Section § 130400

Explanation

This law establishes the Golden Bear State Pharmacy Assistance Program, which is related to pharmacies assisting Californians.

Terms defined in this law include the 'Department,' referring to the State Department of Health Services, the 'Fund' referring to the program's Rebate Fund, and 'Medicare beneficiary,' specifically referring to Medicare beneficiaries who are California residents.

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

Section § 130401

Explanation

This law allows Medicare beneficiaries to join a prescription drug discount program. Apart from already mentioned programs, they can now access this new division's benefits. The department is responsible for informing Medicare beneficiaries about their rights and how the discount works. It's mandatory for them to register once at a participating pharmacy, pay a set administrative fee, and receive a registration card, with materials for this card provided by the department.

(a)CA Health & Safety Code § 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)CA Health & Safety Code § 130401(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)CA Health & Safety Code § 130401(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.

Section § 130401.1

Explanation

This law allows the department to receive gifts, bequests, or donations specifically aimed at educating Medicare beneficiaries about their rights to join a program. This can include outreach services and materials like brochures and advertisements. Usually, certain approvals are needed for such gifts, but this exemption simplifies the process for these particular items.

Additionally, advertisements received as gifts under this law do not have to follow certain regulations typically required by the government.

(a)CA Health & Safety Code § 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)CA Health & Safety Code § 130401.1(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.

Section § 130402

Explanation

In California, both pharmacies and drug manufacturers can take part in a program that helps provide prescription medications. This program specifically caters to Medicare beneficiaries who aren't living in institutions like nursing homes.

(a)CA Health & Safety 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)CA Health & Safety Code § 130402(b)  Any drug manufacturer may participate in the program provided for under this division.

Section § 130403

Explanation

This law section states that California's health department will try to negotiate rebate deals with drug manufacturers for medications bought by people on Medicare. The agreements will also include a fee for each pharmacy claim handled by the department as per another specific law section.

If the department finds it can't secure enough rebate deals, it can stop working on this program altogether.

(a)CA Health & Safety Code § 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)CA Health & Safety Code § 130403(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.

Section § 130404

Explanation

If you're a Medicare beneficiary with a program card, participating pharmacies will charge you no more than the Medi-Cal rate plus a fee for electronic processing for your meds if there's a rebate deal in place. The total price will be further reduced by the negotiated rebate amount. Pharmacies will get the exact price info electronically from the department. This rule doesn't apply to prescriptions covered by insurance.

(a)CA Health & Safety Code § 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)CA Health & Safety Code § 130404(a)(1)  The Medi-Cal reimbursement rate for the prescription drug, and an amount, as set by the department, to cover electronic transmission charges.
(2)CA Health & Safety Code § 130404(a)(2)  The amount ascertained pursuant to paragraph (1) shall be reduced by the rebate amount negotiated by the department pursuant to Section 130403.
(b)CA Health & Safety Code § 130404(b)  The pharmacy shall request, and the department shall provide, through electronic means, the price to be charged pursuant to this section.
(c)CA Health & Safety Code § 130404(c)  This division shall not apply to any prescription that is covered by insurance.

Section § 130405

Explanation

When a pharmacy gives someone a prescription drug under Section 130404, it sends a bill to the department for a specific amount. The department is then responsible for paying that bill.

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.

Section § 130406

Explanation

This law gives the department the authority to collect advance rebates from drug manufacturers to pay pharmacies. If the department pays a rebate regarding a manufacturer's drug, they must inform the manufacturer. If the rebate paid exceeds what the department collected, the manufacturer must refund the excess amount to the department.

(a)CA Health & Safety Code § 130406(a)  The department may collect prospective rebates from drug manufacturers for payment to pharmacies pursuant to Section 130405.
(b)CA Health & Safety Code § 130406(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)CA Health & Safety Code § 130406(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).

Section § 130406.5

Explanation

This law allows the department to create a program where Medicare beneficiaries can access better prescription drug discounts through drug manufacturer programs compared to the existing program discounts. The Medicare program registration card would work as an access point to these manufacturer discount programs.

The department can negotiate contracts with drug manufacturers for this purpose, and it may hire public or private entities to help with negotiations.

Medicare beneficiaries are not required to join or share personal information for these private discount programs to use the main program. However, they can choose to provide information if needed to join a private discount program.

(a)CA Health & Safety Code § 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)CA Health & Safety Code § 130406.5(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)Copy CA Health & Safety Code § 130406.5(c)
(1)Copy CA Health & Safety Code § 130406.5(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)CA Health & Safety Code § 130406.5(c)(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.

Section § 130407

Explanation

This law creates the Golden Bear State Pharmacy Assistance Program Rebate Fund, where certain payments related to pharmacy rebates are deposited.

The money in this fund is automatically allocated for paying out rebates and covering costs related to managing the program without needing annual budget approvals. Additionally, the money cannot be used for any other purpose or transferred to other funds.

(a)CA Health & Safety Code § 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)CA Health & Safety Code § 130407(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.

Section § 130407.5

Explanation

This section mandates that a department must pay back a $1,000,000 loan that it initially received from the General Fund to cover startup costs for a specific program.

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.

Section § 130408

Explanation

California's health department is tasked with creating a program to stop fraud related to the Golden Bear State Pharmacy Assistance Program. If someone or a group breaks the rules of this fraud prevention program, they might be banned from taking part in the assistance program. The department will also set up specific rules on how this exclusion process works.

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.

Section § 130409

Explanation

This law states that the department can hire staff or use contracts with certain entities to run and manage a healthcare program, including enrolling eligible Medicare beneficiaries and handling payments and rebates. They must ensure services are clearly identified and not seeking federal money. Also, certain contracts can bypass California's usual procurement rules. However, they cannot implement the program until they have all the necessary federal approvals.

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.

Section § 130410

Explanation

This law states that any contract created under this specific division doesn't have to follow the rules and regulations outlined in Part 2 of Division 2 of the Public Contract Code.

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.