2001 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, 3a, or 3b, clause 
 (1), or is eligible under section 256B.057, subdivision 3, 3a, 
 or 3b, clause (1), 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; and 

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

    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. 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.    Report.  The commissioner shall annually 
 report to the legislature on the prescription drug program.  The 
 report must include demographic information on enrollees, 
 per-prescription expenditures, total program expenditures, 
 hospital and nursing home costs avoided by enrollees, any 
 savings to medical assistance and Medicare resulting from the 
 provision of prescription drug coverage under Medicare by health 
 maintenance organizations, other public and private options for 
 drug assistance to the covered population, any hardships caused 
 by the annual deductible, and any recommendations for changes in 
 the prescription drug program. 

    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 

*   NOTE:  The amendment to subdivision 2b by Laws 2001, First 
*Special Session chapter 9, article 2, section 8, is effective 
*July 1, 2002.  Laws 2001, First Special Session chapter 9, 
*article 2, section 8, the effective date.