AB 259

This bill allows SeniorCare participants to purchase, per a prescription order

by the prescribing health care provider, 100-day supplies of prescription drugs

authorized under administrative rules promulgated by the Department of Health

Services and otherwise covered through the SeniorCare program, at the rates

provided under the program. The bill requires DHS to apply for any waiver or

amendment to a waiver of federal Medicaid laws necessary to permit DHS to

implement the provisions of the bill.

The SeniorCare program provides assistance to the elderly in the purchase of

prescription drugs. Under current law, to be eligible for SeniorCare, a person must

be a resident of the state, be at least 65 years of age, not be a recipient of prescription

drug coverage through Medical Assistance, have a household income that does not

exceed 240 percent of the federal poverty line, and pay a program enrollment fee.

Under current law, under the SeniorCare program, only certain maintenance drugs

specified by DHS may be dispensed in amounts up to a 100-day supply. All other

prescription drugs dispensed under the SeniorCare program may be dispensed only

in amounts not to exceed a 34-day supply.

Contingent upon approval by the federal secretary of health and human

services of a waiver or amendment to a waiver requested as required under the bill,

the bill amends the existing DHS administrative rule that allows SeniorCare

providers to dispense certain maintenance drugs in amounts up to but not exceeding

a 100-day supply, as prescribed by a physician. As amended under the bill, the DHS

administrative rule would allow SeniorCare providers to dispense the maintenance

drugs allowed under current law, or any other drug, as determined by DHS on the

basis of clinical considerations, safety, costs, and other factors. If the federal

secretary of health and human services denies the request for a waiver or an

amendment to a waiver, the bill's treatment of the administrative rule is void.