DIVISION 111. GOLDEN BEAR STATE PHARMACY ASSISTANCE PROGRAM [130400 - 130410]
( Division 111 added by Stats. 2001, Ch. 693, Sec. 2. )
(a)
This division shall be known, and may be cited as, the Golden Bear State Pharmacy Assistance Program.
(b)
As used in this division:
(1)
“Department” means the State Department of Health Services.
(2)
“Fund” means the Golden Bear State Pharmacy Assistance Program Rebate Fund.
(3)
“Medicare beneficiary” means a Medicare beneficiary who is a California resident.
(Amended by Stats. 2002, Ch. 542, Sec. 3. Effective January 1, 2003.)
(a)
In addition to participating in the program provided for under Article 24 (commencing with Section 4425) of Chapter 9 of Division 2 of the Business and Professions Code, any Medicare beneficiary may participate in the program provided for under this division.
(b)
The department shall conduct an outreach program to inform Medicare beneficiaries of their right to participate in this program. Medicare beneficiaries shall be informed of the method by which the prescription drug discount is determined and that the discount shall periodically fluctuate. No outreach material shall contain a likeness of an elected state official.
(c)
In order to participate in the program provided for under this division, a Medicare beneficiary shall be required to register on a one-time basis. Registration may be made at any pharmacy participating in this program. In order to register for the program, the Medicare beneficiary shall pay to the pharmacy an administrative fee, which the pharmacy shall retain, in an amount to be established by the department. Upon payment of this fee, the pharmacy shall issue a program registration card, which shall be prepared and provided to the pharmacy by the department, to the Medicare beneficiary.
(Amended by Stats. 2002, Ch. 542, Sec. 4. Effective January 1, 2003.)
(a)
The department may accept on behalf of the state any gift, bequest, or donation of outreach services or materials to inform eligible Medicare beneficiaries of their right to participate in this program. Neither Section 11005 of the Government Code nor any other law requiring approval by a state officer of a gift, bequest, or donation shall apply to these gifts, bequests, or donations. For purposes of this section, outreach services may include, but not be limited to, coordinating and implementing outreach efforts and plans, and outreach materials may include, but not be limited to, brochures, pamphlets, fliers, posters, advertisements, and other promotional items.
(b)
An advertisement provided as a gift, bequest, or donation pursuant to this section shall be exempt from the provisions of Article 5 (commencing with Section 11080) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code.
(Added by Stats. 2002, Ch. 542, Sec. 5. Effective January 1, 2003.)
(a)
Any pharmacy may participate in the program provided for under this division. However, this division shall apply only to prescriptions dispensed to noninstitutionalized Medicare beneficiaries.
(b)
Any drug manufacturer may participate in the program provided for under this division.
(Added by Stats. 2001, Ch. 693, Sec. 2. Effective January 1, 2002.)
(a)
The department shall attempt to negotiate rebate amounts with drug manufacturers for all prescription drugs purchased by Medicare beneficiaries. As part of these agreements, the department shall negotiate a separate fee in an amount required to administer each pharmacy claim reimbursement submitted to the department pursuant to Section 130405.
(b)
If the department determines that it is unable to negotiate rebates with a sufficient number of drug manufacturers, it may cease to continue the implementation or operation of this division.
(Amended by Stats. 2002, Ch. 542, Sec. 6. Effective January 1, 2003.)
(a)
With respect to any prescription drug for which a rebate amount has been negotiated pursuant to Section 130403, upon presentation of a program registration card issued pursuant to Section 130401, a participating pharmacy shall charge Medicare beneficiaries a price for a prescription drug that does not exceed the following computed price:
(1)
The Medi-Cal reimbursement rate for the prescription drug, and an amount, as set by the department, to cover electronic transmission charges.
(2)
The amount ascertained pursuant to paragraph (1) shall be reduced by the rebate amount negotiated by the department pursuant to Section 130403.
(b)
The pharmacy shall request, and the department shall provide, through electronic means, the price to be charged pursuant to this section.
(c)
This division shall not apply to any prescription that is covered by insurance.
(Amended by Stats. 2002, Ch. 542, Sec. 7. Effective January 1, 2003.)
Whenever a pharmacy provides a prescription drug to an individual pursuant to Section 130404, the pharmacy shall bill the department for the amount computed pursuant to paragraph (2) of subdivision (a) of Section 130404 and the department shall pay that amount.
(Added by Stats. 2001, Ch. 693, Sec. 2. Effective January 1, 2002.)
(a)
The department may collect prospective rebates from drug manufacturers for payment to pharmacies pursuant to Section 130405.
(b)
The department shall notify a drug manufacturer of all instances in which it has paid a rebate amount pursuant to Section 130405 with respect to one of the manufacturer’s drugs.
(c)
A drug manufacturer shall pay the department the amount of any rebate of which the drug manufacturer is notified pursuant to subdivision (b) that exceeds the amount collected by the department pursuant to subdivision (a).
(Amended by Stats. 2002, Ch. 542, Sec. 8. Effective January 1, 2003.)
(a)
As part of the program provided in this division, the department may establish a system to provide a Medicare beneficiary access to a drug discount program operated by a drug manufacturer that would provide greater prescription drug discounts than are otherwise available through the program provided in this division. The program registration card issued pursuant to Section 130401 shall serve as the single point of entry to the private drug discount programs of participating manufacturers.
(b)
To establish the system described in subdivision (a), the department may negotiate a contract with a drug manufacturer that operates a prescription drug discount program. To assist in these negotiations, the department may contract with a public or private entity.
(c)
(1)
A Medicare beneficiary shall not in any circumstance be required to participate in, or to disclose information that would determine his or her eligibility to participate in, these private drug discount programs in order to participate in the program provided in this division.
(2)
Notwithstanding paragraph (1), a Medicare beneficiary may voluntarily disclose or provide information that may be necessary to determine eligibility for participation in a private drug discount program.
(Added by Stats. 2002, Ch. 542, Sec. 9. Effective January 1, 2003.)
(a)
The department shall deposit all payments received pursuant to Sections 130406 and 130410 into the Golden Bear State Pharmacy Assistance Program Rebate Fund, which is hereby created in the State Treasury.
(b)
Notwithstanding Section 13340 of the Government Code, the fund is hereby continuously appropriated to the department without regard to fiscal years for the purpose of paying rebates pursuant to Section 130405 and for defraying the costs of administering this division. Notwithstanding any other law, no money in the fund is available for expenditure for any other purpose or for loaning or transferring to any other fund, including the General Fund.
(Amended by Stats. 2002, Ch. 542, Sec. 10. Effective January 1, 2003.)
The department shall repay the General Fund the loan in the amount of one million dollars ($1,000,000), which was appropriated to the department for startup costs associated with the program provided in this division.
(Added by Stats. 2002, Ch. 542, Sec. 11. Effective January 1, 2003.)
The department shall develop a program to prevent the occurrence of fraud under this division. An individual or entity that violates any provision of the fraud prevention program may be precluded from participating in the Golden Bear State Pharmacy Assistance Program. The department shall adopt regulations setting forth a procedure for precluding participation in the program on this basis.
(Amended by Stats. 2002, Ch. 542, Sec. 12. Effective January 1, 2003.)
The department may hire any staff needed for the implementation of this division. The department may also use the contract with the Medi-Cal fiscal intermediary or contract with another public or private entity to implement or administer the program and to enroll Medicare beneficiaries who are eligible to participate in the program, to collect rebates, and to pay claims, only if services provided under this program are specifically identified and reimbursed in a manner that does not claim federal financial reimbursement. For purposes of this division, use of the Medi-Cal program fiscal intermediary shall be exempt from Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code. This division shall not be implemented unless and until the director executes a declaration, which shall be retained by the director, stating that all federal approvals necessary for implementation of this division have been received.
(Amended by Stats. 2002, Ch. 542, Sec. 13. Effective January 1, 2003.)
A contract executed for the purposes of this division is exempt from Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code.
(Added by Stats. 2002, Ch. 542, Sec. 14. Effective January 1, 2003.)