2003 Minnesota Statutes

     256.955 Prescription drug program. 

    Subdivision 1.    Establishment.  The commissioner of 
 human services shall establish and administer a prescription 
 drug program.  

    Subd. 2.    Definitions.  (a) For purposes of this 
 section, the following definitions apply. 

    (b) "Health plan" has the meaning provided in section 
 62Q.01, subdivision 3. 

    (c) "Health plan company" has the meaning provided in 
 section 62Q.01, subdivision 4. 

    (d) "Qualified individual" means an individual who meets 
 the requirements described in subdivision 2a or 2b, and: 

    (1) who is not determined eligible for medical assistance 
 according to section 256B.0575, who is not determined eligible 
 for medical assistance or general assistance medical care 
 without a spenddown, or who is not enrolled in MinnesotaCare; 

    (2) is not enrolled in prescription drug coverage under a 
 health plan; 

    (3) is not enrolled in prescription drug coverage under a 
 Medicare supplement plan, as defined in sections 62A.31 to 
 62A.44, or policies, contracts, or certificates that supplement 
 Medicare issued by health maintenance organizations or those 
 policies, contracts, or certificates governed by section 1833 or 
 1876 of the federal Social Security Act, United States Code, 
 title 42, section 1395, et seq., as amended; 

    (4) has not had coverage described in clauses (2) and (3) 
 for at least four months prior to application for the program; 
 and 

    (5) is a permanent resident of Minnesota as defined in 
 section 256L.09. 

    Subd. 2a.    Eligibility.  An individual satisfying the 
 following requirements and the requirements described in 
 subdivision 2, paragraph (d), is eligible for the prescription 
 drug program: 

    (1) is at least 65 years of age or older; and 

    (2) is eligible as a qualified Medicare beneficiary 
 according to section 256B.057, subdivision 3 or 3a, or is 
 eligible under section 256B.057, subdivision 3 or 3a, and is 
 also eligible for medical assistance or general assistance 
 medical care with a spenddown as defined in section 256B.056, 
 subdivision 5. 

    Subd. 2b.    Eligibility.  Effective July 1, 2002, an 
 individual satisfying the following requirements and the 
 requirements described in subdivision 2, paragraph (d), is 
 eligible for the prescription drug program: 

    (1) is under 65 years of age; and 

    (2) is eligible as a qualified Medicare beneficiary 
 according to section 256B.057, subdivision 3 or 3a or is 
 eligible under section 256B.057, subdivision 3 or 3a and is also 
 eligible for medical assistance or general assistance medical 
 care with a spenddown as defined in section 256B.056, 
 subdivision 5. 

    Subd. 3.    Prescription drug coverage.  Coverage under 
 the program shall be limited to those prescription drugs that: 

    (1) are covered under the medical assistance program as 
 described in section 256B.0625, subdivision 13; 

    (2) are provided by manufacturers that have fully executed 
 senior drug rebate agreements with the commissioner and comply 
 with such agreements; and 

    (3) for a specific enrollee, are not covered under an 
 assistance program offered by a pharmaceutical manufacturer, as 
 determined by the board on aging under section 256.975, 
 subdivision 9, except that this shall not apply to qualified 
 individuals under this section who are also eligible for medical 
 assistance with a spenddown as described in subdivisions 2a, 
 clause (2), and 2b, clause (2). 

    Subd. 4.    Application procedures and coordination with 
 medical assistance.  Applications and information on the 
 program must be made available at county social service 
 agencies, health care provider offices, and agencies and 
 organizations serving senior citizens and persons with 
 disabilities.  Individuals shall submit applications and any 
 information specified by the commissioner as being necessary to 
 verify eligibility directly to the county social service 
 agencies:  

    (1) beginning January 1, 1999, the county social service 
 agency shall determine medical assistance spenddown eligibility 
 of individuals who qualify for the prescription drug program; 
 and 

    (2) program payments will be used to reduce the spenddown 
 obligations of individuals who are determined to be eligible for 
 medical assistance with a spenddown as defined in section 
 256B.056, subdivision 5. 

 Qualified individuals who are eligible for medical assistance 
 with a spenddown shall be financially responsible for the 
 deductible amount up to the satisfaction of the spenddown.  No 
 deductible applies once the spenddown has been met.  Payments to 
 providers for prescription drugs for persons eligible under this 
 subdivision shall be reduced by the deductible.  

    County social service agencies shall determine an 
 applicant's eligibility for the program within 30 days from the 
 date the application is received.  Eligibility begins the month 
 after approval. 

    Subd. 4a.    Referrals to prescription drug assistance 
 program.  County social service agencies, in coordination with 
 the commissioner and the Minnesota Board on Aging, shall refer 
 individuals applying to the prescription drug program, or 
 enrolled in the prescription drug program, to the prescription 
 drug assistance program for all required prescription drugs that 
 the Board on Aging determines, under section 256.975, 
 subdivision 9, are covered under an assistance program offered 
 by a pharmaceutical manufacturer.  Applicants and enrollees 
 referred to the prescription drug assistance program remain 
 eligible for coverage under the prescription drug program of all 
 prescription drugs covered under subdivision 3.  The Board on 
 Aging shall phase-in participation of enrollees, over a period 
 of 90 days, after implementation of the program under section 
 256.975, subdivision 9.  This subdivision does not apply to 
 individuals who are also eligible for medical assistance with a 
 spenddown as defined in section 256B.056, subdivision 5. 

    Subd. 5.    Drug utilization review program.  The 
 commissioner shall utilize the drug utilization review program 
 as described in section 256B.0625, subdivision 13a.  

    Subd. 6.    Pharmacy reimbursement.  The commissioner 
 shall reimburse participating pharmacies for drug and dispensing 
 costs at the medical assistance reimbursement level, minus the 
 deductible required under subdivision 7. 

    Subd. 7.    Cost sharing.  Program enrollees must 
 satisfy a $420 annual deductible, based upon expenditures for 
 prescription drugs, to be paid in $35 monthly increments. 

    Subd. 8. Repealed, 1Sp2003 c 14 art 12 s 101 

    Subd. 9.    Program limitation.  The commissioner shall 
 administer the prescription drug program so that the costs total 
 no more than funds appropriated plus the drug rebate proceeds.  
 Prescription drug program rebate revenues are appropriated to 
 the commissioner and shall be expended to augment funding of the 
 prescription drug program.  New enrollment shall cease if the 
 commissioner determines that, given current enrollment, costs of 
 the program will exceed appropriated funds and rebate proceeds.  

    HIST: 1997 c 225 art 4 s 2; 1997 c 251 s 30; 1999 c 245 art 4 
 s 19-23; 2000 c 488 art 9 s 7-13,36; 1Sp2001 c 9 art 2 s 7,8; 
 2002 c 379 art 1 s 113; 1Sp2003 c 14 art 12 s 5-7 

*   NOTE:  The amendment to subdivision 3 by Laws 2003, First 
*Special Session chapter 14, article 12, section 6, is effective 
*90 days after implementation by the Board on Aging of the 
*prescription drug assistance program under section 256.975, 
*subdivision 9.  Laws 2003, First Special Session chapter 14, 
*article 12, section 6, the effective date. 

*   NOTE:  Subdivision 4a, as added by Laws 2003, First Special 
*Session chapter 14, article 12, section 7, is effective 90 days 
*after implementation by the Board on Aging of the prescription 
*drug assistance program under section 256.975, subdivision 9.  
*Laws 2003, First Special Session chapter 14, article 12, section 
*7, the effective date.