Bills › 88th General Assembly
Where it is now
- Done: IntroducedMarch 11, 2019
- Done: SubcommitteeMarch 5, 2019
- Done: House committeeMarch 7, 2019
- Stopped: Passes the HouseDied when the General Assembly ended
- Next: Senate committee
- Next: Passes the Senate
- Next: To the Governor
- Next: Signed into law
Died when the session ended The 2020 session adjourned on June 14, 2020, the General Assembly’s last regular session. Bills that didn’t pass both chambers died. What’s a funnel?
What’s in it
AI summary If a pharmacy gives a patient only part of their medicine at one time, they cannot charge extra dispensing fees for the second trip. This rule ensures that Medicaid patients and those using certain insurance plans are only charged one standard fee for a single prescription, even if the medicine is picked up in multiple parts.1
Read the official explanation
This bill relates to the dispensing fee for partially dispensed prescriptions. The bill requires the department of human services to adopt administrative rules to require that if a Medicaid provider who is authorized to dispense prescription drugs pursuant to Code chapter 155A (pharmacy) initially dispenses a partial quantity of a prescription drug authorized by a prescription, and subsequently dispenses the remaining quantity as authorized by the prescription, the total dispensing fee charged by the provider for that prescription shall not exceed the standard dispensing fee applicable to the same prescription as if the total quantity authorized had been dispensed at one time. The provision applies whether the partial dispensing of a quantity authorized by a prescription is due to a policy of the authorized dispenser, a supply deficit, or for any other reason. The bill also requires this provision for an authorized dispenser under Code chapter 155A (pharmacy) and under third-party payment provider contracts or policies delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2020.
House subcommittee
Named March 5, 2019. On March 7, 2019 it recommended passage.
Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part
Fiscal note
AI summary This bill requires pharmacies to charge only one dispensing fee per month for a specific drug, even if the prescription is filled in multiple smaller amounts. The Medicaid Program is estimated to save $169,000 in fiscal year 2020 and $469,000 in fiscal year 2021 and subsequent fiscal years, which includes a $300,000 one-time cost to the state. Managed care companies will face a one-time cost of $1,000,000 for programming expenses to implement this policy.3
Read the fiscal note
Description
House File 696 directs the Department of Human Services (DHS) to adopt administrative rules to require that if a Medicaid provider who is authorized to dispense prescription drugs initially dispenses a partial quantity of a prescription drug authorized by a prescription, and subsequently dispenses the remaining quantity as authorized by the prescription, the total dispensing fee charged by the provider for that prescription shall not exceed the standard dispensing fee applicable to the same prescription as if the total quantity authorized had been dispensed at one time. The Bill applies the same requirement to authorized dispensers under third-party payment provider contracts or policies delivered, issued for delivery, continued, or renewed in this State on or after January 1, 2020, that provide for third-party payment or prepayment of health or medical expenses.
Background
The Bill addresses the issue of some pharmacies being reimbursed multiple dispensing fees per month for the same patient and same drug for small drug quantities (e.g., seven days’ supply), while other pharmacies receive one dispensing fee for a one-month supply. The intent is for Medicaid to pay one dispensing fee per month per drug, whether that be for one fill for 31 days or for multiple fills for up to 31 days.
Assumptions
- The DHS will save $1,563,000 annually by paying one dispensing fee per month per drug.
- The fee-for-service (FFS) Pharmacy Point of Sale (POS) system does not currently support the partial fill segment of the National Council for Prescription Drug Programs (NCPDP) standards and would require programming changes to implement these changes.
- The programming changes for FFS are estimated to take 300 to 400 hours. There are 10,000 programming hours per year built into the current contract, so no additional cost is anticipated for FFS.
- There will be a $1,000,000 one-time cost to the managed care companies for programming expenses to implement the new policy.
- The Federal Medical Assistance Percentage (FMAP) rate is 70.0% federal and 30.0% State based on a blended rate between Medicaid and the Iowa Health and Wellness Plan prescription drug costs.
Fiscal Impact
House File 696 is estimated to save the Medicaid Program $169,000 in FY 2020 and $469,000 in FY 2021 and subsequent fiscal years. This includes a $300,000 one-time cost to the State to implement the policy change.
Source
- Department of Human Services
- Pharmacy Dispensing Fee Limitation · March 18, 2019 · $469,000
Iowa Code it changes
Lobbying
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88th General Assembly