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Chapter 256

Section 256.955

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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 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 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 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; 2004 c 288 art 6 s 18-20

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Revisor of Statutes