August 20, 2019

SB 16-027: Allowing Medicaid Clients to Receive Prescriptions Through the Mail

On January 13, 2016, Sens. Beth Martinez Humenik and Nancy Todd along with Reps. Dianne Primavera and Lois Landgraf introduced SB 16-027Concerning Allowing the Option for Medicaid Clients to Obtain Prescribed Drugs Through Mail, and, In Connection Therewith, Reducing an Appropriation. The bill has passed through the Senate Health & Human Services and Appropriations Committees with amendments in each committee and was passed on Second and Third Reading in the Senate Committee of the Whole. In the House, the bill passed out of the Health, Insurance, & Environment Committee with amendments and is now in the House Appropriations Committee.

The proposed bill specifically relates to persons receiving medical assistance (Recipients). The bill would allow recipients the option to receive prescribed medications, used to treat chronic medical conditions, through the mail. The bill also provides that the recipient may receive up to a certain amount of the medication and would still pay the same copayment amount as recipients receiving the medication by another method.

The proposed bill provides that the department of health care policy and financing shall encourage recipients to use any local retail pharmacy for mail delivery. Furthermore, the bill would require the state board of medical services to adopt rules, “to the extent allowed by federal law,” relating to the option to receive medications through the mail. Specifically, the bill proposes to make subsection (1)(a)(II) of C.R.S. § 25.5-5-505 mandatory, stating “the state board rules must include the definition of maintenance medications.”

The bill also proposes the addition of subsection (1)(c) of C.R.S. § 25.5-5-505. The subsection states “a pharmacy may provide maintenance medications through the mail to medical assistance recipients in accordance with all applicable state and federal laws if the pharmacy is enrolled as a provider with the state department and is registered with the state board of pharmacy, created and existing pursuant to C.R.S. § 12-42.5-103.”

Additionally, the Senate provided amendments to Section 2 of the proposed bill, Appropriations – Adjustments to 2016 Long Bill. The amendments provide, in relevant part, that to implement the Act, the appropriations made for the 2016-17 fiscal year to the Department of Health Care Policy and Financing for medical services premiums are adjusted in the following ways: (a) the general fund appropriation is decreased by $9,084; and (b) The cash funds appropriation from the hospital provider fee cash fund is decreased by $409. Furthermore, subsection (2) of Section 2 proposes that the fiscal year medical services premiums for the Department of Health Care Policy and Financing will be decreased by $20,424.

Mark Proust is a 2016 JD Candidate at the University of Denver Sturm College of Law.

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