53-6-1002. Prescription drug expansion program -- rules. (1) By July 1, 2004, or upon securing any necessary waivers, the department shall provide for an expansion of prescription drug benefits under the medicaid program by offering prescription drugs at a discounted price to qualified individuals whose income is at a level set by the department at or below 200% of the federal poverty level. Subject to subsection (7), the department shall charge an annual application fee of $25 for the program. The application fee must be deposited in the medicaid prescription drug rebate account established in subsection (2).
     (2) There is a medicaid prescription drug 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 medicaid prescription drug expansion program must be deposited in the account. The money in the account, which is administered by the department, must be used to expand medicaid prescription drug benefits. Interest on account balances accrues to the account. The purpose of the account is to:
     (a) reimburse participating retail pharmacies for the discount on the average wholesale price of prescription drugs provided to qualified residents pursuant to this part; and
     (b) reimburse the department for contracted services, administrative costs, associated computer costs, professional fees paid to participating retail pharmacies, 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. The rules may be based upon rules adopted in other states to administer similar programs.
     (5) The department shall adopt rules to establish the discounted price to be charged to participants in the program. The department may establish a 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 200% 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 cards to eligible individuals.
     (7) Establishment of the prescription drug expansion program is contingent upon approval by the federal government that the program in this part will qualify for federal financial participation under federal laws implementing the medicaid program. The department may adopt rules necessary to implement conditions required by federal law or conditions required as part of the federal government's agreement to waive certain requirements of federal law.
     (8) If program costs are expected to exceed the legislative authorization for the program, the department shall adjust discounted prices, the application fee, or eligibility standards to maintain the program within the available funding.

     History: En. Sec. 2, Ch. 551, L. 2003.