H.B. 33 Enrolled

ASSISTANCE FOR PEOPLE WITH BLEEDING
DISORDERS
2005 GENERAL SESSION
STATE OF UTAH
Chief Sponsor: David Litvack
Senate Sponsor: Gene Davis
Sheryl L. Allen
DeMar Bud Bowman
D. Gregg Buxton
Carl W. Duckworth
James R. Gowans
Neal B. HendricksonPatricia W. Jones
Bradley G. Last
Steven R. Mascaro
John G. Mathis
Ronda Rudd MenloveKaren W. Morgan
Carol Spackman Moss
Patrick Painter
Paul Ray
Larry B. Wiley
LONG TITLE
General Description:
This bill amends the Comprehensive Health Insurance Pool act to create a pilot
program, establishes a grant process in the Department of Health for assistance to
people with bleeding disorders, and creates an ongoing appropriation for fiscal year
2005-06 of $250,000 from the General Fund to a bleeding disorders assistance grant
program in the Department of Health.
Highlighted Provisions:
This bill:
. creates a five-year pilot program within the Comprehensive Health Insurance Pool
Act for disease and pharmaceutical management of bleeding disorders;
. permits enrollees in the pilot program to participate in a federal 340B discounted
drug pricing program;
. requires the Comprehensive Health Insurance Pool to report on its claims
experience and pharmaceutical costs under the pilot program;
. permits the Comprehensive Health Insurance Pool to terminate the pilot program
under certain circumstances;

. establishes a grant program within the Department of Health for assistance to people
with bleeding disorders; and
. makes technical corrections.
Monies Appropriated in this Bill:
This bill creates an ongoing appropriation of $250,000 from the General Fund to the
Department of Health, for the 2005-06 fiscal year, for a grant program to assist people
with bleeding disorders.
Other Special Clauses:
This bill provides revisor instructions.
Utah Code Sections Affected:
ENACTS:
26-47-100, Utah Code Annotated 1953
26-47-103, Utah Code Annotated 1953
31A-29-113.5, Utah Code Annotated 1953
RENUMBERS AND AMENDS:
26-47-102, (Renumbered from 26-47-101, as last amended by Chapter 280, Laws of Utah
2004)

Be it enacted by the Legislature of the state of Utah:
Section 1. Section 26-47-100 is enacted to read:
CHAPTER 47. HEALTH CARE ASSISTANCE ACT
26-47-100. Title.
This chapter is known as the "Health Care Assistance Act."
Section 2. Section 26-47-102 , which is renumbered from Section 26-47-101 is
renumbered and amended to read:
[26-47-101]. 26-47-102. Prescription Drug Assistance Program.
(1) No later than October 1, 2003, the department shall implement a Prescription Drug
Assistance Program. The program shall assist persons seeking information about how to obtain

prescription drugs at a reduced price or no cost. The program shall:
(a) collect eligibility and enrollment information about programs that make prescription
drugs available to consumers at a reduced price or no cost;
(b) provide information collected under Subsection (1)(a) to consumers upon request via
a toll-free phone line, the Internet, and mail;
(c) inform pharmacists and other health care providers of the Prescription Drug
Assistance Program; and
(d) assist consumers in completing applications to participate in programs identified
under Subsection (1)(a).
(2) Any pharmaceutical manufacturer, distributor, or wholesaler operating in the state
shall:
(a) notify the department of any program operated by it to provide prescription drugs to
consumers at a reduced price or no cost; and
(b) provide the department with information about eligibility, enrollment, and benefits.
(3) Pharmacies, as defined in Title 58, Chapter 17b, Pharmacy Practice Act, shall notify
their patients of the Prescription Drug Assistance Program. This notification shall include
displaying the program's toll-free number, and may include distributing a brochure or oral
communication.
(4) The department may accept grants, gifts, and donations of money or property for use
by the Prescription Drug Assistance Program.
(5) The department shall report to the Health and Human Services Interim Committee
and the Joint Health and Human Services Appropriations Subcommittee on the performance of
the Prescription Drug Assistance Program prior to the 2004 and 2005 Annual General Sessions
of the Legislature.
Section 3. Section 26-47-103 is enacted to read:
26-47-103. Department to award grants for assistance to persons with bleeding
disorders.
(1) For purposes of this section:

(a) "Hemophilia services" means a program for medical care, including the costs of
blood transfusions, and the use of blood derivatives and blood clotting factors.
(b) "Person with a bleeding disorder" means a person:
(i) who is medically diagnosed with hemophilia or a bleeding disorder;
(ii) who is not eligible for Medicaid or the Children's Health Insurance Program; and
(iii) who has either:
(A) insurance coverage that excludes coverage for hemophilia services;
(B) exceeded his insurance plan's annual maximum benefits;
(C) exceeded his annual or lifetime maximum benefits payable under Title 31A, Chapter
29, Comprehensive Health Insurance Pool Act; or
(D) insurance coverage available under either private health insurance, Title 31A,
Chapter 29, Comprehensive Health Insurance Pool Act, Utah mini COBRA coverage under
Section 31A-22-722 , or federal COBRA coverage, but the premiums for that coverage are greater
than a percentage of the person's annual adjusted gross income as established by the department
by administrative rule.
(2) (a) Within appropriations specified by the Legislature for this purpose, the
department shall make grants to public and nonprofit entities who assist persons with bleeding
disorders with the cost of obtaining hemophilia services or the cost of insurance premiums for
coverage of hemophilia services.
(b) Applicants for grants under this section:
(i) must be submitted to the department in writing; and
(ii) must comply with Subsection (3).
(3) Applications for grants under this section shall include:
(a) a statement of specific, measurable objectives, and the methods to be used to assess
the achievement of those objectives;
(b) a description of the personnel responsible for carrying out the activities of the grant
along with a statement justifying the use of any grant funds for the personnel;
(c) letters and other forms of evidence showing that efforts have been made to secure

financial and professional assistance and support for the services to be provided under the grant;
(d) a list of services to be provided by the applicant;
(e) the schedule of fees to be charged by the applicant; and
(f) other provisions as determined by the department.
(4) The department may accept grants, gifts, and donations of money or property for use
by the grant program.
(5) (a) The department shall establish rules in accordance with Title 63, Chapter 46a,
Utah Administrative Rulemaking Act, governing the application form, process, and criteria it
will use in awarding grants under this section.
(b) The department shall report to the Health and Human Services Interim Committee
and to the Legislative Executive Appropriations Committee by November 1, 2006, and every
year thereafter on the implementation of the grant program.
Section 4. Section 31A-29-113.5 is enacted to read:
31A-29-113.5. Pilot Program for Chronic Disease and Pharmaceutical
Management of Bleeding Disorders.
(1) Beginning July 1, 2005, and ending on July 1, 2010, the pool policy shall include a
pilot program for hemophilia and bleeding disorders in accordance with this section.
(2) In accordance with this Subsection (2), the pool's pilot program shall:
(a) permit enrollees in the pool who have hemophilia or a bleeding disorder to participate
in a pharmaceutical program for people with hemophilia and bleeding disorders administered by
an entity that is qualified as a federal 340B Drug Pricing Program of the Public Health Service
Act, enacted in Public Law 102-585, the Veterans Health Care Act of 1992;
(b) pay the eligible medical expenses for the enrollee's participation in the pilot program
subject to all applicable plan benefits and limitations; and
(c) may not impose cost containment measures on an enrollee who participates in the
pilot program greater than the cost containment measures imposed on other enrollees under the
provisions of Subsection 31A-29-113 (6).
(3) (a) The pool may establish the pilot program through the best means available for

obtaining the lowest drug discount pricing, including administering the pilot program through the
Department of Health's 340B Medicaid drug discount program or the Ryan White HIV drug
discount program.
(b) The Department of Health shall assist the pool with administering the pilot program,
including assistance in processing claims for the drug discount and chronic disease management
services.
(4) (a) The board shall report to the commissioner and to the Health and Human Services
Interim Committee prior to October 30, 2010 regarding the claims experience and
pharmaceutical costs under the pilot program.
(b) The board may discontinue the pilot program created in this section prior to July 1,
2010, if prior to discontinuing the pilot program:
(i) the board reports on the need to discontinue the pilot program to the Health and
Human Services Interim Committee and the Commerce and Revenue Appropriations
Subcommittee; and
(ii) either:
(A) the commissioner and the board determine that the requirements of the pilot program
jeopardize the actuarial soundness of the pool; or
(B) the entity that is qualified as a 340B Drug Pricing Program is disqualified by federal
law from providing 340B drug pricing discounts to enrollees in the pool.
Section 5. Appropriation.
Subject to future budget constraints, there is appropriated as an ongoing appropriation,
$250,000 for fiscal year 2005-06 from the General Fund to the Department of Health for the
purpose of funding the hemophilia and bleeding disorders grant program created in Section
26-47-103 .
Section 6. Revisor instructions.
It is the intent of the Legislature that, in preparing the Utah Code database for publication,
the Office of Legislative Research and General Counsel shall renumber Section 26-47-100 to
Section 26-47-101 .