§ 42-4-118 — Prescription drug assistance program created; eligibility criteria; benefits provided; coverage of medications

Wyoming § 42-4-118

• Jurisdiction: Wyoming
• Title 42: Welfare
• Ch. 4: MEDICAL ASSISTANCE AND SERVICES
• Art. 1: IN GENERAL

Text

(a) There is created a prescription drug assistance
program to assist residents of the state. The program shall be a
state funded program to provide prescription drug assistance, in
addition to the services provided under the Wyoming Medical
Assistance and Services Act. Effective July 1, 2002, the
prescription drug assistance program shall replace the minimum
medical program. Eligibility for assistance under the program
created by this section shall not constitute an entitlement and
services shall be provided under this section only to the extent
funds are available.
(b) Residents of the state may apply for the prescription
drug assistance program in the manner provided in W.S. 42-4-106.
Upon a determination of eligibility, the applicant remains
eligible for assistance under the prescription drug assistance
program as provided in this section. If a recipient ceases to be
a resident of the state, his eligibility under the program shall
terminate. The department shall by rule and regulation establish
income eligibility guidelines no later than July 1 of each year
based on the federal poverty levels in effect on January 1 of
that calendar year. Persons with family income of one hundred
percent (100%) of the federal poverty level or less shall be
eligible under this section. The rules shall take into
consideration family size up to four (4) individuals.
Eligibility for families consisting of more than four (4)
individuals shall be determined on the basis of the income of a
family of four (4) individuals. Persons eligible for
prescription drug assistance under other state or federal
programs, except the state high risk health insurance pool,
shall be ineligible for assistance under the prescription drug
assistance program.
(c) Except as provided by this subsection, an eligibility
determination made under subsection (b) of this section shall be
valid for one (1) year. A recipient whose monthly income changes
by more than one-third (1/3), shall report the change in income
to the department. The recipient is entitled to a
redetermination if his income has declined and may, at the
option of the department, be subject to a redetermination if his
income has increased.
(d) A recipient shall be required to pay a copayment per
prescription of ten dollars ($10.00) for generic drugs and
twenty-five dollars ($25.00) for brand name drugs.
(e) The department shall project costs of the program
created by this section at least quarterly and compare those
projected costs against the funds appropriated for the program.
If the funds available to the program are insufficient to meet
the projected costs of the program, the department shall take
action to prevent the program from incurring costs beyond
available funds, including taking any of the following actions:
(i) Imposing a moratorium on new enrollments in the
program;
(ii) Reducing the gross family income eligibility
level specified in subsection (b) of this section;
(iii) Imposing higher prescription drug copayments
not to exceed twenty-five dollars ($25.00) per prescription;
(iv) Eliminating specified drugs from eligibility
under the program;
(v) Carrying claims for payment into the next
biennium if the amount of claims are less than one twenty-fourth
(1/24) of the appropriation that has been enacted for the next
biennium.