-the-counter medications, cough and cold agents, and barbiturates.
> California AB 2911 of 2006 establishes the California Discount Prescription Drug Program within the Department of Health Services. The voluntary drug discount program includes: 1) individuals with annual income to 300% of the federal poverty guidelines, 2) persons or families facing extraordinary medical expenses equal to at least 10 percent of annual income, or 3) is enrolled in the Medicare Program, but whose prescription drugs are not covered by the Medicare Program. The program excludes persons who receive coverage in whole or in part by Medi-Cal (Medicaid), state-funded health programs like the Healthy Families Program or "another third-party payer, provided that the individual has not reached the annual limit on his or her prescription drug coverage." Also requires the Department to negotiate drug discount agreements with drug manufacturers " and shall attempt to negotiate the maximum possible discount" and pursue manufacturer rebate agreements for drugs in each therapeutic category, with such manufacturer price disclosures defined as confidential. Law also includes a mechanism allowing the state to remove a manufacturer’s product from the state’s Medi-Cal preferred drug formulary and "may require prior authorization" if the drug company does not provide sufficient discounts. The use of prior authorization option takes effect August 2010. The law was signed by the governor as Chapter 619 of 2006 on September 29, 2006. |Legislative news release 8/30/06
CT HB 6002 (Public Act 00-2), enacted in June 2000 special session, Section 29 authorized a new "Part B" benefit within the ConnPACE program, for those over income for the existing program. It authorizes a "prescription drug benefit where recipients may receive prescription drugs at a reduced cost which to the extent possible is at or below the current Medicaid rate." The Commissioner of Social Services must propose an eligibility limitation level, and must determine that the program is cost-neutral before it may be implemented, not later than July 1, 2001. Sections 35-45 also make adjustments in the PACE program. Signed 6/21/2000.
> H.6495 of 2003, an FY 03 Budget reduction law, increases copayments from $12 up to $16.25; increases the application fee from $25 to $30; and reduces the dispensing fee to retail pharmacies for ConnPACE (and Medicaid) , from $3.85 to $3.60. Signed by Governor Rowland 2/28/03 as Public Act 03-2. A separate 2003 law, SB 2001, established a procedure for estate financial recovery for deceased persons who had been enrolled in ConnPACE.
DC - Has a drug benefit program within the DC Healthcare Alliance, created in 2000 District legislation. DC's unique legal status allows the city's public system to provide the pharmaceuticals at low-cost, because of access to Department of Defense Purchasing. Residents must be an Alliance patient to receive the drug benefit: the eligibility criteria is income not more than 200 percent of the federal poverty level ($19,140 for a single person in 2005) and not be eligible for any other type of coverage like Medicaid. Once qualified, enrollees receive the drugs at no cost if they are on the formulary list.
FL - SB 940 of 2000- Created a new Pharmaceutical Expense Assistance program for persons over 65 who are "dually eligible for Medicaid and Medicare but without pharmaceutical coverage". State subsidy is limited to $80 per month; participants are responsible for a 10 percent co-payment. Appropriated $15 million; signed 6/8/2000. > HB 59 of 2002 - Established the Ron Silver Senior Drug Program. (§ 409.9065) Directs revision of the 2000 subsidy program and creation of a state pharmacy benefit that includes annual per-member benefit limits and cost-sharing provisions. Persons age 65 or over with incomes between 88 percent and 120 percent of the poverty level will be eligible for coverage up to the amount of appropriations. If the federal government increases the federal Medicaid match, persons aged 65 or over with incomes up to 150 percent of poverty will be eligible. Authorizes submission of a section 1115 waiver request. If the full 1115 waiver is approved, elderly persons will be eligible for coverage up to a "level that can be supported with funds provided." Signed by Governor Bush, 6/07/02.
> The Medicare Prescription Discount Program is not a structured state agency-run program. It is a state law (enacted in 2000) that mandates the maximum amount that a Medicaid Participating pharmacy in Florida can charge a Medicare recipient; there is not an enrollment process. Therefore, it is not eligible to "coordinate" benefits with the Medicare Discount cards. [Clarification as submitted by AHCA, December 2004.]
> SB 22A of 2003: The FY 04 budget included $16.2 million for expansion of the Silver Lifesaver Rx Program, to seniors up to 200 percent of federal poverty. Sliding scale benefits include "Eligible individuals with incomes up to 120 percent of the federal poverty level receive a discount of 100 percent for the first $160 worth of prescription drugs they receive each month, subject to copayments; others receive discounts of 50 percent, 41 percent, or 37 percent for those between 175 and 200 percent, with no monthly dollar limit. The program runs under the Pharmacy Plus federal waiver approved in 2002. Note: As of 2/04, online materials from the state program describe eligibility maximum income as 120% of federal Poverty.
> Updated Dec. 21, 2005, Silver SaveRx program will terminate as of January 1, 2006 due to the Medicare Part D program.
HI - HB 2834 of 2002 established the Hawaii Rx pharmaceutical discount program for all state residents. It provides for the state to obtain manufacturers' rebates on drugs that are offered at discounted prices to program participants. Discounts are intended to be at least at the Medicaid discount level. It also provides reimbursement to participating pharmacists and establishes an advisory commission and special fund. The program would take effect July 1, 2004.
> A separate law, HB 1950, also signed May 31, 2002, established the Medicaid prescription drug expansion program to offer discounted prescription drugs to qualified individuals whose income is at or below 300 percent of the federal poverty level (In Hawaii, $30,600 for an individual). It includes a $1.5 million appropriation so the state can pay $1 per prescription written. This program requires a federal waiver; however a federal court ruling that struck down the Healthy Maine program makes it less likely this Hawaii law can be implemented without modification.
> The approximate discount program enrollment as of 5/13/05 is 142,636, meaning that 142, 636 people are able to use the program. The number of people that have the actual card would be less since HI limits the card to two cards per household. > SB 802 of 2005 creates a new State Pharmacy Assistance subsidy program to provide medically necessary prescriptions to residents age 65 and older and disabled individuals, with incomes up to 100 percent of federal poverty. Medicare MMA beneficiaries in 2006 and Hawaii Rx enrollees are eligible for coordinated benefits. The program "may pay all or some of the deductibles, co-insurance payments, premiums and co-payments required under the federal Medicare part D pharmacy benefit program, subject to receipt of sufficient rebates", and facilitate enrollment and coordination of benefits between the state pharmacy assistance program and the new Medicare part D drug benefit program.
IL - On January 28, 2002 the U.S. Department of Health and Human Services announced an Illinois Medicaid 1115 demonstration project to help cover "virtually all drugs for most of the seniors who currently participate in the state subsidy program." The expansion gives an estimated 368,000 low- and moderate-income seniors prescription drug coverage through the Medicaid program starting in June 2002. The existing state-only program covers individuals with income up to $21,218 and couples up to $28,480. The new Medicaid tie-in program covers individuals and couples earning up to 200 percent of poverty or $17,200 annually for an individual and $23,220 for a couple. Enrollees pay a $3 co-payment for each prescription for expenses of up to $1,750 a year. Above that figure, the program pays 80 percent of the costs and the enrollee will be responsible for 20 percent. Illinois does not plan to charge an enrollment fee for the program. View: IL SeniorCare Preferred Drug List updated December 30, 2003.
> A separate discount card program was enacted by the legislature in 2003, and became operational January 1, 2004. The Governor's office projected that up to 2 million people could participate. Seniors and other will pay a $25 annual enrollment fee, to receive discounts estimated to be around 20%. As of August 2004 only 13,500 seniors had paid the $25 application fee. For 2005 the terms included Age: senior citizens and disabled; Income: no limit. and a $10 annual fee. > For 2006, HB 973 of 2005 changed the Rx Buying Club to include allresidents with incomes up to 300% of federal poverty.
> In late 2003, Illinois Governor Blagojevich launched a separate executive initiative focused on state purchasing of discounted pharmaceuticals from Canada. The project maintains a separate state-funded web site with information at http://www.affordabledrugs.il.gov/. No medicines have been purchased as of early January 2004.
> Illinois HB 3872 of 2000 raised income levels from $16,000 for an individual or couple to $21,218 for an individual and $28,480 for a couple, and lowered deductibles and copayments; also added four categories of drugs to the formulary. Signed into law, 5/8/2000. A separate act, HB 4437 appropriated $35 million of tobacco settlement funds to expand the program. Signed into law, 5/17/2000. In 2001, the budget, HB 3491, included a requirement that the state seek federal reimbursement under Medicaid for people up to 250 percent of federal poverty served by the state subsidy program.
IN - S 228 of 2002 (§38) changes the Rx program as of July 1, 2002 to provide a direct benefit at the time of the sale instead of the semi-annual reimbursement in the original law. In April 2003 the state received approval for a "Pharmacy Plus" 1115 Medicaid waiver to obtain matching funds for the program. HHS approves expanding pharmacy benefits to Indiana elderly (HHS Department news release, 4/10/03.) > In June 2003 state officials expressed concern about the waiver's condition that could cap expenditures at $6 million over the next five years; lawmakers had provided $8 million for FY 03, an amount that anticipated $12 million in federal matching funds, aimed as serving about 30,000 people. IA - The Priority Prescription Savings Program currently utilizes a limited preferred drug list, although "all prescription medications" are available through the program.
KS - As of October 1, 2001 the Department of Aging is implementing the new Kansas Senior Pharmacy Assistance Law. Eligibility requirements include details not contained in statute: an individual must be age 67 with 3 open enrollment months; also a current recipient of the "dual eligible" QMB or SMLB Medicare programs. Prescriptions for acute illness are excluded. Enrollees must submit a "pharmacy printout of all prescriptions purchased." The maximum reimbursement per individual is $1,200 annually, with reimbursement checks to be sent by December 31.
> S 268 of 2003 expanded the program with features including: eligibility now is age 65 or older, with incomes up to 200 percent of federal poverty ($17,960 for an individual in 2003), if federal matching funds are obtained through a Pharmacy Plus Medicaid waiver. The program would be suspended if a future federal benefit would cover the enrollees. As of July 2003 funding levels continue to cover individuals up to 135% of federal poverty guidelines. About 3,800 residents are automatically eligible, of whom 1,500 submitted reimbursement claims as of June 2003.
KY - SB 23 of 2005 - Creates a new state subsidized pharmacy assistance program for seniors over 65 and under 150% FPL that wraps around Medicare Part D. The program "may pay all or some of the deductibles, coinsurance payments, premiums, and copayments" required under the Medicare Part D pharmacy benefit program. Authorizes state contracts with one or more prescription drug plans to coordinate the prescription benefits and preferred enrollment in such plans, with an opt-out for individuals. It was signed by the governor as Chapter 136 of the Acts of 2005 on 3/18/05.
LA - The Louisiana Seniors Pharmacy Assistance Program enacted in 2003 required separate appropriations, which were not approved in 2003-2006. As a result the program is on indefinite hold; largely because virtually all eligible residents (up to 100% of FPL) are eligible for the Medicare Prescription benefit as of January 2006, there are no plans to activate the program. A separate law (SB 1132 of 2003) created the Louisiana SenioRx program, which functions as a clearinghouse to link qualifying senior citizens with pharmaceutical aid programs. PhRMA is a partner in operating the program. [2/07]
ME - On June 1, 2001 Maine converted its 25-year old subsidy program into a broader "Healthy Maine Prescription Program", including both subsidies and discounts according to income categories. A Federal Circuit Court ruling of December 24, 2002 struck down the waiver that allowed the discount portion of the program to serve people up to 300 percent of poverty.
Recent history: In 1999 Maine extended Medicaid prescription coverage to 185 percent of poverty level. Signed by Governor in the Appropriations Bill. In 2000, S.1026, now Public Law 786, creates new pharmaceutical discounts for persons without prescription drug insurance coverage. Signed by the Governor 5/11/2000. The U.S. Supreme Court has issued a ruling generally favorable to the state-only Maine Rx law in May 2003; however in June the legislature enacted a revised program, renamed Maine Rx Plus. This law changes details of eligibility and negotiations to achieve discounts. It retains the provision calling for possible general Rx prices controls (§2693), but postpones the effective date to July 2005.
MD - In April 2001 the legislature enacted HB 6. It 1) Creating the Maryland Pharmacy Discount Program as part of Medicaid through an 1115 waiver. The 2001 statute stated that if the federal waiver is approved, any Medicare beneficiary without drug coverage would be eligible to enroll and will receive a discount on purchases tied to the Medicaid price less rebates. However, under the approved waiver (granted July 2002), as of July 2003 program eligibility is determined by income level. Applicants with income at or below 175 percent of the federal poverty level ($16,296 for an individual and $21,864 for a couple as of 1/05) will be eligible for the program. There are no monthly or annual participation fees or monthly premiums. The enrollee is assessed a 65 percent co-pay and a $1.00 processing fee for each prescription.
2) Expanded the Short-Term Prescription Drug Subsidy Plan began in 2000 after Medicare HMOs left many parts of the state. The 2001 law reduces the premium to $10, eliminates the deductible, and extends the program statewide. The benefit cap of $1000 remains in place. Persons with incomes up to 300 percent of the poverty level are eligible. It also sets up an outreach and notification program. This means the state would subsidize both a privately managed plan (the Short-Term Prescription Drug Subsidy Plan) and a state-run plan (the Pharmacy Discount Program). The program may sunset on June 30, 2005 unless extended. Signed 4/20/01 as Chapter 134 and 135; modified in 2003 (see above charts).
> MD SB 282 of 2005 - Renamed the Program to be the Senior Prescription Drug Assistance Program; altering the eligibility requirements to cover Medicare eligibles with annual incomes up to 300 percent of FPL; requiring the Program to provide a wrap-around state subsidy for the cost of a portion of Medicare Part D or Medicare Advantage Plan premiums and deductibles, with a state monthly premium of $10 per month and no deductible; repealed parts of the Maryland Pharmacy Discount Program.
> MD HB 1143 of 2005 - Established a new state discount category, expanding the eligibility requirements of the Maryland Pharmacy Discount Program to cover non-Medicare beneficiaries, especially under age 65, who are uninsured, with annual household income up to 200% of federal poverty guidelines; authorized the state to seek and obtain a CMS waiver, similar to the previously-granted waiver for seniors under 175% of poverty. On Octover 4, 2006CMS rejected Md. plan to give uninsured a drug discount, with the Federal government concluding that the state financed its share of program with illegitimate Medicaid-related funds. > MD: Since the Maryland Pharmacy Discount Program (MPDP) only enrolled individuals with Medicare, due to implementation of the Medicare Part D Pharmacy Program, the MPDP ceased as of December 31, 2005. To get Medicare prescription coverage, these individuals must choose and enroll in a Medicare Prescription Drug Plan (PDP). Beginning July 2006, Maryland established a new program called the Primary Adult Care Program or PAC for short. PAC offers health services to people 19 and over who make limited amounts of money each year. If a resident was in the Maryland Pharmacy Assistance Program (MPAP) or the Maryland PrimaryCare Program, he or she will be transferred to PAC. PAC will replace these programs. PAC includes "Free visits to a family doctor (also called a Primary Care Provider or PCP); free outpatient visits to a counselor or psychiatrist for mental health services and lower-priced or no-cost prescription drugs.
MA - 1) The "Pharmacy Outreach Program" established by law (sec. 45 of H.5300 of 2000) is operational, now named Mass. MedLine, and run by the Mass, College of Pharmacy. It had a $250,000 state budget, within the RxAdvantage line-item in FY2002. It has a website at: http://www.massmedline.com/.
2) On August 2, 2002 Massachusetts submitted a Pharmacy Plus Medicaid 115 waiver to obtain matching funds for the eligible portion of the Prescription Advantage subsidy plan. It was never approved.
3) Prescription Advantage was changed beginning 1/1/2006 to provide a wrap around benefit to all enrollees eligible for Medicare Part D. Another 3,000 enrollees not eligible for Medicare remain on the program with a original state-subsidized pharmacy insurance benefit.
5) MedMetrics Health Partners is the company that manages the Prescription Advantage pharmacy benefit starting July 1, 2006, replacing Caremark.
MI - For 12 years Michigan state law allowed residents 65 and over, with household income under 150 percent of federal poverty to claim a refundable tax credit up to $600 for prescription drugs expenditures that exceed 5 percent of household income. 20,000 people claimed the tax credit in 2000. The law was repealed in 2001 and replaced as noted below.
> In 2001 the state enacted the Elder Prescription Insurance Coverage (EPIC) Program, which replaced and repealed the earlier programs. Implementation began Oct. 1, 2001. > On January 26, 2004 Governor Granholm announced a new discount card aimed at serving all resident without other prescription coverage, with no age limit and no enrollment fee. As announced, the initial plan is intended to go into effect in September 2004 without legislative authority.
MN reports that their program has expended $8,651,209 from startup in January 1999 through June 2001 for prescription drugs for enrollees. (7/30/01). A 2001 law, S 4, signed 6/29/01, adds eligibility requirements for individuals who were enrolled in a Medicare risk plan prior to March 1, 2001, to which an annual prescription drug benefit of $400 was added for 2001. > On December 10, 2001 the agency announced it will not be able to expand coverage from 120 percent to 135 percent of poverty ($10,597) or to the disabled, due to budget restrictions in FY 2002.
MO - In October 2001, the Governor signed special session HB3, creating a new direct subsidy program for seniors with individual income not more than $17,000 annually. The program will open enrollment by April 1, 2002 and go into effect July 1, 2001. Revised estimates released in late June 2002 show that enrollment may be about 25,000 for the program's first year. Originally, the state planned to spend $4 million to promote the program, but that amount was reduced to $250,000 because of financial constraints. Rebecca Mankin, the program's executive director, said many seniors did not want to "go through the hassle" of completing the program's three-page application.
> S14 of 1999 - created a prescription drug state income tax credit of $200 per year, for persons 65 years and older with income not more than $15,000. Over $15,000 the credit is reduced $2 for every $100 of income. (A $24,899 income = $2 credit) Signed by Governor and effective 8/28/99 including the 1999 tax year. In the first year of operation 446,372 refund checks were issued for a total of $81,971,741. Because of taxpayer confusion, the state authorized refunds sent to all individuals who qualified, regardless of whether such individuals indicated their entitlement to the credit. In the second year about 266,000 refunds were paid. The tax credit ended on December 31, 2001.
MT - SB 473 was signed into law May 1, 2003. It provides for a prescription drug expansion program within Medicaid, offering a discounted price to qualified individuals within income up to 200% of the federal poverty level, with exact maximum to be set by the Department of Public Health and Human Resources. Eligible people include: those at least 62 years of age, those 18 and older defined as disabled by the federal Social Security Program, or eligible for state mental; health services. Some features will be determine by departmental regulation, specifically, "The department shall adopt rules to establish the discounted price to be charged to participants in the program" and "may establish a discounted price to encourage the use of generic drugs over higher-cost brand-name drugs." The law is contingent on federal waiver approval. In January 2005, the Medicaid agency clarified "though the bill was passed by the 2003 Legislature, the program was not implemented after extensive discussions with CMS regarding the specifics of the program."
NV - The "Senior Rx" insurance program initially had two plans, one called Nevada Blue, which will have a lower premium and offer more generic drugs, and Nevada Silver, which will cost more and cover some name brand drugs. Seniors with household incomes of $12,700 or less per year were eligible for a $40 a month state subsidy for the cost of the coverage, making Nevada Blue's cost to participants $34.76 per month and Nevada Silver's cost $58.31 per month. For those with incomes in higher ranges the subsidy was less and the premium payment is higher. Applications were available as of January 1, 2001. These provisions were changed substantially by a new law SB 539, signed 6/12/01, that allows the state to subsidize up to 100 percent of the annual premium. The program reached its required size of 3,500 in October 2001. > In 2003, SB 459 raised the maximum family income from $21,800 to $28,660 and authorized a Pharmacy Plus Medicaid waiver application, effective July 1, 2003.
NH - Although no programs have been established or enacted by legislative action, in November1999 the Governor and Executive Council authorized a two year pilot program, (see action #87) that provides discounts of up to 40 percent on generic drugs and 15 percent on brand name drugs. Enrollment for those over 65 began in January 2000. Seniors pay cash for their prescriptions at participating pharmacies, and no state funds are used. A private company, National Prescription Administrators, runs the program. The state contract ended December 31, 2001, but the program continues to operate in 2002 "in collaboration with the state of New Hampshire."
New Hampshire also applied for a federal Medicaid waiver in 2000 to allow Medicare beneficiaries to receive prescription drugs as well as medical equipment a discounted price. The waiver had not received approval as of 3/02.
NJ - S. 2000, the FY 2000-01 budget bill included $313 million for the PAAD program, plus a proposal expanding eligibility up to $35,000, estimated to cover about 100,000 additional seniors and disabled. The cost would be $25 million in the first year, and $50 million annually, using tobacco settlement funds. The budget appropriation was approved, (see section 57) contingent on passage of a new prescription drug discount program for persons over income for PAAD. This new program, Senior Gold, in S.6; chapter 96 of 2001 was signed 5/15/01.
NM - SB 91, signed March 5, 2002, establishes the Senior Prescription Drug Program. Eligibility covers persons age sixty-five years or older; with no other prescription drug benefit; includes an enrollment fee not to exceed $60.00 per year to cover the cost of administering the program. Participants will pay a discount price "not exceed the dispensing fee plus the contracted discounted price made available to the authority." The NM Retiree Health Care Authority will administer the program in conjunction with the consolidated purchasing process in the Health Care Purchasing Act. No state funds are appropriated to subsidize drug purchases. (see fiscal analysis).
> SB 391 of 2003 authorizes a Medicaid 1115 Pharmacy Plus waiver for persons up to 185 percent of federal poverty. It appropriates $150,000 in start-up funds; the fiscal analysis estimates maximum enrollment eligibility at 21,000, with the state share of benefits at $10 million, out of projected $50.4 million total annual budget..
> A 1994 NM law, § 7-2-18.3 provided a prescription drug tax credit of 3 percent of the taxpayer's actual unreimbursed expenditures for prescription drugs purchased in the state up to $150 per individual. The law was repealed effective 1/1/1999, and replaced by a wholesale "gross receipts tax deduction for prescription drugs, resulting in an estimated 6 percent reduction for the retail consumer; see NM § 7-9-73.2.
NY - The FY 2001 appropriations bill (on-line description) included a significant expansion of EPIC eligibility. The maximum income increased from $18,500 individual and $24,400 for a couple, to $35,000 for an individual and $50,000 for a couple, effective January 2001. Signed by the Governor, 5/2000. > A FY 2002 appropriations bill, A8315, allocates $15 million to EPIC. Signed by the Governor, 3/30/01. > As of May 2002, the EPIC program had expanded by 42,000 to 277,000, up from a July 2001 figure of 235,000. For FY03 the appropriation includes $484.9 million gross expenditures, minus $94 million from rebates and $14.7 million from participant fee revenue.
NC - HB 1840, section 11.39, the FY 2001 budget, includes a $500,000 increase for the state's new prescription drug program. There also was a legislative study commission. Signed by Governor 7/6/2000 as Session Law 00-67.
> In December 2001, Governor Easley announced the state will use $35 million from the national tobacco settlement to begin subsidizing prescription drug bills for up to 100,000 participants, with expanded enrollment by March 2002. Eligibility requirements are expanded to cover age 65 and older earning $17,180 or less, $23,220 for a couple. Enrollees will get a 60 percent discount. The North Carolina Health and Wellness Trust Fund Commission approved a program that will help cover the cost of prescription drugs for uninsured, low-income seniors. The Commission awarded $105 million over three years to the state Dept. of Health and Human Services to administer the program called "Carolina Cares." The new plan replaced the earlier Prescription Drug Assistance Program. The program began operation in October 2002, with a $600 annual cap on prescription benefits. It closed 1/1/06.
> In November 2006, Governor Easley launched NCRx as a Medicare wrap around. Beginning in 2007, seniors will be able to choose from 51 different Medicare Prescription Drug Plans. Costs of premiums range from $17.80 to $85.90 per month. NCRx will then step in to cover part of these monthly premiums for North Carolinians with annual incomes at 175 percent of the federal poverty level. Iindividuals earning less than $17,150 a year with assets worth less than $20,000, not including a home or car, will qualify for NCRx. Married couples making less than $23,100 a year with assets less than $30,000 will also qualify. The state estimates that 50,000 North Carolinians will sign up for the Medicare Part D state assistance plan over the next two and a half years and has dedicated $24 million from the Health and Wellness Trust Fund to pay for the program. (11/06 update)
OH - SB 261 of 2002, see §173.06. The law provides for the Department of Aging to establish a prescription drug discount card program for residents age 60 or over, or disabled. Part of a broader "Golden Buckeye Card," it permits one or more discount card programs, with enrollment and use of multiple cards permitted; provides for a "financial incentive program" to retail pharmacies; also permits negotiation with one or more drug manufacturers for discounts in drug prices or rebates. The bill appropriates $377, 560 for administration. SB 261 was signed by the governor on June 6, 2002. Implementation was delayed because of a need to increase participation by state pharmacies (only 65 percent had negotiated participation by July '03). The program began operation in early October 2003. As implemented, eligibility for the basic prescription savings is automatic and seniors 60 years and receive their free Golden Buckeye card in the mail. There is no enrollment fee. A total of 2,142,339 cards had been mailed as of 5/25/04, with 672,255 actual uses, for a total "money saved" calculated as $8.7 million, and "average percent savings" when using the Golden Buckeye price equal to 23.9%.
> A new "Medicare Golden Buckeye" card was made available, effective June 1, 2004, as a federally endorsed Medicare discount program.
> HB 311 of 2003 - A second discount program, "Ohio's Best Rx", was signed into law on December 4, 2003. Eligibility includes residents age 60 years or old, or residents with family income not to exceed 250 percent of federal poverty guidelines ($22,450 for an individual). It was scheduled to be operational in mid-2004, but the Best Rx program "is expected to begin accepting applications in January 2005." See Chart comparing Ohio programs.
OK SB 547, now Chapter 419 of 2005 - Established the new Oklahoma Prescription Drug Discount Program, to negotiate voluntary discounts with manufacturers and use Medicaid reimbursement rates for pharmacies. Discounts will be provided as a 100 percent pass through to program enrollees, defined as uninsured residents and their families. Also authorizes an annual enrollment fee for those over 150 percent of FPL. Requires "preference" for an in-state contracted PBM; once selected the PBM must provide “full disclosure and transparency of financial relationships with manufacturers” for the program. Coordination of benefits with Medicare pharmaceutical benefits are not detailed in the law. OR - SB 9 of 2001 became law July 30, 2001. It created the "Senior Prescription Drug Assistance Program" which has three main provisions. 1) The state will set a discounted rate not to exceed the Medicaid rate at which pharmacies could charge eligible seniors for prescription drugs. This program became operational statewide on May 2003. It includes a 2003 price comparison chart online. As of July '03 about 50% of the pharmacies in Oregon are registered in the program, including most of the largest chain pharmacies.
2) Subject to available funds, the law created a state subsidy of up to 50 percent of "the Medicaid price of the prescription drug, using a sliding scale based on the income and resources of an enrollee. Maximum income eligibility is 185 percent of FPL, age 65 year or older, with less than $2000 in resources not counting home or car. Maximum benefit is $2000 per year. The program may have an enrollment fee of up to $50 annually, and retail pharmacies may charge a dispensing fee not more than Medicaid fees ($4.28). Provides for use of cigarette tax revenues to "reimburse retail pharmacies for subsidized prices. 2A) As of December 2001, the subsidy plan was put "on hold" due to funding shortfalls. The $5 million appropriated in FY 2002 was reallocated as part of budget cuts to address the state's $850 million shortfall.
3) Creates the Patient Assistance Program in the College of Pharmacy at Oregon State University to assist low-income residents in gaining access to free drug assistance programs offered by pharmaceutical companies if a patient is not eligible for publicly funded prescription drug benefits. Appropriates $100,000 for education and outreach. Includes an immediate effective date. > Oregon Prescription Drug Program was launched in 2005 as a discount plan, emphasizing evidence-based medicine. The current program is open to Oregon residents who are: a) at least 54 years old; b) earn less than 185% of the federal poverty level (currently $18,130 per individual); and c) have not had private prescription drug coverage for the six months preceding application to the program. There is no enrollment fee. The OPDP card will entitle users to discounts on prescription drugs up to 60%. Those signed up for Medicare Part D prescription coverage also are eligible for this program. > As of December 2006 eligibility in the discount plan was expanded to include all ages and all incomes; Gov. Ted Kulongoski's FY08 budget proposal included $740,000 to promote the new program. The operational expenses will be at no cost to taxpayers.
PA - H 888 of 2003 substantially increased income eligibility for the PACENET program. The 2003 maximums of $17,000 for an individual and $19,000 for a couple were increased for 2004-05 to $23,500 for an individual and $31,500 for a couple. The PACE program for lower-income residents has a $500 increase in maximum eligibility, to $14,500 for an individual. > "Outreach medication education in Pennsylvania: A non-commercial source of evidence-based information about medication choices for physicians", Presentation by Michele Spetman, M.S., M.P.H.: May 19, 2006 (in PPT format)
RI - > The Prescription Drug Discount for the Uninsured program, enacted in 2004, was launched in late 2006, with a PBM contract with PharmaCare Management Services, a subsidiary of CVS Drugs. The original $25 annual fee was reduced to $20.
> the FY 2001 budget included $1.2 million to cover an additional 9,000 people. The program paid 60 percent of the medication bills for those up to $15,932; 30 percent of bill for those up to $19,999, and 15 percent of the bill for individuals up to $34,999. H 7862a, Article 30 was signed by the Governor, 6/30/2000; S 2863 was signed on 7/13/2000 effective 7/01.
SC - the FY 2001 appropriations bill, Act 406 of 2000 in section 47, included authorization for a new senior pharmacy program. A pharmaceutical benefit management company, ACS (formerly Consultec) oversees the program. Initial applicant enrollment was open October 16 through Dec. 1, 2000, except for those who first qualify after that date. Priority was given to single seniors with $12,525 annual income and married couples with a combined income of $16,875, although eligibility was up to $19,678. For 2002, eligibility was adjusted to $15,505 for individuals and $20,895 for couples. Discounts are available for initial purchases up to an annual $500 deductible, after which SILVERxCARD will cover all prescription costs above the participant's co-payment amount.
> HHS approved a Pharmacy Plus waiver for SC in July 2002, allowing for up to $57 million in federal funds to match a $23 million state contribution in 2003. SilverxCard will also expand to serve seniors with incomes between 175-200 percent of poverty ($20,317 to $23,800 for a family of two) who will begin enrolling Jan. 1, 2003.
> In 2003, H 3586 created the South Carolina Retirees and Individuals Pooling Together for Savings (SCRIPTS) Program to provide discounted prescription drugs to non-Medicaid seniors, age 65 and over. The state may enter into contracts with "other states, other governmental purchasing pools, and nonprofit organizations to assist in the administration of this program." It "must be funded entirely from annual enrollment fees" collected from program participants. The state is authorized to seek federal waivers to implement the program. It was signed by governor 6/18/03 as Act 59.
SD - Establishes a senior citizen prescription drug benefit program, "to negotiate the purchase of prescription drugs to be offered at a reduced cost to the eligible participants." The program will be open to any resident age 65 and older and any person meeting the eligibility criteria for a disability. It will be run by the Bureau of Personnel, which "may enter into agreements with private entities and cooperate with other local, state, or federal agencies to implement the purposes of the program." It requires rules "regarding various discounts on the purchase of pharmaceuticals for participating members and regarding dispensing and intervention fees." The program is authorized to create a preferred drug list "for the benefit of participating members and pharmacies." The program would sunset July 1, 2005 unless continued.
TN - SB 1371 of 2003 provides for establishment of a "TennCare Rx program prescription benefit to individuals lacking prescription drug insurance coverage who meet criteria established by the bureau of TennCare and the general assembly in its annual appropriation," designed to serve a non-Medicaid population, with further details not specified. The new program "may implement tiered co-payments and prior authorization and step therapy requirements" for the program based on the state preferred drug list (PDL).
> TN - 4,200 apply on first day of CoverRX enrollment; Prescription-drug plan targets uninsured, poor. News from The Tennessean, 1/4/07.
TX - H 494 of 1999 by Rep. Glen Maxey includes the following section #2: Drug Rebates. "The department shall develop a voluntary drug manufacturer rebate program for drugs purchased by or on behalf of a client of the Kidney Health Care Program or the Chronically and Disabled Children's Services Program not eligible for Medicaid rebates." It was enacted and signed by Governor George Bush, 6/19/99.
On June 15, 2001, Governor Rick Perry signed four bills affecting pharmaceutical policy. HB 1094 creates a subsidy program; HB 915 and SB 893 relate to pharmaceutical discounts and SB 1763 relates to coordinating information about free drug programs by pharmaceutical manufacturers.
HB 915 of 2001 created the Interagency Council on Pharmaceuticals Bulk Purchasing, which combines Health Dept., public employees, and all other state programs. States that the Council "shall develop procedures that member agencies must follow in purchasing pharmaceuticals." As of summer 2003, no structures or contracts have been completed.
VT - H 842, section 117, the FY 2001 appropriations bill, included authorization for a waiver application to HCFA, to expand eligibility in the VHAP program up to 300 percent of poverty. H 842 section 117 became law 5/29/2000; the federal waiver was approved in early November, with implementation begun January 2001. On June 8, 2001 the US Appeals Court ruled against the program, in case No. 01-5029 Pharmaceutical Research and Manufacturers of America, Appellant v. Tommy G. Thompson - full text on-line The VHAP program covers acute and maintenance drugs for a $1-3 copay. VSCRIPT covers maintenance drugs only for a $2-4 copay. VSCRIPT expanded clients pay 41.25 percent of the prescription cost.
> In 2004, the budget, H 768, established the Healthy Vermonters Plus discount program, primarily for residents under age 65 with annual income up to 350 percent of poverty.
> In November 2004 Vermont announced that federal CMS has agreed to hold Vermont’s pharmacy benefit programs harmless from any costs associated with the new drug benefits offered in the Medicare Modernization Act (MMA). "This means that no one currently enrolled in our pharmacy programs will lose their benefits, or pay more for their prescriptions, as a result of the new Medicare drug benefit,” stated Governor Douglas.
> The original discount program included a Medicaid waiver with 2% state payment toward cost of drugs; it received an adverse federal ruling on 12/24/02. VA - H 2225 of 2003 establishes a state Rx fund to accept appropriations, donations, grants, and in-kind contributions "to develop and implement programs that will enhance current prescription programs." It mandates a state commission to "prepare a plan to establish the Healthy Lives Prescription Assistance Program to provide prescription drug benefits for low-income senior citizens and persons with disabilities, but requires future legislative action for implementation.
WA - SB 6088 of 2003 establishes a discount and a subsidy program. Eligible residents, defined as the disabled age 19-49 and people age 50 or older with incomes up to 300 percent of the federal poverty level, would be able to purchase pharmaceuticals at a discounted price, based on voluntary negotiated discounts initiated by the Health Care Authority for state agencies. Participants are charged an enrollment fee. The program is subject to sunset review and termination on June 30, 2010. The law also requires the state to seek a "Pharmacy Plus" waiver under Medicaid to to provide subsidies to Medicare-eligible residents up to 200 percent of federal poverty guidelines.
> On May 25, 2001 a Washington state court struck down the Governor's AWARDS drug discount program, stating that the executive branch lacks the authority to implement the program without statutory authority. On June 22 the judge noted that state agency has authority to "implement joint purchasing strategies" that have "potential application to all state-purchased health services". Since AWARDS "does not involve state purchased health services and therefore exceeds the authority" in state law. The agency has transferred enrollees into the Readers Digest YourXplan and refunded their AWARDS enrollment fee. (Coalition for Affordable Prescriptions for Seniors v. State of Washington, State of Washington, Thurston County Superior Court, No. 01-2-00525-9).
> H.6088 of 2003 authorized creation of the Rx Washington discount card program. As implemented in June 2004, it is a mail order discount prescription drug program for Washington residents between 50 and 64 years old who aren't eligible for the new Medicare discount card, and who earn less than 300% of the federal poverty level (approximately $2,328 per month for an individual). The Rx Washington discount card program costs $10 per year and gives members a 15% to 25% discount on their prescription drugs. While about 40,000 Washington residents potentially qualify, the Health Care Authority estimates that far fewer will enroll. Many current discount cards from other sources offer the same or better discounts. The Rx Washington card became available June 1, 2004 to coordinate with the availability of the federal Medicare discount cards. (excerpt of HCA briefing 6/30/04). > In November 2005, CMS published a list of state programs including the "Washington State Health Insurance Pharmacy Assistance Program" as a "qualified SPAP."
> Medicare Copayment plan: On February 4, 2006, Gov. Gregoire announced a new plan to use $14 million already appropriated for the "clawback" but no longer owed to HHS due a recalculation of the state's total for FY 2006. The funds will be used as a state payment of the $1 to $5 copayments owed by dual-eligibles. "There are a multitude of transition issues that must be dealt with; but setting those aside for the moment, it is the co-pays that serve to be the greatest barrier to this population receiving medications. I have spoken to the Legislative leadership, they have agreed for one year to appropriate the $14 million of state money to pay for these co-pays."
WV - SB 127 of 2001 authorizes a broad in-state and multi-state initiative to achieve pharmaceutical savings. Signed May 15, 2001. > Beginning September 2001, seniors in the pilot "SPAN II" discount program were transferred to an expanded Golden Mountaineer Discount Card: As of 12/31/01, 13,809 were enrolled. The program states: Total Number of Prescriptions Filled: 39,884; Total Savings for all Prescriptions: $281,473.52; Average Savings Per Prescription: 17.40 percent
WI - 2001 Act 16, section 1838gb. (see pages 313 - 315 of this 789-page law) The 2001-03 biennial budget created a state-only prescription drug assistance program. The program covers persons 65 and older up to 240 percent of federal poverty ($20,618 for individual); it requires a $20 annual enrollment fee, and a $500 deductible for those with income over 160 percent of FPL (est. $13,800) plus a 2-tier copayment of $5 for generics and $15 for all others. The start date was September 1, 2002.
> The Badger Rx Gold program was opened in March 2005 to provide discounts to residents lacking drug coverage. It is part of a state purchasing pool, "designed to help keep prescription drugs accessible and affordable for Wisconsin residents. If you live in Wisconsin, you are eligible. It's that simple. There is no age requirement and no screening for pre-existing health conditions. Modeled after a landmark drug benefit program developed for employees of the State of Wisconsin, BadgerRx Gold is a public-private sector partnership between the state and Navitus Health Solutions to bring affordable prescription drugs to the uninsured and underinsured. The purchasing power of this partnership is now being offered to Wisconsin residents. BadgerRx Gold is not a drug discount card. It is a program that offers lower costs on carefully selected medications monitored for your safety and well-being through a team of Wisconsin physicians and pharmacists." It is described as "saving up to 25-40 percent." > SeniorCareRx in October 2005 obtained agreement from CMS that current enrollees can remain in the program instead of signing up for a Part D Medicare plan, but not face the penalty of higher premiums if the join Medicare plan in future years. This may set a precedent for other SPAPs with Pharmacy Plus Waivers.
WY - S 34 was signed on March 11, 2002. It creates a new Prescription Drug Assistance Program, for any family earning less than 200 percent of the federal poverty level. ($17,720 annually for an individual; $36,200 for a family of four.) Families between 150 percent and 200 percent FPL would receive state financial assistance for prescription drug costs after meeting a $1,000 deductible for their first three months of program participation. After the initial three months, the deductible would drop to $300 and beneficiaries would be charged $10 copays for generic drugs and $25 for brand-name medications. Those in families between 100 percent and 150 percent FPL would also have a $1,000 deductible for three months. The deductible for this group would drop to $100 after three months, with copayments. Families at or below 100 percent FPL would not have a deductible, but would be responsible for copayments. An annual enrollment fee is $20. If program funding runs out, the health department could cease operating the benefit, or could stop accepting new enrollees, exclude families with higher incomes, increase the deductibles or copayments or remove selected drugs from the program formulary. The program began July 1, 2002, and replaces the currently-operating Minimum Medical Program. Operating costs are estimated at $5 million. As of September 30, 2002, the program served 1,234 people, of whom 870 were adults age 21-64 and 348 age 65 or older. For the 3rd quarter claims paid equaled $383,672.71 (annualized estimate = $1,534,688)
PharmAssist started in December 2003 and provides WY residents a clearinghouse of information on pharmaceutical discount programs as well as a consultation with a pharmacist for a $5 copayment. The state picks up the remainder of the consultation cost which helps find savings, and provides advice on avoiding dangerous interactions and answers other drug-related questions. Copies of their recommendations are sent to the participant's physician as well.
Hghlights: 2001 - 2005 2005 Highlights: Arkansas established a new Rx discount program including residents under 65. Hawaíi (on July 8), Kentucky (on March 18) and New Hampshire (on July 26) each created a new subsidy program for Medicare eligible under 150 percent of federal poverty. Montana created a new subsidy program for Medicare enrollees, and a separate discount program for residents under 65. Maryland, New Mexico and Oklahoma established voluntary discount card programs for residents under age 65. Alaska, Connecticut, Delaware, Illinois, Maryland, Massachusetts, Nevada, New Jersey, New York and Vermont have established wrap-around plans for Medicare enrollees in existing state programs. Details of these changes are listed in NCSL's report "2005 Prescription Drug State Legislation."
2004 Highlights: Connecticut, Massachusetts, New York and North Carolina added laws authorizing automatic enrollment in one or more state-approved Medicare discount cards, to be used in combination with state benefits. Maine, Michigan, Pennsylvania and New Jersey are using auto-enrollment via state executive actions. Missouri, Nevada and Rhode Island have selected state-preferred discount cards. Alaska and the District of Columbia both enacted new temporary subsidy programs in March, with Alaska's already operational by April. Michigan launched a discount program in September. The Hawaii Rx+ program became operational on July 1. Vermont enacted Healthy Vermonters Plus, the Illinois discount program opened January 1, the Maine Rx Plus program began operation January 17, Arizona announced the new CoppeRx discount program, with 1.1 million cards being mailed to Medicare enrollees in January. The Rx Washington discount program opened June 1. Rhode Island established a new discount card for uninsured residents under age 65. South Dakota repealed their 2003 discount card program, effective August 2004.
2003 Highlights: Pennsylvania expanded eligibility for Rx subsidies up to $31,500 for couples, Louisiana authorized a new subsidy program, Washington authorized both a subsidy and a discount plan; Ohio and South Carolina created new discount plans, Tennessee established the disabled EligibilityTennCare Rx Program, the Maine Rx plan was cleared for operation by the U.S. Supreme Court (May 19) and was redesigned by the legislature (June 13), the Ohio and Oregon discount plans became operational, Florida expanded maximum eligibility; Maryland revised its subsidy and discount plans; Montana enacted a discount program under Medicaid in May, South Dakota enacted a discount card plan and New Mexico authorized its first subsidy plan. An Arizona discount card program started in June by the executive branch. Virginia established a state pharmaceutical fund and mandated that a commission prepare a plan to establish the Healthy Lives Prescription Assistance Program. Connecticut has increased copayments to $16.25 and lowered dispensing fees and created an estate recovery mechanism. Kansas and Nevada reauthorized and expanded their subsidy programs. Massachusetts closed enrollment in Prescription Advantage due to budget reductions but restored funds as of July 1; Wyoming closed enrollment in June. Funding shortfalls have delayed indefinitely the launch of the subsidy programs in Arizona, Arkansas, Oregon and Texas.
2002 Highlights: Hawaii, New Mexico, Ohio and Vermont enacted discount programs and Wyoming created a broader subsidy program. In January 2002 Illinois and HHS approved a Medicaid demonstration to subsidize pharmaceuticals for seniors with income up to 200 percent of poverty guidelines; five states received such approval for these "Pharmacy Plus" waivers, and nine additional others submitted applications. (By 2006 only Wisconsin had continuted their waiver.)
2001 Highlights: The North Carolina Health and Wellness Trust Fund Commission approved a program that will help cover the cost of prescription drugs for uninsured, low-income seniors. Missouri passed a subsidy plan that was signed October 5, 2001; Wisconsin enacted a subsidy program within their budget in August, 2001; Oregon enacted a subsidy program in July, 2001; Texas enacted new programs in June, 2001; Arizona enacted a new pilot program in May 2001 and Arkansas authorized a Medicaid tie-in program in April, 2001. Major expansions in eligibility were enacted in several states including Illinois, Massachusetts, Michigan, New York, Rhode Island, Maryland, Nevada and New Jersey; most of these changes took effect in 2001. In May, the Washington AWARDS discount program was "struck down" because the state agency does not have the authority to implement it without legislative approval; enrollment fees have been refunded.
Author: Richard Cauchi, NCSL Health Program ~ Denver, Colorado
Notes: Methodology: This Appendix and the main report, State Pharmaceutical Assistance Programs, is updated periodically to reflect latest laws, developments, policy adjustments and recently released statistics. As such, the report is not an academic-style survey or "snapshot" comparison of all listed programs. The main NCSL Report document will be updated regularly on the web at http://www.ncsl.org/programs/health/drugaid.htm
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