2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 10. Prescription Drug Plus Discount Program › 53-6-1002. Prescription drug plus discount program -- rules

53-6-1002. Prescription drug plus discount program -- rules.
(1) The department may provide for a prescription drug plus discount program offering prescription drugs at a discounted price to qualified individuals whose income is at a level set by the department at or below 250% of the federal poverty level and who meet the requirements in 53-6-1003.
(2) There is a prescription drug plus discount program rebate account in the state special revenue fund to the credit of the department. All money received by the state as rebates from pharmaceutical manufacturers for the program must be deposited in the account. The money in the account, which is administered by the department, must be used to expand prescription drug benefits to qualified individuals. Interest on account balances accrues to the account. The purpose of the account is to:
(a) reimburse participating retail pharmacies for the secondary discounted price; and
(b) reimburse the department for contracted services, administrative costs, associated computer costs, professional fees paid to participating retail pharmacies, pharmacy benefit administrators, and other reasonable program costs.
(3) The department shall provide for sufficient personnel to ensure efficient administration of the program. The extent and the magnitude of the program must be determined by the department on the basis of the calculated need of the recipient population and available funds. The department may not spend more on this program than is available through appropriations, federal or other grants, and other established and committed funding sources. The department may accept, for the purposes of carrying out this program, federal funds appropriated under any federal law relating to the furnishing of free or low-cost drugs to disadvantaged, elderly, and disabled individuals, may take action that is necessary for the purposes of carrying out that federal law, and may accept from any other agency of government, individual, group, or corporation funds that may be available to carry out this part.
(4) The department may adopt rules relating to the conduct of this program.
(5) The department shall, if the department determines that sufficient funds are available, adopt rules to establish the secondary discounted price to be charged to participants in the program. The department may establish a secondary discounted price to encourage the use of generic drugs over higher-cost brand-name drugs.
(6) The department shall establish by rule eligibility based upon the applicant's family income as provided in 53-6-1003. The total income may not exceed 250% of the federal poverty level. The department may adopt rules defining income. In establishing eligibility based upon income, the department shall take into account the amount of funding available for the program. The department shall issue enrollment materials to eligible individuals.
(7) Establishment of the program is contingent upon compliance with all applicable federal laws. The department may adopt rules necessary to implement conditions required by federal law.
(8) If program costs are expected to exceed the legislative authorization for the program, the department shall adjust discounted prices or eligibility standards to maintain the program within the available funding.
(9) Participation in the program by a pharmacy or a pharmaceutical manufacturer is voluntary.
(10) (a) The department may not contract with either an in-state or out-of-state mail service pharmacy, as defined in 37-7-702, for the purposes of the program for at least 1 year after persons eligible for the program have begun to purchase drugs through the program. At that time, the department shall evaluate the number of pharmacies within the state providing prescription drugs as part of the program.
(b) If the department determines that there are insufficient pharmacies participating in the program to allow reasonable access to persons qualified to purchase prescription drugs through the program, it may, after the evaluation provided for in subsection (10)(a), use one or more in-state or out-of-state mail service pharmacies, or both, for the purposes of the program.
History: En. Sec. 2, Ch. 551, L. 2003; amd. Sec. 5, Ch. 287, L. 2005.