130th Ohio General Assembly
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H. B. No. 290As Introduced
As Introduced

124th General Assembly
Regular Session
2001-2002
H. B. No. 290


REPRESENTATIVES D. Miller, Jerse, Patton, Barnes, Britton, Distel, Sykes, Allen, Cirelli, Jones, Strahorn, Barrett, Fedor, Beatty, Key, Krupinski, Metelsky, Sferra, Lendrum, S. Smith, Woodard, Boccieri, Rhine, Coates, Carano



A BILL
To enact sections 5110.01, 5110.02, 5110.03, 5110.04, 5110.06, 5110.07, 5110.08, 5110.09, 5110.10, 5110.12, 5110.15, 5110.16, 5110.18, 5110.19, 5110.20, 5110.21, 5110.25, 5110.26, 5110.27, and 5110.28 of the Revised Code to create the Rx Program.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1.  That sections 5110.01, 5110.02, 5110.03, 5110.04, 5110.06, 5110.07, 5110.08, 5110.09, 5110.10, 5110.12, 5110.15, 5110.16, 5110.18, 5110.19, 5110.20, 5110.21, 5110.25, 5110.26, 5110.27, and 5110.28 of the Revised Code be enacted to read as follows:
Sec. 5110.01.  As used in this chapter:
(A) "Manufacturer of dangerous drugs," "terminal distributor of dangerous drugs," and "wholesale distributor of dangerous drugs" have the same meanings as in section 4729.01 of the Revised Code.
(B) "Medicaid" has the same meaning as in section 5111.01 of the Revised Code.
(C) "Prescription drug" means a dangerous drug as defined in division (F)(1) of section 4729.01 of the Revised Code.
(D) "Rx program participant" means an individual determined eligible for the Rx program and issued an Rx program enrollment card.
(E) "State health program" means a health program that is funded in whole or part with state funds or administered by a state agency.
Sec. 5110.02.  There is hereby established in the department of job and family services the Rx program. An Rx program participant shall receive an Rx program enrollment card to be presented to terminal distributors of dangerous drugs to receive discounts provided for under section 5110.15 of the Revised Code on prescription drugs covered by the program pursuant to section 5110.27 of the Revised Code.
Sec. 5110.03.  The director of job and family services may coordinate the Rx program with other programs administered by the director or, pursuant to an interagency agreement, directors of other state departments, to enhance efficiency, reduce the cost of prescription drugs, and maximize the benefits of the Rx program and other programs. Coordination may include making participants of other programs eligible for the Rx program.
Sec. 5110.04.  There is hereby created in the state treasury the Rx program fund. The fund shall consist of rebates made by manufacturers of dangerous drugs and wholesale distributors of dangerous drugs pursuant to rebate agreements entered into under section 5110.25 of the Revised Code and money the general assembly appropriates for the Rx program. The director of job and family services shall use money in the fund to reimburse a terminal distributor of dangerous drugs the amount of the discount the terminal distributor provides an Rx program participant on a prescription drug pursuant to section 5110.15 of the Revised Code and pay the terminal distributor a professional fee established by rules adopted under section 5110.06 of the Revised Code. The director shall also use money in the fund to pay the administrative costs of the Rx program, including administrative costs associated with contracted services, computers, and other reasonable administrative matters. Investment earnings of the fund shall be credited to the fund.
Sec. 5110.06.  The director of job and family services shall adopt rules in accordance with Chapter 119. of the Revised Code to implement the Rx program. The rules shall provide for all of the following:
(A) Simplified eligibility determination procedures for the Rx program;
(B) The manner in which a terminal distributor of dangerous drugs shall disclose to an Rx program participant the amount the program has saved the participant on the cost of a prescription drug covered by the Rx program that the participant purchases from the terminal distributor. The rules shall not require a terminal distributor of dangerous drugs to reveal any proprietary information.
(C) Claim forms to be used by a terminal distributor of dangerous drugs under section 5110.18 of the Revised Code;
(D) The amount of the professional fee to be paid to terminal distributors of dangerous drugs pursuant to section 5110.19 of the Revised Code. The professional fee shall be three dollars initially. The director shall review the professional-fee amount periodically to determine whether it should be increased.
(E) A schedule for manufacturers of dangerous drugs and wholesale distributors of dangerous drugs to pay rebates to the director pursuant to a rebate agreement entered into under section 5110.25 of the Revised Code;
(F) Notwithstanding this chapter, adjustments to the requirements and terms of the Rx program to accommodate any federally funded prescription drug programs created after the effective date of this section.
Sec. 5110.07.  The director of job and family services shall seek a waiver of federal law or regulation if necessary to implement the Rx program.
Sec. 5110.08.  The director of job and family services shall report enrollment in and the financial status of the Rx program to the speaker and minority leader of the house of representatives and the president and minority leader of the senate not later than the second week of each January.
Sec. 5110.09.  The director of job and family services shall undertake outreach efforts to publicize the Rx program and maximize enrollment in the program.
Sec. 5110.10.  An individual who is a resident of this state is eligible to participate in the Rx program.
Sec. 5110.12.  An individual seeking to participate in the Rx program shall apply to the Ohio department of job and family services.
Sec. 5110.15.  Each terminal distributor of dangerous drugs shall discount the amount it charges an Rx program participant for a prescription drug covered by the program. The amount of the discount shall be the amount of the rebate a manufacturer of dangerous drugs or wholesale distributor of dangerous drugs pays the director of job and family services for the prescription drug pursuant to a rebate agreement entered into under section 5110.25 of the Revised Code.
Sec. 5110.16.  In accordance with rules adopted under section 5110.06 of the Revised Code, a terminal distributor of dangerous drugs shall disclose to an Rx program participant the amount the program has saved the participant on the cost of a prescription drug covered by the program that the participant purchases from the terminal distributor.
Sec. 5110.18.  A terminal distributor of dangerous drugs that provides an Rx program participant a discount on a prescription drug pursuant to section 5110.15 of the Revised Code shall submit a claim to the director of job and family services verifying the amount the terminal distributor charged the participant for the prescription drug. The terminal distributor shall use a claim form prescribed in rules adopted under section 5110.06 of the Revised Code.
Sec. 5110.19.  Using claims submitted by a terminal distributor of dangerous drugs under section 5110.18 of the Revised Code, the director of job and family services shall reimburse a terminal distributor of dangerous drugs the amount of the discount the terminal distributor provides an Rx program participant on a prescription drug pursuant to section 5110.15 of the Revised Code and pay the terminal distributor the professional fee established by rules adopted under section 5110.06 of the Revised Code for each claim. The director shall make the reimbursements and payments on a weekly or biweekly basis.
Sec. 5110.20.  The director of job and family services shall not impose a transaction charge on a terminal distributor of dangerous drugs that submits a claim under section 5110.18 of the Revised Code.
Sec. 5110.21.  The director of job and family services shall not release any information included on a claim submitted to the director under section 5110.18 of the Revised Code that is subject to confidentiality protection under federal or state law.
Sec. 5110.25.  Each manufacturer of dangerous drugs and wholesale distributor of dangerous drugs that sells prescription drugs through a state health program may enter into a rebate agreement with the director of job and family services under which the manufacturer or wholesale distributor is to make rebate payments to the director on a quarterly basis or in accordance with a schedule established by rules adopted under section 5110.06 of the Revised Code.
Sec. 5110.26.  The director of job and family services shall negotiate with each manufacturer of dangerous drugs and wholesale distributor of dangerous drugs that enters into a rebate agreement with the director under section 5110.25 of the Revised Code the amount of the rebate the manufacturer or wholesale distributor shall pay to the director under that section. In the process of negotiations, the director shall do both of the following:
(A) Take into consideration rebates provided for under 42 U.S.C.A. 1396r-8, the average wholesale price of prescription drugs, and any other information on prescription drug prices and price discounts available to the director;
(B) Use the director's best efforts to obtain a rebate amount that is at least as much as the amount of the rebate provided for under 42 U.S.C.A. 1396r-8 or not less than the amount the federal government receives as a discount, rebate, or price reduction for prescription drugs.
Sec. 5110.27.  The Rx program shall cover a prescription drug if the prescription drug is included in a rebate agreement entered into under section 5110.25 of the Revised Code.
Sec. 5110.28. The director of job and family services shall do both of the following with respect to manufacturers of dangerous drugs and wholesale distributors of dangerous drugs that do not enter into a rebate agreement under section 5110.25 of the Revised Code:
(A) Maintain a list of all those manufacturers and wholesale distributors and make it available to the public;
(B) Require all prescription drugs manufactured by those manufacturers and distributed by those wholesale distributors to receive prior authorization by the department of job and family services pursuant to 42 U.S.C. 1396r-8 before the costs of those drugs may be reimbursed under medicaid.
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