Introduced by Committee on Human Services
Subject: Health; prescription drugs; Medicare Part D
Statement of purpose: This bill proposes to ensure that Vermonters eligible for Medicare and Medicaid or VPharm receive needed pharmaceuticals in a timely fashion.
AN ACT RELATING TO MEDICARE PART D PRESCRIPTION DRUG BENEFIT AND VPHARM
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. FINDINGS
The general assembly finds that:
(1) There is a public health emergency due to the federal implementation of Medicare Part D, which has resulted in serious operational problems, causing Vermonters to be turned away at the pharmacy without the drugs they need.
(2) The operational problems include: a computer processing system which fails to provide pharmacists with the information necessary to process claims; prescription drug plans which have not given Vermonters cards with information about their coverage under Part D; incorrect or insufficient information about how to resolve problems with coverage; and customer service lines which Vermonters are unable to access.
(3) Information about VPharm beneficiaries auto-enrolled into four of 11 prescription drug plans is not accessible to pharmacists, and at least 2,000 Vermonters are unable to receive coverage for drugs at the pharmacy at this time because of this problem.
(4) The office of Vermont health access, pharmacists, the area agencies on aging, the office of the Vermont health care ombudsman, and other advocates have worked tirelessly to assist Vermonters in navigating the problems and difficulties with the implementation of Medicare Part D.
Sec. 2. VPHARM TRANSITIONAL COVERAGE
(a) Notwithstanding the agency of human services rules established pursuant to Sec. 316(b) of No. 71 of the Acts of 2005 regarding coverage of pharmaceutical drugs by VPharm due to operational problems with Medicare Part D and any other conflicting provision of law, the office of Vermont health access shall provide individuals eligible for Medicare with coverage for pharmaceutical drugs if the individual meets the eligibility requirements of Vermont Rx established in chapter 19 of Title 33. An individual shall not be disqualified from coverage under Vermont Rx solely due to the individual’s eligibility for Medicare. Coverage for drugs shall be limited to the same coverage as provided under Vermont Rx.
(b) Coverage under this act shall be available until the operational problems with Medicare Part D have been resolved or at 11:59 p.m. on February 10, 2006, whichever occurs first. The office of Vermont health access may extend coverage past this date if federal operational problems continue and the appropriation under Sec. 3 of this act is sufficient.
(c) The office shall guarantee that individuals receive coverage for needed pharmaceuticals through an easy and simple process and may provide pharmacists with prior approval for coverage. The office of Vermont health access shall provide pharmacists, beneficiaries, and advocacy organizations with information about accessing coverage.
(d) The office shall pursue reimbursement from the Medicare program and entities providing Medicare Part D prescription drug plans for any state funds expended for pharmaceuticals that should have been covered by Medicare. Any reimbursement received by the Agency of Human Services under this subsection shall revert to the general fund.
Sec. 3. APPROPRIATION
(a) The sum of $7 million is appropriated from the general fund to the Agency of Human Services to provide coverage of pharmaceuticals under this act. Any unused funds appropriated for this act shall revert to the general fund and shall not be used for any other purpose.
(b) The sum of $400,000.00 is appropriated from the general fund to the department of disabilities, aging, and independent living to increase funding for the area agencies on aging for assistance to individuals in addressing Medicare Part D enrollment and operational issues.
Sec. 4. EFFECTIVE DATE
This act shall take effect upon passage.
The Vermont General Assembly
115 State Street