CHAPTER 17

FORMERLY

SENATE BILL NO. 18

AS AMENDED BY

SENATE AMENDMENT NO. 1

AN ACT TO AMEND TITLE 16 OF THE DELAWARE CODE RELATING TO THE DELAWARE PRESCRIPTION DRUG PAYMENT PROGRAM.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE :

Section 1. AMEND § 3002B, Title 16, Delaware Code, by including the phrase “and certain Medicare Part D costs” after the phrase “prescription drugs” and before the phrase “to Delaware’s low-income and disabled citizens”, and by including the phrase “(excluding Medicare Part D coverage)” after the word “federal” and before the phrase “state or private sources”.

Section 2. AMEND § 3003B, Title 16, Delaware Code, by adding a new subsection (f) as follows:

“(f) ‘Medicare Part D costs’ shall mean monthly premiums, deductibles and those drug costs falling into Part D coverage gap up to the Program benefit limits and subject to Program co-pay requirements as described in §3005B(a)(4). Medicare Part D costs do not include Medicare Part D co-payments.”

Section 3. AMEND § 3004B, Title 16, Delaware Code, by deleting the phrase “payment assistance for prescription drugs” as it appears in the first line and substituting in lieu thereof the phrase “the Program”.

Section 4. AMEND § 3004B(6), Title 16, Delaware Code, by deleting the phrase “through a Medicare Supplemental Policy” and the word “other” as they appear in that subsection.

Section 5. AMEND § 3004B(6), Title 16, Delaware Code, by deleting the word “and” as it appears at the end of that subsection, and by adding the phrase “(excluding Medicare Part D coverage);” after the phrase “third party payer prescription benefit”.

Section 6. AMEND § 3004B, Title 16, Delaware Code, by adding a new subsection (7) as follows:

“(7) Be enrolled in Medicare Part D and Medicare Part D Low Income Subsidy if eligible; and”

Section 7. AMEND § 3004B, Title 16, Delaware Code, by renumbering the remaining subsections as necessary.

Section 8. AMEND § 3005B(a), Title 16, Delaware Code, by deleting paragraphs (1)-(7) in their entirety and substituting in lieu thereof:

“(1) Payment assistance shall not exceed $2,500 in a benefit year to assist each eligible person in the purchase of prescription drugs and the payment of certain Medicare Part D costs.

(2) Medicare Part D coverage will be primary to payment assistance under the Program.

(3) The Department shall restrict covered prescription drugs covered under the Program to those manufactured by pharmaceutical companies that agree to provide manufacturer rebates under the drug rebate program established for non-Medicaid programs. The Department shall establish a State rebate program that it determines is in the best interests of the citizens who are being served. The rebate amount shall be calculated using the full methodology prescribed by the Federal government for the Medicaid program. Notwithstanding any provisions of the Delaware Code to the contrary, the Department shall deposit any drug rebate funds received into the appropriate Social Services program account and be used to meet program costs.

(4) The Department shall develop a co-payment requirement, which shall not exceed 25% of the acquisition cost but shall be no lower than $5. Co-payment amounts may vary when a generic drug is purchased by eligible persons in the Program. These same co-payment amounts shall apply to prescription drug costs not covered by Medicare Part D. The co-payment may be waived in cases of severe hardship.

(5) The Secretary or the Secretary's designee shall provide a clear, written explanation defining the scope of the Program's coverage, the amount of the cost-sharing requirements and any limitations on access to covered prescription drugs. The Department shall provide notice, when 75% of the cap has been expended. The Department will also notify persons of the process to appeal a decision denying reimbursement for prescription drugs or denying a person's eligibility for the Program. Services shall begin on the 1st day of the month, following the month that eligibility is determined. Eligible individuals will receive an identification card for the Program.

(6) No drug prescription may exceed 100 dosing units or a 34-day supply, whichever is greater.

(7) No system of administration shall make direct cash payment to any eligible person.”

Section 10. AMEND § 3005B(b)(2), Title 16, Delaware Code, by deleting the word “fiscal” as it appears throughout that subsection.

Section 11. AMEND § 3006B, Title 16, Delaware Code, by deleting the phrase “Semi-annual report” as it appears in the heading and throughout that subsection, and substituting in lieu thereof the phrase “Annual Report”.

Section 12. This Act shall become effective on January 1, 2006.

Approved April 26, 2005