PRIOR PRINTER'S NOS. 1044, 1816, 1836 PRINTER'S NO. 1889
No. 888 Session of 2003
INTRODUCED BY VANCE, EACHUS, KENNEY, WALKO, E. Z. TAYLOR,
GRUCELA, ADOLPH, BARD, BALDWIN, BARRAR, BASTIAN, BROWNE,
BUTKOVITZ, BUXTON, CAPPELLI, CASORIO, CORNELL, CORRIGAN,
COSTA, DAILEY, DALLY, J. EVANS, FEESE, FLICK, FREEMAN, GABIG,
GERGELY, GILLESPIE, GINGRICH, HARHAI, HARPER, HASAY,
HENNESSEY, HERMAN, HERSHEY, HORSEY, JAMES, KELLER, KIRKLAND,
LAUGHLIN, LEH, LEWIS, MACKERETH, MAHER, MARSICO, McCALL,
McGILL, McNAUGHTON, MELIO, MICOZZIE, R. MILLER, S. MILLER,
MUNDY, NAILOR, NICKOL, O'NEILL, PALLONE, PETRARCA, PETRI,
PICKETT, PISTELLA, RAYMOND, READSHAW, ROBERTS, ROSS, RUBLEY,
SAINATO, SAYLOR, SCAVELLO, SCHRODER, SEMMEL, SHANER, SOLOBAY,
STEIL, R. STEVENSON, T. STEVENSON, J. TAYLOR, THOMAS, TIGUE,
TRAVAGLIO, TURZAI, WANSACZ, WATSON, WEBER, WILT, WRIGHT,
YOUNGBLOOD, YUDICHAK, ZUG AND FABRIZIO, MARCH 13, 2003
AS REPORTED FROM COMMITTEE ON HEALTH AND HUMAN SERVICES, HOUSE
OF REPRESENTATIVES, AS AMENDED, JUNE 2, 2003
AN ACT
1 Providing for pharmaceutical assistance for the elderly, for
2 pharmaceutical purchasing, for limited prescription drug
3 redistribution within certain health care facilities, for <--
4 pharmaceutical practices and cost control program and for the
5 Pharmaceutical Assistance Clearinghouse; imposing additional
6 powers and duties on the Department of Aging, the Department
7 of Health, the Department of Public Welfare and the Secretary
8 of Administration; and making repeals.
9 TABLE OF CONTENTS
10 Chapter 1. Preliminary Provisions
11 Section 101. Short title.
12 Chapter 3. Pharmaceutical Matters
13 Subchapter A. Pharmaceutical Assistance for the Elderly
14 Section 301. Legislative findings.
1 Section 302. Definitions.
2 Section 303. Determination of eligibility.
3 Section 304. Physician and pharmacy participation.
4 Section 305. Drug utilization review system.
5 Section 306. Reduced assistance.
6 Section 307. Rebates for expenses prohibited.
7 Section 308. Request for proposal.
8 Section 309. Program generally. <--
9 Section 310. Generic drugs.
10 Section 311. Supply.
11 Section 312. Mail order system.
12 Section 313. Indication of price.
13 Section 314. Reimbursement.
14 Section 315. Nonliability.
15 Section 316. Income verification.
16 Section 317. Contract.
17 Section 318. The Pharmaceutical Assistance Contract for the
18 Elderly Needs Enhancement Tier.
19 Section 319. Board.
20 Section 320. Penalties.
21 Section 321. Prescription Drug Education Program.
22 Section 322. Outreach program.
23 Section 323. Accountability.
24 Subchapter B. Prudent Pharmaceutical Purchasing
25 Section 341. Definitions.
26 Section 342. Rebate agreement.
27 Section 343. Disposition of funds.
28 Subchapter C. Pharmacy Best Practices and Cost Control
29 Program
30 Section 361. Definitions.
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1 Section 362. Committee.
2 Section 363. Program.
3 Subchapter D. Pharmaceutical Assistance Clearinghouse
4 Section 371. Definitions.
5 Section 372. Pharmaceutical Assistance Clearinghouse.
6 Section 373. Toll-free telephone number.
7 Section 374. Assistance available.
8 Section 375. Reporting.
9 SECTION 309. DRUG UTILIZATION REVIEW AND THERAPEUTIC <--
10 INTERCHANGE.
11 SECTION 310. PROGRAM GENERALLY.
12 SECTION 311. GENERIC DRUGS.
13 SECTION 312. SUPPLY.
14 SECTION 313. MAIL SERVICE PROGRAM.
15 SECTION 314. INDICATION OF PRICE.
16 SECTION 315. REIMBURSEMENT.
17 SECTION 316. NONLIABILITY.
18 SECTION 317. INCOME VERIFICATION.
19 SECTION 318. CONTRACT.
20 SECTION 319. THE PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE
21 ELDERLY NEEDS ENHANCEMENT TIER.
22 SECTION 320. BOARD.
23 SECTION 321. PENALTIES.
24 SECTION 322. PRESCRIPTION DRUG EDUCATION PROGRAM.
25 SECTION 323. OUTREACH PROGRAM.
26 SUBCHAPTER B. PRUDENT PHARMACEUTICAL PURCHASING
27 SECTION 341. DEFINITIONS.
28 SECTION 342. REBATE AGREEMENT.
29 SECTION 343. DISPOSITION OF FUNDS.
30 SUBCHAPTER C. PHARMACEUTICAL ASSISTANCE CLEARINGHOUSE
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1 SECTION 361. DEFINITIONS.
2 SECTION 362. PHARMACEUTICAL ASSISTANCE CLEARINGHOUSE.
3 SECTION 363. TOLL-FREE TELEPHONE NUMBER.
4 SECTION 364. ASSISTANCE AVAILABLE.
5 SECTION 365. REPORTING.
6 Chapter 51. Miscellaneous Provisions
7 Section 5101. Federal programs.
8 Section 5102. Repeals.
9 Section 5103. Effective date.
10 The General Assembly of the Commonwealth of Pennsylvania
11 hereby enacts as follows:
12 CHAPTER 1
13 PRELIMINARY PROVISIONS
14 Section 101. Short title.
15 This act shall be known and may be cited as the
16 Pharmaceutical Reform Act.
17 CHAPTER 3
18 PHARMACEUTICAL MATTERS
19 SUBCHAPTER A
20 PHARMACEUTICAL ASSISTANCE FOR THE ELDERLY
21 Section 301. Legislative findings.
22 Finding that an increasing number of this Commonwealth's
23 elderly citizens who are living on fixed incomes are
24 experiencing difficulties in meeting the costs of life-
25 sustaining prescription drugs, the General Assembly, in its
26 responsibilities to provide for the health, welfare and safety
27 of the residents of this Commonwealth, hereby continues a
28 limited State pharmaceutical assistance program for the elderly.
29 Section 302. Definitions.
30 The following words and phrases when used in this subchapter
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1 shall have the meanings given to them in this section unless the
2 context clearly indicates otherwise:
3 "A-rated generic therapeutically equivalent drug." A drug
4 product that the Commissioner of Food and Drugs of the United
5 States Food and Drug Administration has approved as safe and
6 effective and has determined to be therapeutically equivalent,
7 as listed in "The Approved Drug Products with Therapeutic
8 Equivalence Evaluations" (Food and Drug Administration "Orange
9 Book"), with a specific "A" code designation only.
10 "Average wholesale cost." The cost of a dispensed drug based
11 upon the price published in a national drug pricing system in
12 current use by the Department of Aging as the average wholesale
13 price of a prescription drug in the most common package size.
14 "Average wholesale price." Average wholesale cost.
15 "Board." The Pharmaceutical Assistance Review Board.
16 "CMS." Center for Medicare and Medicaid Services.
17 "Department." The Department of Aging of the Commonwealth.
18 "Eligible claimant." A resident of this Commonwealth for no
19 less than 90 days, who is 65 years of age and older, whose
20 annual income is less than the maximum annual income and who is
21 not otherwise qualified for public assistance under the act of
22 June 13, 1967 (P.L.31, No.21), known as the Public Welfare Code.
23 "FDA." The United States Food and Drug Administration of the
24 Public Health Service of the Department of Health and Human
25 Services.
26 "Income." All income from whatever source derived,
27 including, but not limited to, salaries, wages, bonuses,
28 commissions, income from self-employment, alimony, support
29 money, cash public assistance and relief, the gross amount of
30 any pensions or annuities, including railroad retirement
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1 benefits, all benefits received under the Social Security Act
2 (49 Stat. 620, 42 U.S.C. § 301 et seq.) except Medicare
3 benefits, all benefits received under State unemployment
4 insurance laws and veterans' disability payments, all interest
5 received from the Federal Government or any state government or
6 any instrumentality or political subdivision thereof, realized
7 capital gains, rentals, workmen's compensation and the gross
8 amount of loss of time insurance benefits, life insurance
9 benefits and proceeds, except the first $5,000 of the total of
10 death benefits payments, and gifts of cash or property, other
11 than transfers by gift between members of a household, in excess
12 of a total value of $300, but does not include surplus food or
13 other relief in kind supplied by a government agency or property
14 tax rebate.
15 "Mail service program." A program set forth in section 312 <--
16 313 to dispense prescription drugs by postal delivery service
17 designated and administered by the department and any entity
18 with which it contracts, upon an enrollee's submission of a
19 prescription and the applicable copayment.
20 "Maintenance drug." A prescription drug prescribed to an
21 individual for a chronic condition the use of which is medically
22 necessary for a consecutive period of at least 60 days.
23 "Maximum annual income." For PACE eligibility, annual income
24 which shall not exceed $14,000 $14,500 in the case of single <--
25 persons nor $17,200 $17,700 in the case of the combined annual <--
26 income of persons married to each other. Persons may, in
27 reporting income to the Department of Aging, round the amount of
28 each source of income and the income total to the nearest whole
29 dollar, whereby any amount which is less than 50¢ is eliminated.
30 "PACE." The Pharmaceutical Assistance Contract for the
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1 Elderly program provided for in this subchapter.
2 "PACENET." The Pharmaceutical Assistance Contract for the
3 Elderly Needs Enhancement Tier provided for in this subchapter.
4 "Pharmacy." A pharmacy licensed by the Commonwealth.
5 "Prescription drug." All drugs requiring a prescription in
6 this Commonwealth, insulin, insulin syringes and insulin
7 needles. Experimental drugs or drugs prescribed for wrinkle
8 removal or hair growth are prohibited.
9 "Private contractor." A person, partnership or corporate
10 entity that enters into a contract with the Commonwealth to
11 provide services under the provisions of this subchapter.
12 "Program." The Pharmaceutical Assistance Contract for the
13 Elderly (PACE) and the Pharmaceutical Assistance Contract for
14 the Elderly Needs Enhancement Tier (PACENET) as established by
15 this subchapter, unless otherwise specified.
16 "Provider." A pharmacy or dispensing physician enrolled as a
17 provider in the program.
18 Section 303. Determination of eligibility.
19 The department shall adopt regulations relating to the
20 determination of eligibility of prospective claimants and
21 providers, including dispensing physicians, and the
22 determination and elimination of program abuse. To this end, the
23 department shall establish a compliance unit staffed
24 sufficiently to fulfill this responsibility. The department
25 shall have the power to declare ineligible any claimant or
26 provider who abuses or misuses the established prescription
27 plan. The department shall have the power to investigate cases
28 of suspected provider or recipient fraud.
29 Section 304. Physician and pharmacy participation.
30 Any physician, pharmacist, pharmacy or corporation owned in
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1 whole or in part by a physician or pharmacist enrolled as a
2 provider in the program or that has prescribed medication for a
3 claimant in the program who is precluded or excluded for cause
4 from the Department of Public Welfare's medical assistance
5 program shall be precluded or excluded from participation in the
6 program. No physician precluded or excluded from the Department
7 of Public Welfare's medical assistance program shall have claims
8 resulting from prescriptions paid for by the program.
9 Section 305. Drug utilization review system.
10 The department shall ensure that a state-of-the-art
11 therapeutic drug utilization review system is established to
12 monitor and correct misutilization of drug therapies.
13 Section 306. Reduced assistance.
14 Any eligible claimant whose prescription drug costs are
15 covered in part by any other plan of assistance or insurance may
16 be required to receive reduced assistance under the provisions
17 of this subchapter.
18 Section 307. Rebates for expenses prohibited.
19 A system of rebates or reimbursements to the claimant for
20 prescription drugs shall be prohibited.
21 Section 308. Request for proposal.
22 (a) General.--The department shall prepare a request for
23 proposal for the purpose of providing pharmaceutical assistance
24 for the elderly within this Commonwealth. Upon the adoption of
25 the General Fund budget, the Department of Revenue shall be
26 authorized to transmit the appropriated funds in the State
27 Lottery Fund to the State Treasurer to be deposited in the
28 Pharmaceutical Assistance Contract for the Elderly Fund. This
29 fund shall consist of appropriations and interest and shall be
30 created by the State Treasurer to fund the operations of the
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1 program by the department and the private contractor. Funds not
2 expended in the fiscal year in which they were appropriated
3 shall not lapse and shall be available for use in the next
4 fiscal year.
5 (b) Additional requests.--To provide for the continued
6 operation of the program, the department shall prepare, as
7 needed, requests for proposals, in addition to that set forth in
8 subsection (a), for the purpose of providing pharmaceutical
9 assistance for the elderly within this Commonwealth. A request
10 for proposal shall require potential private contractors to
11 submit a proposal for a period of time and with monetary
12 limitations as determined by the department. Upon the enactment
13 of an appropriation from the State Lottery Fund, the Department
14 of Revenue shall be authorized to transmit the appropriated
15 amount to the State Treasurer to be deposited in the
16 Pharmaceutical Assistance Contract for the Elderly Fund. Funds
17 not expended in the fiscal year in which they were appropriated
18 shall not lapse and shall be available for use in the next
19 fiscal year.
20 SECTION 309. DRUG UTILIZATION REVIEW AND THERAPEUTIC <--
21 INTERCHANGE.
22 (A) DRUG UTILIZATION REVIEW.--THE DEPARTMENT SHALL ENSURE
23 THAT A STATE-OF-THE-ART THERAPEUTIC DRUG UTILIZATION REVIEW
24 SYSTEM IS ESTABLISHED TO MONITOR AND CORRECT MISUTILIZATION OF
25 DRUG THERAPIES.
26 (B) THERAPEUTIC INTERCHANGE.--THE DEPARTMENT MAY DEVELOP A
27 THERAPEUTIC INTERCHANGE PROGRAM BASED ON NATIONAL MEDICAL
28 STANDARDS THAT ESTABLISH THERAPEUTICALLY EQUIVALENT DRUGS WHICH
29 PRODUCE IDENTICAL LEVELS OF CLINICAL EFFECTIVENESS AND OUTCOMES.
30 THE PROGRAM SHALL AUTHORIZE PHARMACY BENEFIT COVERAGE WHEN A
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1 PATIENT'S HEALTH CARE PROVIDER PRESCRIBES A PRESCRIPTION DRUG
2 NOT IN THE PROGRAM IF ANY OF THE FOLLOWING APPLY:
3 (1) THE PROGRAM DRUG:
4 (I) HAS NOT BEEN EFFECTIVE IN TREATING THE PATIENT'S
5 CONDITION; OR
6 (II) IS NOT EXPECTED WITH REASONABLE CERTAINTY TO BE
7 EFFECTIVE IN TREATING THE PATIENT'S CONDITION.
8 (2) THE PROGRAM DRUG CAUSES OR IS REASONABLY EXPECTED TO
9 CAUSE ADVERSE OR HARMFUL REACTIONS IN THE PATIENT.
10 (3) OTHER CLINICAL CRITERIA APPROVED BY THE DEPARTMENT
11 ARE COMPLIED WITH.
12 Section 309 310. Program generally. <--
13 (a) Parameters of program.--The program shall include the
14 following:
15 (1) Participating pharmacies shall be paid within 21
16 days of the contracting firm receiving the appropriate
17 substantiation of the transaction. Pharmacies shall be
18 entitled to interest for payment not made within the 21-day
19 period at a rate approved by the board.
20 (2) Collection of the copayment by pharmacies shall be
21 mandatory.
22 (3) Senior citizens participating in the program are not
23 required to maintain records of each transaction.
24 (4) A system of rebates or reimbursements to eligible
25 claimants for pharmaceutical expenses shall be prohibited.
26 (5) There shall be the following copayments: <--
27 (i) For generic drugs - $5.
28 (ii) For preferred drug list drugs - $10.
29 (iii) For drugs which are not on the preferred drug
30 list - $15.
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1 (5) THE COPAYMENT AMOUNT FOR GENERIC OR MULTI-SOURCE <--
2 DRUGS SHALL BE LESS THAN THE COPAYMENT AMOUNT FOR SINGLE-
3 SOURCE DRUGS.
4 (6) Payments as follows:
5 (i) Except as provided in subparagraph (ii), to
6 pharmacies on behalf of eligible claimants for costs of
7 the prescription drug in excess of the copayment as
8 provided in subsections (b) and (c), plus a dispensing
9 fee of $3.50 or the dispensing fee established by the
10 department by regulation, whichever is greater.
11 (ii) For A-rated generic therapeutically equivalent
12 drugs, to pharmacies on behalf of eligible claimants for
13 the upper limits established under 42 CFR § 447.332
14 (relating to upper limits for multiple source drugs),
15 plus a dispensing fee of $4 or the dispensing fee
16 established by the department by regulations, whichever
17 is greater.
18 (7) In no case shall the Commonwealth or any person
19 enrolled in the program be charged more than the price of the
20 drug at the particular pharmacy on the date of the sale.
21 (b) Multiple-source drugs.--Except for brand name drugs that
22 are certified in accordance with subsection (d), the department
23 payment for multiple-source drugs must not exceed the amount
24 that would result from the application of the specific limits
25 established in accordance with subsection (e). If a specific
26 limit has not been established under subsection (e), then the
27 rule for "other drugs" set forth in subsection (c) applies.
28 (c) Other drugs.--The department payments for brand name
29 drugs certified in accordance with subsection (d) and drugs
30 other than multiple-source drugs for which a specific limit has
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1 been established under subsection (e) must not exceed in the
2 aggregate payment levels that the department has determined by
3 applying the lower of the:
4 (1) Estimated acquisition costs plus reasonable
5 dispensing fees established by the department.
6 (2) Providers' usual and customary charges to the
7 general public.
8 (d) Certification of brand-name drugs.--
9 (1) The upper limit for payments for multiple-source
10 drugs for which a specific limit has been established under
11 subsection (e) does not apply if a physician certifies in his
12 or her own handwriting that a specific brand is medically
13 necessary for a particular recipient.
14 (2) The department must decide what certification form
15 and procedure are used.
16 (3) A checkoff box on a form is not acceptable but a
17 notation like "brand necessary" is allowable.
18 (4) The department may allow providers to keep the
19 certification forms if the forms will be available for
20 inspection by the department.
21 (e) Establishment and issuance of a listing of multiple-
22 source drugs.--
23 (1) The department will use the CMS listings that
24 identify and set upper limits for multiple-source drugs that
25 meet the following requirements:
26 (i) All of the formulations of the drug approved by
27 the Food and Drug Administration (FDA) have been
28 evaluated as therapeutically equivalent in the most
29 current edition of their publication, Approved Drug
30 Products with Therapeutic Equivalence Evaluations,
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1 including supplements or in successor publications.
2 (ii) At least three suppliers list the drug, which
3 has been classified by the FDA as category "A" in its
4 publication, Approved Drug Products with Therapeutic
5 Equivalence Evaluations, including supplements or in
6 successor publications, based on all listings contained
7 in current editions, or updates, of published compendia
8 of cost information for drugs available for sale in this
9 Commonwealth.
10 (2) The department publishes the list of multiple-source
11 drugs for which upper limits have been established and any
12 revisions to the list in Medicaid program instructions.
13 (3) The department will identify the sources used in
14 compiling these lists.
15 Section 310 311. Generic drugs. <--
16 (a) General.--Notwithstanding any other statute or
17 regulation, if an A-rated generic therapeutically equivalent
18 drug is available for dispensing to a claimant, the provider
19 shall dispense the A-rated generic therapeutically equivalent
20 drug to the claimant. The department shall not reimburse
21 providers for brand name products except in the following
22 circumstances:
23 (1) There is no A-rated generic therapeutically
24 equivalent drug available on the market. This paragraph does
25 not apply to the lack of availability of an A-rated generic
26 therapeutically equivalent drug in the providing pharmacy
27 unless it can be shown to the department that the provider
28 made reasonable attempts to obtain the A-rated generic
29 therapeutically equivalent drug or that there was an
30 unforeseeable demand and depletion of the supply of the A-
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1 rated generic therapeutically equivalent drug. In either
2 case, the department shall reimburse the provider for 90% of
3 the average wholesale cost plus a dispensing fee based on the
4 least expensive A-rated generic therapeutically equivalent
5 drug for the brand drug dispensed.
6 (2) The Department of Health has determined that a drug
7 shall not be recognized as an A-rated generic therapeutically
8 equivalent drug for purpose of substitution under section
9 5(b) of the act of November 24, 1976 (P.L.1163, No.259),
10 referred to as the Generic Equivalent Drug Law.
11 (3) At the time of dispensing, the provider has a
12 prescription on which the brand name drug dispensed is billed
13 to the program by the provider at a usual and customary
14 charge which is equal to or less than the least expensive
15 usual and customary charge of any A-rated generic
16 therapeutically equivalent drug reasonably available on the
17 market to the provider.
18 (b) Copayment.--If a claimant chooses not to accept the A-
19 rated generic therapeutically equivalent drug required by
20 subsection (a), the claimant shall be liable for the copayment
21 and 70% of the average wholesale cost of the brand name drug.
22 (c) Substitution or construction.--The dispensing of an A-
23 rated generic therapeutically equivalent drug in accordance with
24 this subchapter shall not be deemed incorrect substitution under
25 section 6(a) of the Generic Equivalent Drug Law.
26 (d) Medical exception.--A medical exception process shall be
27 established by the department, which shall be published as a
28 notice in the Pennsylvania Bulletin and distributed to providers
29 and recipients in the program.
30 Section 311 312. Supply. <--
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1 (a) Requirement.--Except as set forth in subsection (b),
2 prescription benefits for any single prescription shall be
3 limited to a 30-day supply of the prescription drug or 100
4 units, whichever is less for acute conditions.
5 (b) Exceptions.--
6 (1) In the case of diagnosis for acute conditions,
7 prescription benefits for any single prescription shall be
8 limited to a 15-day supply.
9 (2) Subsection (a) shall not apply to topical ointments
10 or gels which are not available in containers which meet the
11 size and supply restrictions set forth in subsection (a).
12 (c) Subsection (a) does not apply to contracts under section
13 312(c) 313(C). <--
14 Section 312 313. Mail service program. <--
15 (a) General rule.--The department shall encourage the use of
16 a mail service program for maintenance drugs for eligible
17 claimants. Only mail order pharmacy services provided by
18 pharmacies which are licensed by the Commonwealth and which have
19 their principal place of business within this Commonwealth may
20 participate as providers under the program.
21 (b) Minimum standards of practice.--The department shall
22 develop and promulgate specific regulations governing the
23 practice of mail order pharmacy and other enrolled providers to
24 include the following minimum standards of practice to ensure
25 the health, safety and welfare of program participants:
26 (1) The appropriate method by which pharmacies verify
27 the identity of the eligible claimant and the authenticity of
28 prescriptions received.
29 (2) The appropriate method by which pharmacies mail or
30 deliver prescription drugs ensuring, to the maximum extent
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1 possible, that the intended eligible claimant is the actual
2 ultimate recipient of any prescription dispensed.
3 (3) The appropriate method by which pharmacies
4 communicate with eligible claimants in emergency situations.
5 (c) Ninety-day supply.--The department shall negotiate mail
6 order contracts to provide a 90-day supply of drugs to eligible
7 claimants at a single copayment rate equal to a 30-day supply
8 for each order.
9 (d) Requirement.--Except as set forth in subsection (e), an <--
10 (D) OPTION.--AN eligible claimant shall MAY use the mail <--
11 service program if the eligible claimant:
12 (1) utilizes a maintenance drug DRUG DEEMED BY THE <--
13 DEPARTMENT TO BE APPROPRIATE FOR MAIL ORDER SERVICE;
14 (2) has filled a prescription; and
15 (3) has refilled the prescription under paragraph (2) at
16 least once.
17 (e) Exception.--Subsection (d) shall not apply to an <--
18 eligible claimant who submits to the department, in a form
19 acceptable to the department, a written statement asserting the
20 eligible claimant's right to fill prescriptions at the pharmacy
21 chosen by the eligible claimant.
22 (f) (E) Rebates.--A mail order contract must include a <--
23 rebate from the prescription drug manufacturer. The rebate must
24 be at least as much as follows:
25 (1) For a brand-name drug, the sum of subparagraphs (i)
26 and (ii):
27 (i) A dispensing fee of at least $6.
28 (ii) The difference between:
29 (A) the average wholesale price; and
30 (B) 20% of that price.
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1 (2) For a generic drug, the sum of subparagraphs (i) and
2 (ii):
3 (i) A dispensing fee of at least $6.
4 (ii) The difference between:
5 (A) the average wholesale price; and
6 (B) 50% of that price.
7 (g) (F) Negotiated payments.--The department shall not <--
8 discriminate against a pharmacy that agrees to accept negotiated
9 payment levels with the same terms and conditions and to adhere
10 to quality standards established by the PACE and PACENET
11 programs.
12 Section 313 314. Indication of price. <--
13 The retail price of the prescription shall be indicated on
14 the label of the prescription container or furnished by separate
15 receipt.
16 Section 314 315. Reimbursement. <--
17 (a) Indication.--The department shall indicate third-party
18 coverage for each eligible claimant.
19 (b) Result.--For-profit third-party insurers and not-for-
20 profit prescription plans shall be responsible for any payments
21 made to a providing pharmacy on behalf of a claimant covered by
22 such a third party.
23 Section 315 316. Nonliability. <--
24 (a) General.--Any person rendering service as a member of a
25 utilization review committee for this program shall not be
26 liable for any civil damages as a result of any acts or
27 omissions in rendering the service as a member of any such
28 committee except any acts or omissions intentionally designed to
29 harm or any grossly negligent acts or omissions which result in
30 harm to the person receiving such service.
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1 (b) Department personnel.--Any officer or employee of the
2 department rendering service as a member of a utilization review
3 committee for this program shall not be liable for any civil
4 damages as a result of any acts or omissions in rendering the
5 service as a member of any such committee or as a result of any
6 decision or action in connection with the program except any
7 acts or omissions intentionally designed to harm or any grossly
8 negligent acts or omissions which result in harm to the person
9 receiving such service.
10 Section 316 317. Income verification. <--
11 (a) General.--The department shall annually verify the
12 income of eligible claimants by requiring income documentation
13 from the claimants. An application for benefits under this
14 subchapter shall constitute a waiver to the department of all
15 relevant confidentiality requirements relating to the claimant's
16 Pennsylvania State income tax information in the possession of
17 the Department of Revenue. The Department of Revenue shall
18 provide the department with the necessary income information
19 shown on the claimant's Pennsylvania State income tax return
20 solely for income verification purposes.
21 (b) Unlawful act.--It shall be unlawful for any officer,
22 agent or employee of the department to divulge or make known in
23 any manner whatsoever any information gained through access to
24 the Department of Revenue information except for official income
25 verification purposes under this subchapter.
26 (c) Penalty.--A person who violates this chapter commits a
27 misdemeanor and shall, upon conviction, be sentenced to pay a
28 fine of not more than $1,000 or to imprisonment for not more
29 than one year, or both, together with the cost of prosecution,
30 and, if the offender is an officer or employee of the
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1 Commonwealth, he shall be dismissed from office or discharged
2 from employment.
3 (d) Coordination of effort.--To the extent possible, the
4 department and the Department of Public Welfare shall coordinate
5 efforts to facilitate the application and enrollment of eligible
6 older people in the Medicaid Healthy Horizons Program by
7 processing these applications at senior citizens centers and
8 other appropriate facilities providing services to the elderly.
9 Section 317 318. Contract. <--
10 The department is authorized to enter into a contract
11 providing for prescription drugs to eligible persons pursuant to
12 this subchapter. The department shall select a proposal that
13 includes, but is not limited to, the criteria set forth in this
14 subchapter.
15 Section 318 319. The Pharmaceutical Assistance Contract for the <--
16 Elderly Needs Enhancement Tier.
17 (a) Establishment.--There is hereby established within the
18 department a program to be known as the Pharmaceutical
19 Assistance Contract for the Elderly Needs Enhancement Tier
20 (PACENET).
21 (b) Eligibility.--A claimant with an annual income of not
22 less than $17,000 $14,500 and not more than $20,000 $22,450 in <--
23 the case of a single person and of not less than $20,001 $17,770 <--
24 and not more than $23,200 $30,300 in the case of the combined <--
25 income of persons married to each other shall be eligible for
26 enhanced pharmaceutical assistance under this section. A person
27 may, in reporting income to the department, round the amount of
28 each source of income and the income total to the nearest whole
29 dollar, whereby any amount which is less than 50¢ is eliminated.
30 (c) Requirements.--Upon enrollment in PACENET, eligible
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1 claimants in the income ranges set forth in subsection (b) shall
2 be required to meet a monthly deductible in unreimbursed
3 prescription drug expenses of $40 per person per month. To
4 qualify for the deductible set forth in this subsection the
5 prescription drug must be purchased for the use of the eligible
6 claimant from a provider as defined in this subchapter. The
7 department, after consultation with the board, may SHALL approve <--
8 an adjustment in the deductible on an annual basis.
9 (d) Copayments.--The following are the copayments: <--
10 (1) For generic drugs - $6.
11 (2) For preferred drug list drugs - $12.
12 (3) For drugs which are not on the preferred drug list -
13 $18.
14 (D) COPAYMENT.--THE COPAYMENT AMOUNT FOR GENERIC OR MULTI- <--
15 SOURCE DRUGS SHALL BE LESS THAN THE COPAYMENT AMOUNT FOR SINGLE-
16 SOURCE DRUGS.
17 Section 319 320. Board. <--
18 (a) General.--The Pharmaceutical Assistance Review Board is
19 continued to ensure that the program is providing and continues
20 to provide the assistance intended in a fiscally responsible
21 manner without excessively hampering the pharmacy industry.
22 (b) Membership.--The board shall be comprised of the
23 following eight persons:
24 (1) The Secretary of Aging, who shall serve as its
25 chairman.
26 (2) The Secretary of Revenue.
27 (3) The Secretary of Health.
28 (4) Five public members, one appointed by the President
29 pro tempore of the Senate, one appointed by the Minority
30 Leader of the Senate, one appointed by the Speaker of the
20030H0888B1889 - 20 -
1 House of Representatives, one appointed by the Minority
2 Leader of the House of Representatives and one appointed by
3 the Governor. Those appointed by the legislative officers
4 shall include two senior citizens who have not been a part of
5 the pharmacy industry to serve as consumer advocates, one
6 representative of the pharmacy industry and one practicing
7 Pennsylvania pharmacist. The individual appointed by the
8 Governor must be a physician. A public member who misses two
9 consecutive meetings without good cause acceptable to the
10 chairman shall be replaced by the appointing authority.
11 (c) Annual review.--Using the annual report submitted by the
12 department pursuant to section 2102 of the act of August 26,
13 1971 (P.L.351, No.91), known as the State Lottery Law, and other
14 appropriate data sources, the board shall conduct an annual
15 review. The board shall develop recommendations concerning any
16 changes in the level of copayment, deductible or in the level of
17 fees paid to participating pharmacists. The board shall review
18 the department's therapeutic drug utilization review program on
19 an ongoing basis. The board may also recommend other changes in
20 the structure of the program and direct the department to enter
21 into discussions with the private contractor concerning
22 amendments to the contract, or the department may enter into
23 such discussion if it deems necessary. The copayment or
24 deductible schedule shall only be adjusted on an annual basis.
25 (d) Meetings.--The board shall meet at least two times per
26 year.
27 Section 320 321. Penalties. <--
28 (a) General.--It shall be unlawful for any person to:
29 (1) Submit a false or fraudulent claim or application
30 under this subchapter, including, but not limited to:
20030H0888B1889 - 21 -
1 (i) aiding or abetting another in the submission of
2 a false or fraudulent claim or application;
3 (ii) receiving benefits or reimbursement under a
4 Federal, state or a private program for prescription
5 assistance and claiming or receiving duplicative benefits
6 hereunder;
7 (iii) soliciting, receiving, offering or paying any
8 kickback, bribe or rebate, in cash or in kind, from or to
9 any person in connection with the furnishing of services
10 under this subchapter;
11 (iv) engaging in a pattern of submitting claims that
12 repeatedly uses incorrect National Drug Code numbers for
13 the purpose of obtaining wrongful enhanced reimbursement;
14 or
15 (v) otherwise violating any provision of this
16 subchapter.
17 (2) Charge a copay if the amount of the copay exceeds
18 the actual cost of the drug purchased.
19 (b) Civil penalty.--In addition to any appropriate criminal
20 penalty for prohibited acts under this subchapter whether or not
21 that act constitutes a crime under 18 Pa.C.S. (relating to
22 crimes and offenses), a provider who violates this section may
23 be liable for a civil penalty, which shall be collected by the
24 department, in an amount not less than $500 and not more than
25 $10,000 for each violation of this chapter. Each violation
26 constitutes a separate offense. If the department collects three
27 or more civil penalties against the same provider, the provider
28 shall be ineligible to participate in either PACE or PACENET for
29 a period of one year. If more than three civil penalties are
30 collected from any provider, the department may determine that
20030H0888B1889 - 22 -
1 the provider is permanently ineligible to participate in PACE or
2 PACENET.
3 (c) Suspension.--The license of any provider who has been
4 found guilty under this subchapter shall be suspended for a
5 period of one year. The license of any provider who has
6 committed three or more violations of this subchapter may be
7 suspended for a period of one year.
8 (d) Reparation.--Any provider, recipient or other person who
9 is found guilty of a crime for violating this subchapter shall
10 repay three times the value of the material gain received. In
11 addition to the civil penalty authorized pursuant to subsection
12 (b), the department may require the provider, recipient or other
13 person to repay up to three times the value of any material gain
14 to PACE or PACENET.
15 Section 321 322. Prescription Drug Education Program. <--
16 The department, in cooperation with the Department of Health,
17 shall develop and implement a Statewide prescription drug
18 education program designed to inform older adults of the dangers
19 of prescription drug abuse and misuse. The prescription dug
20 education program shall include, but not be limited to,
21 information concerning the following:
22 (1) The hazards of prescription drug overdose.
23 (2) The potential dangers of mixing prescription drugs.
24 (3) The danger of retaining unused prescription drugs
25 after the need to take them no longer exists.
26 (4) The necessity to carefully question physicians and
27 pharmacists concerning the effects of taking prescription
28 drugs.
29 (5) The advisability of maintaining a prescription drug
30 profile or other record of prescription drug dosage and
20030H0888B1889 - 23 -
1 frequency of dosage.
2 (6) The desirability of advising family members of the
3 types and proper dosage of prescription drugs which are being
4 taken.
5 (7) The dangers of taking prescription drugs in excess
6 of prescribed dosages.
7 (8) The need to obtain complete, detailed directions
8 from the physician or pharmacist concerning the time period a
9 prescription drug should be taken.
10 Section 322 323. Outreach program. <--
11 The department, in consultation with appropriate Commonwealth
12 agencies, shall coordinate the development of an outreach plan
13 to inform potential contractors, providers and enrollees
14 regarding eligibility and available benefits of the PACE and
15 PACENET programs. The plan shall include provisions for reaching
16 special populations, including nonwhite and non-English-speaking
17 people; for reaching different geographic areas, including rural
18 and inner-city areas; and for assuring that special efforts are
19 coordinated within the overall outreach activities throughout
20 this Commonwealth.
21 Section 323. Accountability. <--
22 (a) Audits.--The PACE and PACENET programs shall be subject
23 to an audit by an independent entity at least once each fiscal
24 year. This subsection shall include fiscal audits, provider
25 claims audits, benefits manager administration audits and
26 manufacturer's rebate audits.
27 (b) Conduct of audit.--The audit shall be conducted in
28 accordance with generally accepted auditing standards as
29 prescribed by the American Institute of Certified Public
30 Accountants, the Governmental Accounting Standards Board, the
20030H0888B1889 - 24 -
1 United States General Accounting Office or other professionally
2 recognized entities that prescribe auditing standards.
3 (c) Access.--The auditor shall be entitled to have access to
4 all of the books, accounts, confidential or nonconfidential
5 reports, vouchers or other records of information in the
6 department and its contractors including access to all
7 electronic data. The auditor shall have access to copyrighted or
8 restricted information obtained by the department and its
9 contractors under subscription agreements and utilized in the
10 preparation of economic estimates only for audit purposes.
11 (d) Purpose and report.--The audit shall determine the
12 following:
13 (1) Whether the records, books and accounts of the
14 department and its contractors accurately reflect the
15 financial and fiscal operations.
16 (2) Whether effective accounting control over revenues,
17 obligations, expenditures, assets and liabilities is
18 maintained.
19 (3) Whether the department and its contractors have
20 obligated, expended, received and used State funds in
21 accordance with the purpose for which those funds have been
22 appropriated.
23 (4) Whether the records, books and accounts of the
24 department and its contractors fairly and accurately reflect
25 the financial and fiscal operations relating to the
26 obligation receipt, expenditure and use of State funds.
27 (5) Whether the department and its contractors are
28 managing and utilizing resources, personnel, property,
29 equipment and space in an economical and efficient manner
30 including causes of inefficiencies or uneconomical practices,
20030H0888B1889 - 25 -
1 inadequacies in management information systems, internal and
2 administrative procedures, organizational structure, use of
3 resources, allocation of personnel, purchasing policies and
4 equipment.
5 (6) Whether financial, program and statistical reports
6 of the department and its contractors contain useful data and
7 are fairly presented.
8 (7) Whether the objectives and intended benefits are
9 being achieved efficiently and effectively.
10 (8) Whether the programs are being performed and
11 administered as authorized and required by law.
12 (9) Whether the benefits manager and pharmacy providers
13 are accurately transmitting and billing PACE and PACENET
14 prescription claims.
15 (e) Report.--The auditor shall submit an annual report of
16 its findings, conclusions and recommendations to the department
17 and its contractors and to the Aging and Youth Committee, the
18 Appropriations Committee and the Public Health and Welfare
19 Committee of the Senate and the Aging and Older Adult Services
20 Committee, the Appropriations Committee and the Health and Human
21 Services Committee of the House of Representatives.
22 (f) Response.--The Department of Aging shall respond to the
23 audit report within 30 days of its release.
24 (g) Contract.--The department shall contract for the audit
25 as follows:
26 (1) The auditor shall earn a basic fee not to exceed
27 $200,000. This fee shall be credited to the department if the
28 auditor is compensated under paragraph (2) in the amount of
29 at least $600,000.
30 (2) The auditor shall earn 30% of the funds collected by
20030H0888B1889 - 26 -
1 the department as a result of the audit.
2 SUBCHAPTER B
3 PRUDENT PHARMACEUTICAL PURCHASING
4 Section 341. Definitions.
5 The following words and phrases when used in this subchapter
6 shall have the meanings given to them in this section unless the
7 context clearly indicates otherwise:
8 "Covered prescription drug." A legend drug, insulin, an
9 insulin syringe or an insulin needle eligible for payment by the
10 Commonwealth under PACE, PACENET or designated pharmaceutical
11 programs.
12 "Designated pharmaceutical programs." The general assistance
13 program and the Special Pharmaceutical Benefit Program in the
14 Department of Public Welfare and the End Stage Renal Dialysis
15 Program in the Department of Health.
16 "PACE." The program under Subchapter A.
17 "PACENET." The program established under section 318 319. <--
18 Section 342. Rebate agreement.
19 PACE, PACENET and designated pharmaceutical programs shall
20 reimburse for any covered prescription drug with a rebate
21 agreement drafted on the same basis as provided in section 1927
22 of Title XIX of the Social Security Act (49 Stat. 620, 42 U.S.C.
23 § 1396 r-8).
24 Section 343. Disposition of funds.
25 (a) PACE and PACENET.--Money received under this subchapter
26 in connection with PACE and PACENET shall be deposited in the
27 Pharmaceutical Assistance Contract for the Elderly Fund.
28 (b) Pharmaceutical programs.--Money received under this
29 subchapter in connection with designated pharmaceutical programs
30 shall be treated as a refund of expenditures to the
20030H0888B1889 - 27 -
1 appropriation which originally provided the funding for the
2 pharmaceutical purchase.
3 SUBCHAPTER C <--
4 PHARMACY BEST PRACTICES AND COST CONTROL PROGRAM
5 Section 361. Definitions.
6 The following words and phrases when used in this subchapter
7 shall have the meanings given to them in this section unless the
8 context clearly indicates otherwise:
9 "Committee." The Pharmacy Best Practices and Cost Control
10 Advisory Committee established in section 362.
11 "Department." The Department of Aging of the Commonwealth.
12 "Program." The Pharmacy Best Practices and Cost Control
13 Program established in section 363.
14 "Secretary." The Secretary of Aging of the Commonwealth.
15 § 362. Advisory committee.
16 (a) Establishment.--The Pharmacy Best Practices and Cost
17 Control Advisory Committee is established in the department.
18 (b) Members.--The committee is comprised of the following:
19 (1) The secretary or a designee, who shall serve as
20 chairperson.
21 (2) Four members appointed by the Governor. Members
22 under this paragraph must possess expertise in medicine or
23 pharmacy.
24 (3) One member appointed by the President pro tempore of
25 the Senate and one member appointed by the Minority Leader of
26 the Senate.
27 (4) One member appointed by the Speaker of the House of
28 Representatives and one member appointed by the Minority
29 Leader of the House of Representatives.
30 (c) Terms.--Terms are as follows:
20030H0888B1889 - 28 -
1 (1) The secretary shall serve ex officio.
2 (2) A member under subsection (b)(2) shall serve a term
3 of six years.
4 (3) A member under subsection (b)(3) shall serve a term
5 of four years but may be removed at the pleasure of the
6 appointing authority.
7 (4) A member under subsection (b)(4) shall serve a term
8 of two years but may be removed at the pleasure of the
9 appointing authority.
10 (5) An appointment to fill a vacancy shall be for the
11 period of the unexpired term or until a successor is
12 appointed and qualified.
13 (d) Quorum.--A majority of the members of the committee
14 constitutes a quorum.
15 (e) Compensation.--Members shall receive no payment for
16 their services. Members who are not employees of State
17 government shall be reimbursed for necessary and reasonable
18 expenses incurred in the course of their official duties.
19 Section 363. Program.
20 (a) Establishment.--The secretary shall establish a Pharmacy
21 Best Practices and Cost Control Program for PACE and PACENET
22 enrollees designed to reduce the cost of providing prescription
23 drugs, while maintaining high quality in prescription drug
24 therapies. The program shall be implemented consistent with
25 section 1927 of the Social Security Act (49 Stat. 620, 42 U.S.C.
26 § 1396r-8). The program shall include all of the following:
27 (1) A preferred list of covered prescription drugs which
28 identifies preferred choices within selected therapeutic
29 classes for particular diseases and conditions, including
30 generic alternatives. Therapeutic classes and drugs to be
20030H0888B1889 - 29 -
1 preferred in the classes shall be selected by the department
2 upon recommendations by the committee.
3 (2) Utilization review procedures, including a prior
4 authorization review process which meets the requirements of
5 section 1927(d)(5) of the Social Security Act (42 U.S.C. §
6 1396r-8(d)(5)).
7 (3) A supplemental rebate program or any other strategy
8 designed to negotiate with pharmaceutical manufacturers to
9 lower the cost of prescription drugs for the department's
10 Medicaid program.
11 (4) Education programs, including a counterdetailing
12 program, designed to provide information and education on the
13 therapeutic and cost-effective utilization of prescription
14 drugs to physicians, pharmacists and other health care
15 professionals authorized to prescribe and dispense
16 prescription drugs.
17 (5) Any other cost containment activity adopted by the
18 department which is designed to reduce the cost of providing
19 prescription drugs while maintaining high quality in
20 prescription drug therapies.
21 (b) Pooling.--The secretary shall evaluate the benefits of
22 participating, but is not required to participate, in joint
23 prescription drug purchasing agreements or pooling arrangements
24 with other states. Such actions shall include:
25 (1) The execution of any lawful joint purchasing or
26 pooling agreements with other participating states which the
27 secretary determines will lower the Medicaid cost of
28 prescription drugs while maintaining high quality in
29 prescription drug therapies.
30 (2) Renegotiation and amendment of existing contracts to
20030H0888B1889 - 30 -
1 which the department is a party if renegotiation and
2 amendment will be of economic benefit to the department.
3 (c) Reports.--The secretary shall report quarterly to the
4 committee on the department's progress in securing participation
5 in joint purchasing or pooling agreements.
6 (d) Authorized coverage.--The program shall authorize
7 pharmacy benefit coverage when a patient's health care provider
8 prescribes a prescription drug not on the preferred drug list or
9 a prescription drug which is not the list's preferred choice
10 under the same terms as coverage for preferred choice drugs if
11 any of the following apply:
12 (1) The preferred choice has not been effective or, with
13 reasonable certainty, is not expected to be effective in
14 treating the patient's condition.
15 (2) The preferred choice causes or is reasonably
16 expected to cause adverse or harmful reactions in the
17 patient.
18 (3) Other clinical criteria recommended by the committee
19 and approved by the department is complied with.
20 (4) If the prescriber does not wish substitution to take
21 place, the prescriber shall write "brand necessary" or "no
22 substitution" in the prescriber's own handwriting on the
23 prescription blank, together with a written statement that
24 the generic or therapeutic equivalent has not been effective,
25 or with reasonable certainty is not expected to be effective,
26 in treating the patient's medical condition or causes or is
27 reasonably expected to cause adverse or harmful reactions in
28 the patient. In the case of an unwritten prescription, there
29 shall be no substitution if the prescriber expressly
30 indicates to the pharmacist that the brand name drug is
20030H0888B1889 - 31 -
1 necessary and substitution is not allowed because the generic
2 or therapeutic equivalent has not been effective, or with
3 reasonable certainty is not expected to be effective, in
4 treating the patient's medical condition or causes or is
5 reasonably expected to cause adverse or harmful reactions in
6 the patient.
7 (e) Exclusions.--The department, with recommendations from
8 the committee, shall determine diseases and therapeutic classes
9 relating to treatment for diseases excluded from the program as
10 to Medicaid enrollees already taking specified drugs at the time
11 the program is implemented.
12 (f) Response.--The program's prescriber-indicated prior
13 authorization process shall ensure that there will be a response
14 to a request for prior authorization by telephone or other
15 telecommunication device within 24 hours after receipt of the
16 request for prior authorization and that a 72-hour supply of the
17 drug prescribed will be provided in an emergency or when the
18 program does not provide a response within 24 hours. The prior
19 authorization process shall be designed to minimize
20 administrative burdens on prescribers, pharmacists and
21 consumers.
22 (g) Procedure.--The program shall establish procedures for
23 the timely review of prescription drugs newly approved by the
24 Food and Drug Administration, including procedures for the
25 review of newly approved prescription drugs in emergency
26 circumstances.
27 (h) Reports.--The department shall submit annual reports on
28 the programs under subsection (a) and (b) to the Aging and Youth
29 Committee, the Appropriations Committee and the Public Health
30 and Welfare Committee of the Senate and the Aging and Older
20030H0888B1889 - 32 -
1 Adult Services Committee, the Appropriations Committee and the
2 Health and Human Services Committee of the House of
3 Representatives. The reports shall include classes of drugs,
4 exceptions, cost effectiveness, movement of market share and
5 increased utilization of generic drugs.
6 SUBCHAPTER D C <--
7 PHARMACEUTICAL ASSISTANCE CLEARINGHOUSE
8 Section 371 361. Definitions. <--
9 The following words and phrases when used in this subchapter
10 shall have the meanings given to them in this section unless the
11 context clearly indicates otherwise:
12 "Clearinghouse." The Pharmaceutical Assistance Clearinghouse
13 established in section 372 362. <--
14 "Department." The Department of Aging of the Commonwealth.
15 "Patient assistance program." A program offered by a
16 pharmaceutical manufacturer under which the manufacturer
17 provides prescription medications at no charge or at a
18 substantially reduced cost. The term does not include the
19 provision of a drug as part of a clinical trial.
20 Section 372 362. Pharmaceutical Assistance Clearinghouse. <--
21 (a) Establishment.--Within 120 days of the effective date of
22 this subchapter, the department shall establish the
23 Pharmaceutical Assistance Clearinghouse. Each pharmaceutical
24 manufacturer that does business in this Commonwealth and offers
25 a patient assistance program shall inform the department of all
26 of the following:
27 (1) The existence of the patient assistance program.
28 (2) The eligibility requirements for the patient
29 assistance program.
30 (3) The drugs covered by the patient assistance program.
20030H0888B1889 - 33 -
1 (4) Information, such as a telephone number, which may
2 be used to apply for the patient assistance program.
3 (b) Information.--The clearinghouse shall maintain the
4 information submitted by pharmaceutical manufacturers and make
5 it available to the public.
6 (c) Staff.--The department shall ensure that the
7 clearinghouse is staffed at least during normal business hours.
8 The department shall contract for the services of a school of
9 pharmacy to staff the clearinghouse.
10 Section 373 363. Toll-free telephone number. <--
11 The department shall establish a toll-free telephone number
12 through which the members of the public may obtain information
13 from the clearinghouse about available patient assistance
14 programs.
15 Section 374 364. Assistance available. <--
16 (a) Direct.--
17 (1) The clearinghouse shall assist any individual in
18 determining whether a patient assistance program is offered
19 for a particular drug and whether the individual may be
20 eligible to obtain the drug through a patient assistance
21 program.
22 (2) The clearinghouse may assist an individual who
23 wishes to apply for a patient assistance program by assisting
24 with the preparation of an application and coordinating
25 communications between the individual's physician and a
26 pharmaceutical manufacturer on behalf of the individual for
27 the purpose of obtaining approval to participate in the
28 patient assistance program.
29 (b) Referrals.--The clearinghouse shall make referrals to
30 any publicly funded program for which it deems a patient
20030H0888B1889 - 34 -
1 eligible.
2 Section 375 365. Reporting. <--
3 The department shall report annually to the Governor and the
4 General Assembly on the activities of the clearinghouse. The
5 report shall include:
6 (1) The number of individuals who have been assisted by
7 the clearinghouse.
8 (2) The number and benefits of patient assistance
9 programs listed with the clearinghouse.
10 (3) The number of patients referred to publicly funded
11 programs under section 374(b) 364(B). Programs under this <--
12 paragraph include the Pharmaceutical Assistance Contract for
13 the Elderly Program, medical assistance and programs of the
14 Department of Veterans Affairs.
15 (4) Other information deemed relevant by the department.
16 CHAPTER 51
17 MISCELLANEOUS PROVISIONS
18 Section 5101. Federal programs.
19 If the Federal Government enacts programs similar to PACE or
20 PACENET, the State programs shall be construed to only
21 supplement the Federal programs and all persons qualified for
22 coverage under the Federal program shall utilize that Federal
23 program before utilizing any State program.
24 Section 5102. Repeals.
25 (a) Specific.--Chapters 5 and 7 of the act of August 26,
26 1971 (P.L.351, No.91), known as the State Lottery Law, are
27 repealed.
28 (b) General.--All other acts and parts of acts are repealed
29 insofar as they are inconsistent with this act.
30 Section 5103. Effective date.
20030H0888B1889 - 35 -
1 This act shall take effect immediately.
E14L67VDL/20030H0888B1889 - 36 -