Sec. C-1. 22 MRSA §254-A, as amended by PL 2001, c. 691, §2 and affected by §6, is repealed.
Sec. C-2. 22 MRSA §258, sub-§1, ¶A, as enacted by PL 2001, c. 293, §5, is amended to read:
A. "Elderly low-cost drug program" means the program established as part of the Healthy Maine Prescription Program pursuant to section 254 254-D.
Sec. C-3. 22 MRSA §2681, sub-§3, as enacted by PL 1999, c. 786, Pt. A, §3, is amended to read:
3. Rebate agreement. A drug manufacturer or labeler that sells prescription drugs in this State through the elderly low-cost drug program under section 254 254-D or any other publicly supported pharmaceutical assistance program shall enter into a rebate agreement with the department for this program. The rebate agreement must require the manufacturer or labeler to make rebate payments to the State each calendar quarter or according to a schedule established by the department.
Sec. C-4. 22 MRSA §2681, sub-§9, as amended by PL 2003, c. 494, §8, is further amended to read:
9. Dedicated fund. The Maine Rx Plus Dedicated Fund, referred to in this section as the "fund," is established to receive revenue from manufacturers and labelers who pay rebates as provided in subsection 4 and any appropriations or allocations designated for the fund. The purposes of the fund are to reimburse retail pharmacies for discounted prices provided to qualified residents pursuant to subsection 5; to reimburse the department for contracted services including pharmacy claims processing fees, administrative and associated computer costs and other reasonable program costs; and to benefit the elderly low-cost drug program under section 254 254-D. The fund is a nonlapsing dedicated fund. Interest on fund balances accrues to the fund. Surplus funds in the fund must be used for the benefit of the program. Notwithstanding Title 5, section 1585, surplus funds may also be transferred to the elderly low-cost drug program established under section 254 254-D.
Sec. C-5. 22 MRSA §3174-G, sub-§1-B, as amended by PL 2001, c. 650, §2, is further amended to read:
1-B. Funding. State funds necessary to implement subsection 1-C must include General Fund appropriations and Other Special Revenue allocations from the Fund for a Healthy Maine to the elderly low-cost drug program operated pursuant to section 254 254-D, including rebates received in that program from pharmaceutical manufacturers, that are no longer needed in that program as a result of the Medicaid waiver obtained pursuant to subsection 1-C.
Sec. C-6. 22 MRSA §3174-G, sub-§1-C, as enacted by PL 2001, c. 650, §3, is amended to read:
1-C. Prescription drug waiver program. Except as provided in paragraph G, the department shall apply to the federal Centers for Medicare and Medicaid Services for a waiver or amend a pending or current waiver under the Medicaid program authorizing the department to use federal matching dollars to enhance the prescription drug benefits available to persons who qualify for the elderly low-cost drug program established under section 254 254-D. The program created pursuant to the waiver is the prescription drug waiver program, referred to in this subsection as the "program."
A. As funds permit, the department has the authority to establish income eligibility levels for the program up to and including 200% of the federal nonfarm income official poverty level, except that for individuals in households that spend at least 40% of income on unreimbursed direct medical expenses for prescription medications, the income eligibility level is increased by 25%.
B. To the extent reasonably achievable under the federal waiver process, the program must include the full range of prescription drugs provided under the Medicaid program on the effective date of this subsection and must limit copayments and cost sharing for participants. If cost sharing above the nominal cost sharing for the Medicaid program is determined to be necessary, the department may use a sliding scale to minimize the financial burden on lower-income participants.
C. Coverage under the program may not be less beneficial to persons who meet the qualifications of former section 254 than the coverage available under that section on September 30, 2001.
D. In determining enrollee benefits under the program, to the extent possible, the department shall give equitable treatment to coverage of prescription medications for cancer, Alzheimer's disease and behavioral health.
E. The department is authorized to provide funding for the program by using funds appropriated or allocated to provide prescription drugs under sections 254 254-D and 258.
Sec. C-7. 24-A MRSA §5002-B, sub-§2-A, as enacted by PL 2001, c. 410, Pt. B, §7, is amended to read:
2-A. Low-cost drugs for the elderly or disabled program. An issuer that offers standardized plans that include prescription drug benefits shall permit an insured who has a plan from the same issuer without prescription drug benefits to purchase a plan with prescription drug benefits under the following circumstances:
A. The insured was covered under the low-cost drugs for the elderly or disabled program established by Title 22, former section 254 or section 254-D;
B. The insured applies for a plan with prescription drug coverage within 90 days after losing eligibility for the low-cost drugs for the elderly or disabled program established by Title 22, former section 254 or section 254-D; and
C. The insured either:
(1) Had a Medicare supplement plan with prescription drug benefits from the same issuer prior to enrolling in the low-cost drugs for the elderly or disabled program established by Title 22, former section 254 or section 254-D; or
(2) Is entitled to continuity of coverage pursuant to subsection 1 and has had prescription drug benefits, through either a Medicare supplement plan or the low-cost drugs for the elderly or disabled program established by Title 22, section 254 254-D, since the insured's open enrollment period with no gap in prescription drug coverage in excess of 90 days.
The purchase of a plan with prescription drug benefits by an insured pursuant to this subsection does not affect eligibility for coverage under the low-cost drugs for the elderly or disabled program established by Title 22, section 254 254-D if the insured is not covered by a Medicare supplement plan with prescription drug benefits at the time of reapplying for coverage under the low-cost drugs for the elderly or disabled program established by Title 22, section 254 254-D.
Effective September 17, 2005.
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