SENATE BILL 1036

47th legislature - STATE OF NEW MEXICO - first session, 2005

INTRODUCED BY

Stuart Ingle

AN ACT

RELATING TO PUBLIC ASSISTANCE; INCREASING THE DISPENSING FEE PAID BY THE MEDICAID PROGRAM TO PHARMACIES LOCATED IN RURAL AND CRITICAL ACCESS AREAS; AMENDING AND ENACTING SECTIONS OF THE PUBLIC ASSISTANCE ACT.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     Section 1. Section 27-2-16 NMSA 1978 (being Laws 1974, Chapter 31, Section 1, as amended) is amended to read:

     "27-2-16. COMPLIANCE WITH FEDERAL LAW.--[A.] Subject to the availability of state funds, the human services department may provide assistance to aged, blind or disabled individuals in the amounts consistent with federal law to enable the state to be eligible for medicaid funding. Individuals shall be determined to be aged, blind or disabled according to regulations of the human services department.

          [B. If drug product selection is permitted by Section 26-3-3 NMSA 1978, reimbursement by the medicaid program shall be limited to the wholesale cost of the lesser expensive therapeutic equivalent drug generally available in New Mexico plus a reasonable dispensing fee of at least three dollars sixty-five cents ($3.65).]"

     Section 2. A new section of the Public Assistance Act is enacted to read:

     "[NEW MATERIAL] REIMBURSEMENT RATE--PRESCRIPTIONS--MEDICAID.--

          A. To ensure continued access to quality pharmacy services for participants in the medicaid population and to ensure access by participants in rural parts of the state, the human services department shall establish by rule a methodology for determining reimbursement rates for all prescriptions to be paid through the medicaid program, including the state children's health insurance program and any waiver programs approved by the federal department of health and human services. The human services department shall utilize a methodology comprised of only ingredient cost and the dispensing fee.

          B. Reimbursement for rural pharmacies shall be at the rate set by the human services department, unless otherwise agreed to by the rural pharmacy by contract, provided that no contract shall require a rural pharmacy to accept a dispensing fee of less than four dollars ($4.00). As used in this subsection, "rural pharmacy" means a pharmacy located in the county of Chaves, Curry, Eddy, Grant, Lea, Luna, McKinley, Otero, Roosevelt, Sandoval, San Juan, Taos or Valencia.

          C. Reimbursement for critical access pharmacies shall be at the rate set by the human services department, unless otherwise agreed to by the critical access pharmacy by contract, provided that no contract shall require a critical access pharmacy to accept a dispensing fee of less than four dollars twenty-five cents ($4.25). As used in this subsection, a "critical access pharmacy" means a pharmacy located in the county of Catron, Cibola, Colfax, De Baca, Guadalupe, Harding, Hidalgo, Lincoln, Mora, Quay, Rio Arriba, San Miguel, Sierra, Socorro, Torrance or Union.

          D. Reimbursement for all urban pharmacies shall be at the rate set by the human services department, unless otherwise agreed to by the urban pharmacy by contract. The human services department may establish a different dispensing fee for urban pharmacies in medically underserved areas. As used in this subsection, "urban pharmacy" means a pharmacy located in the county of Bernalillo, Dona Ana, Los Alamos or Santa Fe."

     Section 3. EFFECTIVE DATE.--The effective date of the provisions of this act is July 1, 2005.

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