SECTIONS 130400-130410 - California Statutes

HEALTH AND SAFETY CODE

SECTION 130400-130410

130400. (a) This division shall be known, and may be cited as, the
Golden Bear State Pharmacy Assistance Program.
(b) As used in this division:
(1) "Department" means the State Department of Health Services.
(2) "Fund" means the Golden Bear State Pharmacy Assistance Program
Rebate Fund.
(3) "Medicare beneficiary" means a Medicare beneficiary who is a
California resident.

130401. (a) In addition to participating in the program provided
for under Article 24 (commencing with Section 4425) of Chapter 9 of
Division 2 of the Business and Professions Code, any Medicare
beneficiary may participate in the program provided for under this
division.
(b) The department shall conduct an outreach program to inform
Medicare beneficiaries of their right to participate in this program.
Medicare beneficiaries shall be informed of the method by which the
prescription drug discount is determined and that the discount shall
periodically fluctuate. No outreach material shall contain a likeness
of an elected state official.
(c) In order to participate in the program provided for under this
division, a Medicare beneficiary shall be required to register on a
one-time basis. Registration may be made at any pharmacy
participating in this program. In order to register for the program,
the Medicare beneficiary shall pay to the pharmacy an administrative
fee, which the pharmacy shall retain, in an amount to be established
by the department. Upon payment of this fee, the pharmacy shall issue
a program registration card, which shall be prepared and provided to
the pharmacy by the department, to the Medicare beneficiary.

130401.1. (a) The department may accept on behalf of the state any
gift, bequest, or donation of outreach services or materials to
inform eligible Medicare beneficiaries of their right to participate
in this program. Neither Section 11005 of the Government Code nor any
other law requiring approval by a state officer of a gift, bequest,
or donation shall apply to these gifts, bequests, or donations. For
purposes of this section, outreach services may include, but not be
limited to, coordinating and implementing outreach efforts and plans,
and outreach materials may include, but not be limited to,
brochures, pamphlets, fliers, posters, advertisements, and other
promotional items.
(b) An advertisement provided as a gift, bequest, or donation
pursuant to this section shall be exempt from the provisions of
Article 5 (commencing with Section 11080) of Chapter 1 of Part 1 of
Division 3 of Title 2 of the Government Code.

130402. (a) Any pharmacy may participate in the program provided
for under this division. However, this division shall apply only to
prescriptions dispensed to noninstitutionalized Medicare
beneficiaries.
(b) Any drug manufacturer may participate in the program provided
for under this division.

130403. (a) The department shall attempt to negotiate rebate
amounts with drug manufacturers for all prescription drugs purchased
by Medicare beneficiaries. As part of these agreements, the
department shall negotiate a separate fee in an amount required to
administer each pharmacy claim reimbursement submitted to the
department pursuant to Section 130405.
(b) If the department determines that it is unable to negotiate
rebates with a sufficient number of drug manufacturers, it may cease
to continue the implementation or operation of this division.

130404. (a) With respect to any prescription drug for which a
rebate amount has been negotiated pursuant to Section 130403, upon
presentation of a program registration card issued pursuant to
Section 130401, a participating pharmacy shall charge Medicare
beneficiaries a price for a prescription drug that does not exceed
the following computed price:
(1) The Medi-Cal reimbursement rate for the prescription drug, and
an amount, as set by the department, to cover electronic
transmission charges.
(2) The amount ascertained pursuant to paragraph (1) shall be
reduced by the rebate amount negotiated by the department pursuant to
Section 130403.
(b) The pharmacy shall request, and the department shall provide,
through electronic means, the price to be charged pursuant to this
section.
(c) This division shall not apply to any prescription that is
covered by insurance.

130405. Whenever a pharmacy provides a prescription drug to an
individual pursuant to Section 130404, the pharmacy shall bill the
department for the amount computed pursuant to paragraph (2) of
subdivision (a) of Section 130404 and the department shall pay that
amount.

130406. (a) The department may collect prospective rebates from
drug manufacturers for payment to pharmacies pursuant to Section
130405.
(b) The department shall notify a drug manufacturer of all
instances in which it has paid a rebate amount pursuant to Section
130405 with respect to one of the manufacturer's drugs.
(c) A drug manufacturer shall pay the department the amount of any
rebate of which the drug manufacturer is notified pursuant to
subdivision (b) that exceeds the amount collected by the department
pursuant to subdivision (a).

130406.5. (a) As part of the program provided in this division, the
department may establish a system to provide a Medicare beneficiary
access to a drug discount program operated by a drug manufacturer
that would provide greater prescription drug discounts than are
otherwise available through the program provided in this division.
The program registration card issued pursuant to Section 130401 shall
serve as the single point of entry to the private drug discount
programs of participating manufacturers.
(b) To establish the system described in subdivision (a), the
department may negotiate a contract with a drug manufacturer that
operates a prescription drug discount program. To assist in these
negotiations, the department may contract with a public or private
entity.
(c) (1) A Medicare beneficiary shall not in any circumstance be
required to participate in, or to disclose information that would
determine his or her eligibility to participate in, these private
drug discount programs in order to participate in the program
provided in this division.
(2) Notwithstanding paragraph (1), a Medicare beneficiary may
voluntarily disclose or provide information that may be necessary to
determine eligibility for participation in a private drug discount
program.

130407. (a) The department shall deposit all payments received
pursuant to Sections 130406 and 130410 into the Golden Bear State
Pharmacy Assistance Program Rebate Fund, which is hereby created in
the State Treasury.
(b) Notwithstanding Section 13340 of the Government Code, the fund
is hereby continuously appropriated to the department without regard
to fiscal years for the purpose of paying rebates pursuant to
Section 130405 and for defraying the costs of administering this
division. Notwithstanding any other law, no money in the fund is
available for expenditure for any other purpose or for loaning or
transferring to any other fund, including the General Fund.

130407.5. The department shall repay the General Fund the loan in
the amount of one million dollars ($1,000,000), which was
appropriated to the department for startup costs associated with the
program provided in this division.

130408. The department shall develop a program to prevent the
occurrence of fraud under this division. An individual or entity that
violates any provision of the fraud prevention program may be
precluded from participating in the Golden Bear State Pharmacy
Assistance Program. The department shall adopt regulations setting
forth a procedure for precluding participation in the program on this
basis.

130409. The department may hire any staff needed for the
implementation of this division. The department may also use the
contract with the Medi-Cal fiscal intermediary or contract with
another public or private entity to implement or administer the
program and to enroll Medicare beneficiaries who are eligible to
participate in the program, to collect rebates, and to pay claims,
only if services provided under this program are specifically
identified and reimbursed in a manner that does not claim federal
financial reimbursement. For purposes of this division, use of the
Medi-Cal program fiscal intermediary shall be exempt from Part 2
(commencing with Section 10100) of Division 2 of the Public Contract
Code. This division shall not be implemented unless and until the
director executes a declaration, which shall be retained by the
director, stating that all federal approvals necessary for
implementation of this division have been received.

130410. A contract executed for the purposes of this division is
exempt from Part 2 (commencing with Section 10100) of Division 2 of
the Public Contract Code.