H.B. 267

1

UTAH PHARMACEUTICAL INSURANCE
2 PROGRAM
3 2004 GENERAL SESSION
4 STATE OF UTAH
5 Sponsor: David L. Hogue
6
7 LONG TITLE
8 General Description:
9 This bill creates the Utah Pharmaceutical Insurance Program.
10 Highlighted Provisions:
11 This bill:
12 . creates the Utah Pharmaceutical Insurance Program within the Department of
13 Health;
14 . provides definitions;
15 . establishes eligibility criteria;
16 . specifies benefits;
17 . specifies premium and cost sharing amounts;
18 . designates program revenues as dedicated credits for use by the program;
19 . allows a percentage of program appropriations to be used for administrative costs;
20 . requires annual reporting to the Health and Human Services Appropriations
21 Subcommittee; and
22 . grants rulemaking authority to the Department of Health.
23 Monies Appropriated in this Bill:
24 None
25 Other Special Clauses:
26 None
27 Utah Code Sections Affected:

28 ENACTS:
29 26-47-201, Utah Code Annotated 1953
30 26-47-202, Utah Code Annotated 1953
31 26-47-203, Utah Code Annotated 1953
32 26-47-204, Utah Code Annotated 1953
33 26-47-205, Utah Code Annotated 1953
34 26-47-206, Utah Code Annotated 1953
35 26-47-207, Utah Code Annotated 1953
36 26-47-208, Utah Code Annotated 1953
37
38 Be it enacted by the Legislature of the state of Utah:
39 Section 1. Section 26-47-201 is enacted to read:
40 Part 2. Utah Pharmaceutical Insurance Program
41 26-47-201. Creation of program.
42 There is created within the department the Utah Pharmaceutical Insurance Program.
43 The department shall implement and administer the program in accordance with this Part 2 no
44 later than October 1, 2004.
45 Section 2. Section 26-47-202 is enacted to read:
46 26-47-202. Definitions.
47 As used in this part:
48 (1) "Access":
49 (a) shall be defined by administrative rule;
50 (b) may be based upon various factors, including one's ability to pay premiums,
51 deductibles, copays, and other costs associated with a pharmaceutical benefit plan or health
52 benefit plan; and
53 (c) shall include access through a relative's health benefit plan.
54 (2) "Medicare prescription drug plan":
55 (a) means a Medicare prescription drug plan authorized by Congress after September 1,
56 2003; and
57 (b) does not include a Medicare plan or Medigap plan.
58 (3) "Pharmaceutical benefit plan or health benefit plan":

59 (a) shall be defined by administrative rule;
60 (b) includes:
61 (i) programs under Chapter 18, Medical Assistance Act;
62 (ii) the Utah Children's Health Insurance Program under Chapter 40, Utah Children's
63 Health Insurance Act;
64 (iii) the Utah Comprehensive Health Insurance Pool under Title 31A, Chapter 29,
65 Comprehensive Health Insurance Pool Act;
66 (iv) a health benefit plan as defined in Section 31A-1-301 ;
67 (v) a Medicare plan;
68 (vi) a Medicare prescription drug plan; and
69 (vii) a Medigap plan; and
70 (c) does not include a manufacturer's prescription drug assistance program under
71 Chapter 47, Prescription Drug Assistance.
72 Section 3. Section 26-47-203 is enacted to read:
73 26-47-203. Eligibility criteria.
74 (1) To enroll in the Utah Pharmaceutical Insurance Program, a person must:
75 (a) be at least 19 years of age;
76 (b) be a resident of the state and a citizen of the United States;
77 (c) reside in a household with a gross family income of 200% of the federal poverty
78 level or less;
79 (d) not have access to pharmaceutical benefits under a public or private pharmaceutical
80 benefit plan or health benefit plan; and
81 (e) not be an inmate or a patient in a public institution, as defined by administrative
82 rule.
83 (2) An enrollee who becomes ineligible under Subsection (1) and fails to immediately
84 notify the department shall reimburse the program for the benefits received during the period of
85 ineligibility.
86 (3) A person may not be denied enrollment in the program based on health status.
87 (4) The department may limit enrollment in the program so that program expenditures
88 do not exceed program revenues.
89 Section 4. Section 26-47-204 is enacted to read:

90 26-47-204. Program benefits -- Limits.
91 (1) The Utah Pharmaceutical Insurance Program shall provide to each enrollee, on an
92 individual basis, one of the following:
93 (a) coverage for four prescriptions per month; or
94 (b) premium assistance for the enrollee in an amount established by the department to
95 obtain coverage under:
96 (i) a Medicare prescription drug plan;
97 (ii) a Medicare-qualified retirement plan actuarially equivalent to a Medicare
98 prescription drug plan; or
99 (iii) a Medigap plan with a pharmaceutical benefit.
100 (2) An enrollee may choose which benefit to receive under Subsection (1).
101 (3) Beginning July 1, 2006, the department may modify the benefit limit in Subsection
102 (1)(a) by administrative rule.
103 (4) The department may, by administrative rule, exclude selected pharmaceuticals from
104 the program.
105 Section 5. Section 26-47-205 is enacted to read:
106 26-47-205. Premium -- Cost sharing.
107 (1) An enrollee in the Utah Pharmaceutical Insurance Program shall pay:
108 (a) a $100 annual premium; and
109 (b) if the enrollee receives coverage for prescriptions:
110 (i) for generic pharmaceuticals, $15 per prescription; and
111 (ii) for nongeneric pharmaceuticals:
112 (A) if a generic equivalent is not available, 15% of the cost of the prescription; and
113 (B) if a generic equivalent is available, 30% of the cost of the prescription.
114 (2) Beginning July 1, 2006, the department may modify the premium and cost sharing
115 provisions in Subsection (1) by administrative rule.
116 Section 6. Section 26-47-206 is enacted to read:
117 26-47-206. Dedicated credits -- Administrative costs.
118 (1) Revenues received by the Utah Pharmaceutical Insurance Program shall be
119 deposited in the General Fund as dedicated credits for use by the program.
120 (2) The department may use up to 5% of funds appropriated to the program to pay for

121 actual costs of administering the program.
122 Section 7. Section 26-47-207 is enacted to read:
123 26-47-207. Reporting.
124 The department shall submit an annual financial report for the Utah Pharmaceutical
125 Insurance Program to the Health and Human Services Appropriations Subcommittee.
126 Section 8. Section 26-47-208 is enacted to read:
127 26-47-208. Rulemaking authority.
128 The department shall make rules in accordance with Title 63, Chapter 46a, Utah
129 Administrative Rulemaking Act, to implement the Utah Pharmaceutical Insurance Program in
130 accordance with this part.




Legislative Review Note
as of 1-30-04 4:19 PM

A limited legal review of this legislation raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel