CORRECTIVE REPRINT
PRIOR PRINTER'S NOS. 1044, 1816, 1836, PRINTER'S NO. 2117
1889, 2098
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, 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, FABRIZIO, REED, SAMUELSON, OLIVER,
COY, TANGRETTI, HABAY, GEORGE AND GORDNER, MARCH 13, 2003
AS AMENDED ON THIRD CONSIDERATION, HOUSE OF REPRESENTATIVES,
JUNE 17, 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 and for
4 the Pharmaceutical Assistance Clearinghouse; imposing
5 additional powers and duties on the Department of Aging, the
6 Department of Health, the Department of Public Welfare and
7 the Secretary of Administration; and making repeals.
8 TABLE OF CONTENTS
9 Chapter 1. Preliminary Provisions
10 Section 101. Short title.
11 Chapter 3. Pharmaceutical Matters
12 Subchapter A. Pharmaceutical Assistance for the Elderly
1 Section 301. Legislative findings.
2 Section 302. Definitions.
3 Section 303. Determination of eligibility.
4 Section 304. Physician and pharmacy participation.
5 Section 305. Drug utilization review system.
6 Section 306. Reduced assistance.
7 Section 307. Rebates for expenses prohibited.
8 Section 308. Request for proposal.
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
20030H0888B2117 - 2 -
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 AMENDING THE ACT OF AUGUST 26, 1971 (P.L.351, NO.91), ENTITLED <--
11 "AN ACT PROVIDING FOR A STATE LOTTERY AND ADMINISTRATION
12 THEREOF; AUTHORIZING THE CREATION OF A STATE LOTTERY
13 COMMISSION; PRESCRIBING ITS POWERS AND DUTIES; DISPOSITION OF
14 FUNDS; VIOLATIONS AND PENALTIES THEREFOR; EXEMPTION OF PRIZES
15 FROM STATE AND LOCAL TAXATION AND MAKING AN APPROPRIATION,"
16 FURTHER PROVIDING FOR DEFINITIONS, FOR REQUEST FOR PROPOSAL,
17 FOR PROGRAM GENERALLY, FOR GENERIC DRUGS, FOR RESTRICTED
18 FORMULARY, FOR REIMBURSEMENT, FOR NONLIABILITY, FOR THE
19 PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY NEEDS
20 ENHANCEMENT TIER, FOR THE PHARMACEUTICAL ASSISTANCE REVIEW
21 BOARD, FOR PENALTIES AND FOR THE PRESCRIPTION DRUG EDUCATION
22 PROGRAM; PROVIDING FOR THE PHARMACY BEST PRACTICES AND COST
23 CONTROL PROGRAM; FURTHER PROVIDING FOR DECLARATION OF POLICY,
24 FOR REBATE AGREEMENT, FOR TERMS OF REBATE AGREEMENT AND FOR
25 AMOUNT OF REBATE; PROVIDING FOR A PHARMACEUTICAL ASSISTANCE
26 CLEARINGHOUSE; FURTHER PROVIDING FOR ANNUAL REPORT TO GENERAL
27 ASSEMBLY; AND PROVIDING FOR CONSTRUCTION WITH FEDERAL
28 PROGRAMS.
29 The General Assembly of the Commonwealth of Pennsylvania
30 hereby enacts as follows:
31 CHAPTER 1 <--
32 PRELIMINARY PROVISIONS
33 Section 101. Short title.
34 This act shall be known and may be cited as the
35 Pharmaceutical Reform Act.
36 CHAPTER 3
37 PHARMACEUTICAL MATTERS
38 SUBCHAPTER A
39 PHARMACEUTICAL ASSISTANCE FOR THE ELDERLY
20030H0888B2117 - 3 -
1 Section 301. Legislative findings.
2 Finding that an increasing number of this Commonwealth's
3 elderly citizens who are living on fixed incomes are
4 experiencing difficulties in meeting the costs of life-
5 sustaining prescription drugs, the General Assembly, in its
6 responsibilities to provide for the health, welfare and safety
7 of the residents of this Commonwealth, hereby continues a
8 limited State pharmaceutical assistance program for the elderly.
9 Section 302. Definitions.
10 The following words and phrases when used in this subchapter
11 shall have the meanings given to them in this section unless the
12 context clearly indicates otherwise:
13 "A-rated generic therapeutically equivalent drug." A drug
14 product that the Commissioner of Food and Drugs of the United
15 States Food and Drug Administration has approved as safe and
16 effective and has determined to be therapeutically equivalent,
17 as listed in "The Approved Drug Products with Therapeutic
18 Equivalence Evaluations" (Food and Drug Administration "Orange
19 Book"), with a specific "A" code designation only.
20 "Average wholesale cost." The cost of a dispensed drug based
21 upon the price published in a national drug pricing system in
22 current use by the Department of Aging as the average wholesale
23 price of a prescription drug in the most common package size.
24 "Average wholesale price." Average wholesale cost.
25 "Board." The Pharmaceutical Assistance Review Board.
26 "CMS." Center for Medicare and Medicaid Services.
27 "Department." The Department of Aging of the Commonwealth.
28 "Eligible claimant." A resident of this Commonwealth for no
29 less than 90 days, who is 65 years of age and older, whose
30 annual income is less than the maximum annual income and who is
20030H0888B2117 - 4 -
1 not otherwise qualified for public assistance under the act of
2 June 13, 1967 (P.L.31, No.21), known as the Public Welfare Code.
3 "FDA." The United States Food and Drug Administration of the
4 Public Health Service of the Department of Health and Human
5 Services.
6 "Income." All income from whatever source derived,
7 including, but not limited to, salaries, wages, bonuses,
8 commissions, income from self-employment, alimony, support
9 money, cash public assistance and relief, the gross amount of
10 any pensions or annuities, including railroad retirement
11 benefits, all benefits received under the Social Security Act
12 (49 Stat. 620, 42 U.S.C. § 301 et seq.) except Medicare
13 benefits, all benefits received under State unemployment
14 insurance laws and veterans' disability payments, all interest
15 received from the Federal Government or any state government or
16 any instrumentality or political subdivision thereof, realized
17 capital gains, rentals, workmen's compensation and the gross
18 amount of loss of time insurance benefits, life insurance
19 benefits and proceeds, except the first $5,000 of the total of
20 death benefits payments, and gifts of cash or property, other
21 than transfers by gift between members of a household, in excess
22 of a total value of $300, but does not include surplus food or
23 other relief in kind supplied by a government agency or property
24 tax rebate.
25 "Mail service program." A program set forth in section 313
26 to dispense prescription drugs by postal delivery service
27 designated and administered by the department and any entity
28 with which it contracts, upon an enrollee's submission of a
29 prescription and the applicable copayment.
30 "Maintenance drug." A prescription drug prescribed to an
20030H0888B2117 - 5 -
1 individual for a chronic condition the use of which is medically
2 necessary for a consecutive period of at least 60 days.
3 "Maximum annual income." For PACE eligibility, annual income
4 which shall not exceed $14,500 in the case of single persons nor
5 $17,700 in the case of the combined annual income of persons
6 married to each other. Persons may, in reporting income to the
7 Department of Aging, round the amount of each source of income
8 and the income total to the nearest whole dollar, whereby any
9 amount which is less than 50¢ is eliminated.
10 "PACE." The Pharmaceutical Assistance Contract for the
11 Elderly program provided for in this subchapter.
12 "PACENET." The Pharmaceutical Assistance Contract for the
13 Elderly Needs Enhancement Tier provided for in this subchapter.
14 "Pharmacy." A pharmacy licensed by the Commonwealth.
15 "Prescription drug." All drugs requiring a prescription in
16 this Commonwealth, insulin, insulin syringes and insulin
17 needles. Experimental drugs or drugs prescribed for wrinkle
18 removal or hair growth are prohibited.
19 "Private contractor." A person, partnership or corporate
20 entity that enters into a contract with the Commonwealth to
21 provide services under the provisions of this subchapter.
22 "Program." The Pharmaceutical Assistance Contract for the
23 Elderly (PACE) and the Pharmaceutical Assistance Contract for
24 the Elderly Needs Enhancement Tier (PACENET) as established by
25 this subchapter, unless otherwise specified.
26 "Provider." A pharmacy or dispensing physician enrolled as a
27 provider in the program.
28 Section 303. Determination of eligibility.
29 The department shall adopt regulations relating to the
30 determination of eligibility of prospective claimants and
20030H0888B2117 - 6 -
1 providers, including dispensing physicians, and the
2 determination and elimination of program abuse. To this end, the
3 department shall establish a compliance unit staffed
4 sufficiently to fulfill this responsibility. The department
5 shall have the power to declare ineligible any claimant or
6 provider who abuses or misuses the established prescription
7 plan. The department shall have the power to investigate cases
8 of suspected provider or recipient fraud.
9 Section 304. Physician and pharmacy participation.
10 Any physician, pharmacist, pharmacy or corporation owned in
11 whole or in part by a physician or pharmacist enrolled as a
12 provider in the program or that has prescribed medication for a
13 claimant in the program who is precluded or excluded for cause
14 from the Department of Public Welfare's medical assistance
15 program shall be precluded or excluded from participation in the
16 program. No physician precluded or excluded from the Department
17 of Public Welfare's medical assistance program shall have claims
18 resulting from prescriptions paid for by the program.
19 Section 305. Drug utilization review system.
20 The department shall ensure that a state-of-the-art
21 therapeutic drug utilization review system is established to
22 monitor and correct misutilization of drug therapies.
23 Section 306. Reduced assistance.
24 Any eligible claimant whose prescription drug costs are
25 covered in part by any other plan of assistance or insurance may
26 be required to receive reduced assistance under the provisions
27 of this subchapter.
28 Section 307. Rebates for expenses prohibited.
29 A system of rebates or reimbursements to the claimant for
30 prescription drugs shall be prohibited.
20030H0888B2117 - 7 -
1 Section 308. Request for proposal.
2 (a) General.--The department shall prepare a request for
3 proposal for the purpose of providing pharmaceutical assistance
4 for the elderly within this Commonwealth. Upon the adoption of
5 the General Fund budget, the Department of Revenue shall be
6 authorized to transmit the appropriated funds in the State
7 Lottery Fund to the State Treasurer to be deposited in the
8 Pharmaceutical Assistance Contract for the Elderly Fund. This
9 fund shall consist of appropriations and interest and shall be
10 created by the State Treasurer to fund the operations of the
11 program by the department and the private contractor. Funds not
12 expended in the fiscal year in which they were appropriated
13 shall not lapse and shall be available for use in the next
14 fiscal year.
15 (b) Additional requests.--To provide for the continued
16 operation of the program, the department shall prepare, as
17 needed, requests for proposals, in addition to that set forth in
18 subsection (a), for the purpose of providing pharmaceutical
19 assistance for the elderly within this Commonwealth. A request
20 for proposal shall require potential private contractors to
21 submit a proposal for a period of time and with monetary
22 limitations as determined by the department. Upon the enactment
23 of an appropriation from the State Lottery Fund, the Department
24 of Revenue shall be authorized to transmit the appropriated
25 amount to the State Treasurer to be deposited in the
26 Pharmaceutical Assistance Contract for the Elderly Fund. Funds
27 not expended in the fiscal year in which they were appropriated
28 shall not lapse and shall be available for use in the next
29 fiscal year.
30 Section 309. Drug utilization review and therapeutic
20030H0888B2117 - 8 -
1 interchange.
2 (a) Drug utilization review.--The department shall ensure
3 that a state-of-the-art therapeutic drug utilization review
4 system is established to monitor and correct misutilization of
5 drug therapies.
6 (b) Therapeutic interchange.--The department may develop a
7 therapeutic interchange program based on national medical
8 standards that establish therapeutically equivalent drugs which
9 produce identical levels of clinical effectiveness and outcomes.
10 The program shall authorize pharmacy benefit coverage when a
11 patient's health care provider prescribes a prescription drug
12 not in the program if any of the following apply:
13 (1) The program drug:
14 (i) has not been effective in treating the patient's
15 condition; or
16 (ii) is not expected with reasonable certainty to be
17 effective in treating the patient's condition.
18 (2) The program drug causes or is reasonably expected to
19 cause adverse or harmful reactions in the patient.
20 (3) Other clinical criteria approved by the department
21 are complied with.
22 Section 310. Program generally.
23 (a) Parameters of program.--The program shall include the
24 following:
25 (1) Participating pharmacies shall be paid within 21
26 days of the contracting firm receiving the appropriate
27 substantiation of the transaction. Pharmacies shall be
28 entitled to interest for payment not made within the 21-day
29 period at a rate approved by the board.
30 (2) Collection of the copayment by pharmacies shall be
20030H0888B2117 - 9 -
1 mandatory.
2 (3) Senior citizens participating in the program are not
3 required to maintain records of each transaction.
4 (4) A system of rebates or reimbursements to eligible
5 claimants for pharmaceutical expenses shall be prohibited.
6 (5) The copayment amount for generic or multi-source
7 drugs shall be less than the copayment amount for single-
8 source drugs.
9 (6) Payments as follows:
10 (i) Except as provided in subparagraph (ii), to
11 pharmacies on behalf of eligible claimants for costs of
12 the prescription drug in excess of the copayment as
13 provided in subsections (b) and (c), plus a dispensing
14 fee of $3.50 or the dispensing fee established by the
15 department by regulation, whichever is greater.
16 (ii) For A-rated generic therapeutically equivalent
17 drugs, to pharmacies on behalf of eligible claimants for
18 the upper limits established under 42 CFR § 447.332
19 (relating to upper limits for multiple source drugs),
20 plus a dispensing fee of $4 or the dispensing fee
21 established by the department by regulations, whichever
22 is greater.
23 (7) In no case shall the Commonwealth or any person
24 enrolled in the program be charged more than the price of the
25 drug at the particular pharmacy on the date of the sale.
26 (b) Multiple-source drugs.--Except for brand name drugs that
27 are certified in accordance with subsection (d), the department
28 payment for multiple-source drugs must not exceed the amount
29 that would result from the application of the specific limits
30 established in accordance with subsection (e). If a specific
20030H0888B2117 - 10 -
1 limit has not been established under subsection (e), then the
2 rule for "other drugs" set forth in subsection (c) applies.
3 (c) Other drugs.--The department payments for brand name
4 drugs certified in accordance with subsection (d) and drugs
5 other than multiple-source drugs for which a specific limit has
6 been established under subsection (e) must not exceed in the
7 aggregate payment levels that the department has determined by
8 applying the lower of the:
9 (1) Estimated acquisition costs plus reasonable
10 dispensing fees established by the department.
11 (2) Providers' usual and customary charges to the
12 general public.
13 (d) Certification of brand-name drugs.--
14 (1) The upper limit for payments for multiple-source
15 drugs for which a specific limit has been established under
16 subsection (e) does not apply if a physician certifies in his
17 or her own handwriting that a specific brand is medically
18 necessary for a particular recipient.
19 (2) The department must decide what certification form
20 and procedure are used.
21 (3) A checkoff box on a form is not acceptable but a
22 notation like "brand necessary" is allowable.
23 (4) The department may allow providers to keep the
24 certification forms if the forms will be available for
25 inspection by the department.
26 (e) Establishment and issuance of a listing of multiple-
27 source drugs.--
28 (1) The department will use the CMS listings that
29 identify and set upper limits for multiple-source drugs that
30 meet the following requirements:
20030H0888B2117 - 11 -
1 (i) All of the formulations of the drug approved by
2 the Food and Drug Administration (FDA) have been
3 evaluated as therapeutically equivalent in the most
4 current edition of their publication, Approved Drug
5 Products with Therapeutic Equivalence Evaluations,
6 including supplements or in successor publications.
7 (ii) At least three suppliers list the drug, which
8 has been classified by the FDA as category "A" in its
9 publication, Approved Drug Products with Therapeutic
10 Equivalence Evaluations, including supplements or in
11 successor publications, based on all listings contained
12 in current editions, or updates, of published compendia
13 of cost information for drugs available for sale in this
14 Commonwealth.
15 (2) The department publishes the list of multiple-source
16 drugs for which upper limits have been established and any
17 revisions to the list in Medicaid program instructions.
18 (3) The department will identify the sources used in
19 compiling these lists.
20 Section 311. Generic drugs.
21 (a) General.--Notwithstanding any other statute or
22 regulation, if an A-rated generic therapeutically equivalent
23 drug is available for dispensing to a claimant, the provider
24 shall dispense the A-rated generic therapeutically equivalent
25 drug to the claimant. The department shall not reimburse
26 providers for brand name products except in the following
27 circumstances:
28 (1) There is no A-rated generic therapeutically
29 equivalent drug available on the market. This paragraph does
30 not apply to the lack of availability of an A-rated generic
20030H0888B2117 - 12 -
1 therapeutically equivalent drug in the providing pharmacy
2 unless it can be shown to the department that the provider
3 made reasonable attempts to obtain the A-rated generic
4 therapeutically equivalent drug or that there was an
5 unforeseeable demand and depletion of the supply of the A-
6 rated generic therapeutically equivalent drug. In either
7 case, the department shall reimburse the provider for 90% of
8 the average wholesale cost plus a dispensing fee based on the
9 least expensive A-rated generic therapeutically equivalent
10 drug for the brand drug dispensed.
11 (2) The Department of Health has determined that a drug
12 shall not be recognized as an A-rated generic therapeutically
13 equivalent drug for purpose of substitution under section
14 5(b) of the act of November 24, 1976 (P.L.1163, No.259),
15 referred to as the Generic Equivalent Drug Law.
16 (3) At the time of dispensing, the provider has a
17 prescription on which the brand name drug dispensed is billed
18 to the program by the provider at a usual and customary
19 charge which is equal to or less than the least expensive
20 usual and customary charge of any A-rated generic
21 therapeutically equivalent drug reasonably available on the
22 market to the provider.
23 (b) Copayment.--If a claimant chooses not to accept the A-
24 rated generic therapeutically equivalent drug required by
25 subsection (a), the claimant shall be liable for the copayment
26 and 70% of the average wholesale cost of the brand name drug.
27 (c) Substitution or construction.--The dispensing of an A-
28 rated generic therapeutically equivalent drug in accordance with
29 this subchapter shall not be deemed incorrect substitution under
30 section 6(a) of the Generic Equivalent Drug Law.
20030H0888B2117 - 13 -
1 (d) Medical exception.--A medical exception process shall be
2 established by the department, which shall be published as a
3 notice in the Pennsylvania Bulletin and distributed to providers
4 and recipients in the program.
5 Section 312. Supply.
6 (a) Requirement.--Except as set forth in subsection (b),
7 prescription benefits for any single prescription shall be
8 limited to a 30-day supply of the prescription drug or 100
9 units, whichever is less for acute conditions.
10 (b) Exceptions.--
11 (1) In the case of diagnosis for acute conditions,
12 prescription benefits for any single prescription shall be
13 limited to a 15-day supply.
14 (2) Subsection (a) shall not apply to topical ointments
15 or gels which are not available in containers which meet the
16 size and supply restrictions set forth in subsection (a).
17 (c) Subsection (a) does not apply to contracts under section
18 313(c).
19 Section 313. Mail service program.
20 (a) General rule.--The department shall encourage the use of
21 a mail service program for maintenance drugs for eligible
22 claimants. Only mail order pharmacy services provided by
23 pharmacies which are licensed by the Commonwealth and which have
24 their principal place of business within this Commonwealth may
25 participate as providers under the program.
26 (b) Minimum standards of practice.--The department shall
27 develop and promulgate specific regulations governing the
28 practice of mail order pharmacy and other enrolled providers to
29 include the following minimum standards of practice to ensure
30 the health, safety and welfare of program participants:
20030H0888B2117 - 14 -
1 (1) The appropriate method by which pharmacies verify
2 the identity of the eligible claimant and the authenticity of
3 prescriptions received.
4 (2) The appropriate method by which pharmacies mail or
5 deliver prescription drugs ensuring, to the maximum extent
6 possible, that the intended eligible claimant is the actual
7 ultimate recipient of any prescription dispensed.
8 (3) The appropriate method by which pharmacies
9 communicate with eligible claimants in emergency situations.
10 (c) Ninety-day supply.--The department shall negotiate mail
11 order contracts to provide a 90-day supply of drugs to eligible
12 claimants at a single copayment rate equal to a 30-day supply
13 for each order.
14 (d) Option.--An eligible claimant may use the mail service
15 program if the eligible claimant:
16 (1) utilizes a drug deemed by the department to be
17 appropriate for mail order service;
18 (2) has filled a prescription; and
19 (3) has refilled the prescription under paragraph (2) at
20 least once.
21 (e) Rebates.--A mail order contract must include a rebate
22 from the prescription drug manufacturer. The rebate must be at
23 least as much as follows:
24 (1) For a brand-name drug, the sum of subparagraphs (i)
25 and (ii):
26 (i) A dispensing fee of at least $6.
27 (ii) The difference between:
28 (A) the average wholesale price; and
29 (B) 20% of that price.
30 (2) For a generic drug, the sum of subparagraphs (i) and
20030H0888B2117 - 15 -
1 (ii):
2 (i) A dispensing fee of at least $6.
3 (ii) The difference between:
4 (A) the average wholesale price; and
5 (B) 50% of that price.
6 (f) Negotiated payments.--The department shall not
7 discriminate against a pharmacy that agrees to accept negotiated
8 payment levels with the same terms and conditions and to adhere
9 to quality standards established by the PACE and PACENET
10 programs.
11 Section 314. Indication of price.
12 The retail price of the prescription shall be indicated on
13 the label of the prescription container or furnished by separate
14 receipt.
15 Section 315. Reimbursement.
16 (a) Indication.--The department shall indicate third-party
17 coverage for each eligible claimant.
18 (b) Result.--For-profit third-party insurers and not-for-
19 profit prescription plans shall be responsible for any payments
20 made to a providing pharmacy on behalf of a claimant covered by
21 such a third party.
22 Section 316. Nonliability.
23 (a) General.--Any person rendering service as a member of a
24 utilization review committee for this program shall not be
25 liable for any civil damages as a result of any acts or
26 omissions in rendering the service as a member of any such
27 committee except any acts or omissions intentionally designed to
28 harm or any grossly negligent acts or omissions which result in
29 harm to the person receiving such service.
30 (b) Department personnel.--Any officer or employee of the
20030H0888B2117 - 16 -
1 department rendering service as a member of a utilization review
2 committee for this program shall not be liable for any civil
3 damages as a result of any acts or omissions in rendering the
4 service as a member of any such committee or as a result of any
5 decision or action in connection with the program except any
6 acts or omissions intentionally designed to harm or any grossly
7 negligent acts or omissions which result in harm to the person
8 receiving such service.
9 Section 317. Income verification.
10 (a) General.--The department shall annually verify the
11 income of eligible claimants by requiring income documentation
12 from the claimants. An application for benefits under this
13 subchapter shall constitute a waiver to the department of all
14 relevant confidentiality requirements relating to the claimant's
15 Pennsylvania State income tax information in the possession of
16 the Department of Revenue. The Department of Revenue shall
17 provide the department with the necessary income information
18 shown on the claimant's Pennsylvania State income tax return
19 solely for income verification purposes.
20 (b) Unlawful act.--It shall be unlawful for any officer,
21 agent or employee of the department to divulge or make known in
22 any manner whatsoever any information gained through access to
23 the Department of Revenue information except for official income
24 verification purposes under this subchapter.
25 (c) Penalty.--A person who violates this chapter commits a
26 misdemeanor and shall, upon conviction, be sentenced to pay a
27 fine of not more than $1,000 or to imprisonment for not more
28 than one year, or both, together with the cost of prosecution,
29 and, if the offender is an officer or employee of the
30 Commonwealth, he shall be dismissed from office or discharged
20030H0888B2117 - 17 -
1 from employment.
2 (d) Coordination of effort.--To the extent possible, the
3 department and the Department of Public Welfare shall coordinate
4 efforts to facilitate the application and enrollment of eligible
5 older people in the Medicaid Healthy Horizons Program by
6 processing these applications at senior citizens centers and
7 other appropriate facilities providing services to the elderly.
8 Section 318. Contract.
9 The department is authorized to enter into a contract
10 providing for prescription drugs to eligible persons pursuant to
11 this subchapter. The department shall select a proposal that
12 includes, but is not limited to, the criteria set forth in this
13 subchapter.
14 Section 319. The Pharmaceutical Assistance Contract for the
15 Elderly Needs Enhancement Tier.
16 (a) Establishment.--There is hereby established within the
17 department a program to be known as the Pharmaceutical
18 Assistance Contract for the Elderly Needs Enhancement Tier
19 (PACENET).
20 (b) Eligibility.--A claimant with an annual income of not
21 less than $14,500 and not more than $22,450 in the case of a
22 single person and of not less than $17,770 and not more than
23 $30,300 in the case of the combined income of persons married to
24 each other shall be eligible for enhanced pharmaceutical
25 assistance under this section. A person may, in reporting income
26 to the department, round the amount of each source of income and
27 the income total to the nearest whole dollar, whereby any amount
28 which is less than 50¢ is eliminated.
29 (c) Requirements.--Upon enrollment in PACENET, eligible
30 claimants in the income ranges set forth in subsection (b) shall
20030H0888B2117 - 18 -
1 be required to meet a monthly deductible in unreimbursed
2 prescription drug expenses of $40 per person per month. To
3 qualify for the deductible set forth in this subsection the
4 prescription drug must be purchased for the use of the eligible
5 claimant from a provider as defined in this subchapter. The
6 department, after consultation with the board, shall approve an
7 adjustment in the deductible on an annual basis.
8 (d) Copayment.--The copayment amount for generic or multi-
9 source drugs shall be less than the copayment amount for single-
10 source drugs.
11 Section 320. Board.
12 (a) General.--The Pharmaceutical Assistance Review Board is
13 continued to ensure that the program is providing and continues
14 to provide the assistance intended in a fiscally responsible
15 manner without excessively hampering the pharmacy industry.
16 (b) Membership.--The board shall be comprised of the
17 following eight persons:
18 (1) The Secretary of Aging, who shall serve as its
19 chairman.
20 (2) The Secretary of Revenue.
21 (3) The Secretary of Health.
22 (4) Five public members, one appointed by the President
23 pro tempore of the Senate, one appointed by the Minority
24 Leader of the Senate, one appointed by the Speaker of the
25 House of Representatives, one appointed by the Minority
26 Leader of the House of Representatives and one appointed by
27 the Governor. Those appointed by the legislative officers
28 shall include two senior citizens who have not been a part of
29 the pharmacy industry to serve as consumer advocates, one
30 representative of the pharmacy industry and one practicing
20030H0888B2117 - 19 -
1 Pennsylvania pharmacist. The individual appointed by the
2 Governor must be a physician. A public member who misses two
3 consecutive meetings without good cause acceptable to the
4 chairman shall be replaced by the appointing authority.
5 (c) Annual review.--Using the annual report submitted by the
6 department pursuant to section 2102 of the act of August 26,
7 1971 (P.L.351, No.91), known as the State Lottery Law, and other
8 appropriate data sources, the board shall conduct an annual
9 review. The board shall develop recommendations concerning any
10 changes in the level of copayment, deductible or in the level of
11 fees paid to participating pharmacists. The board shall review
12 the department's therapeutic drug utilization review program on
13 an ongoing basis. The board may also recommend other changes in
14 the structure of the program and direct the department to enter
15 into discussions with the private contractor concerning
16 amendments to the contract, or the department may enter into
17 such discussion if it deems necessary. The copayment or
18 deductible schedule shall only be adjusted on an annual basis.
19 (d) Meetings.--The board shall meet at least two times per
20 year.
21 Section 321. Penalties.
22 (a) General.--It shall be unlawful for any person to:
23 (1) Submit a false or fraudulent claim or application
24 under this subchapter, including, but not limited to:
25 (i) aiding or abetting another in the submission of
26 a false or fraudulent claim or application;
27 (ii) receiving benefits or reimbursement under a
28 Federal, state or a private program for prescription
29 assistance and claiming or receiving duplicative benefits
30 hereunder;
20030H0888B2117 - 20 -
1 (iii) soliciting, receiving, offering or paying any
2 kickback, bribe or rebate, in cash or in kind, from or to
3 any person in connection with the furnishing of services
4 under this subchapter;
5 (iv) engaging in a pattern of submitting claims that
6 repeatedly uses incorrect National Drug Code numbers for
7 the purpose of obtaining wrongful enhanced reimbursement;
8 or
9 (v) otherwise violating any provision of this
10 subchapter.
11 (2) Charge a copay if the amount of the copay exceeds
12 the actual cost of the drug purchased.
13 (b) Civil penalty.--In addition to any appropriate criminal
14 penalty for prohibited acts under this subchapter whether or not
15 that act constitutes a crime under 18 Pa.C.S. (relating to
16 crimes and offenses), a provider who violates this section may
17 be liable for a civil penalty, which shall be collected by the
18 department, in an amount not less than $500 and not more than
19 $10,000 for each violation of this chapter. Each violation
20 constitutes a separate offense. If the department collects three
21 or more civil penalties against the same provider, the provider
22 shall be ineligible to participate in either PACE or PACENET for
23 a period of one year. If more than three civil penalties are
24 collected from any provider, the department may determine that
25 the provider is permanently ineligible to participate in PACE or
26 PACENET.
27 (c) Suspension.--The license of any provider who has been
28 found guilty under this subchapter shall be suspended for a
29 period of one year. The license of any provider who has
30 committed three or more violations of this subchapter may be
20030H0888B2117 - 21 -
1 suspended for a period of one year.
2 (d) Reparation.--Any provider, recipient or other person who
3 is found guilty of a crime for violating this subchapter shall
4 repay three times the value of the material gain received. In
5 addition to the civil penalty authorized pursuant to subsection
6 (b), the department may require the provider, recipient or other
7 person to repay up to three times the value of any material gain
8 to PACE or PACENET.
9 Section 322. Prescription Drug Education Program.
10 The department, in cooperation with the Department of Health,
11 shall develop and implement a Statewide prescription drug
12 education program designed to inform older adults of the dangers
13 of prescription drug abuse and misuse. The prescription dug
14 education program shall include, but not be limited to,
15 information concerning the following:
16 (1) The hazards of prescription drug overdose.
17 (2) The potential dangers of mixing prescription drugs.
18 (3) The danger of retaining unused prescription drugs
19 after the need to take them no longer exists.
20 (4) The necessity to carefully question physicians and
21 pharmacists concerning the effects of taking prescription
22 drugs.
23 (5) The advisability of maintaining a prescription drug
24 profile or other record of prescription drug dosage and
25 frequency of dosage.
26 (6) The desirability of advising family members of the
27 types and proper dosage of prescription drugs which are being
28 taken.
29 (7) The dangers of taking prescription drugs in excess
30 of prescribed dosages.
20030H0888B2117 - 22 -
1 (8) The need to obtain complete, detailed directions
2 from the physician or pharmacist concerning the time period a
3 prescription drug should be taken.
4 Section 323. Outreach program.
5 The department, in consultation with appropriate Commonwealth
6 agencies, shall coordinate the development of an outreach plan
7 to inform potential contractors, providers and enrollees
8 regarding eligibility and available benefits of the PACE and
9 PACENET programs. The plan shall include provisions for reaching
10 special populations, including nonwhite and non-English-speaking
11 people; for reaching different geographic areas, including rural
12 and inner-city areas; and for assuring that special efforts are
13 coordinated within the overall outreach activities throughout
14 this Commonwealth.
15 SUBCHAPTER B
16 PRUDENT PHARMACEUTICAL PURCHASING
17 Section 341. Definitions.
18 The following words and phrases when used in this subchapter
19 shall have the meanings given to them in this section unless the
20 context clearly indicates otherwise:
21 "Covered prescription drug." A legend drug, insulin, an
22 insulin syringe or an insulin needle eligible for payment by the
23 Commonwealth under PACE, PACENET or designated pharmaceutical
24 programs.
25 "Designated pharmaceutical programs." The general assistance
26 program and the Special Pharmaceutical Benefit Program in the
27 Department of Public Welfare and the End Stage Renal Dialysis
28 Program in the Department of Health.
29 "PACE." The program under Subchapter A.
30 "PACENET." The program established under section 319.
20030H0888B2117 - 23 -
1 Section 342. Rebate agreement.
2 PACE, PACENET and designated pharmaceutical programs shall
3 reimburse for any covered prescription drug with a rebate
4 agreement drafted on the same basis as provided in section 1927
5 of Title XIX of the Social Security Act (49 Stat. 620, 42 U.S.C.
6 § 1396 r-8).
7 Section 343. Disposition of funds.
8 (a) PACE and PACENET.--Money received under this subchapter
9 in connection with PACE and PACENET shall be deposited in the
10 Pharmaceutical Assistance Contract for the Elderly Fund.
11 (b) Pharmaceutical programs.--Money received under this
12 subchapter in connection with designated pharmaceutical programs
13 shall be treated as a refund of expenditures to the
14 appropriation which originally provided the funding for the
15 pharmaceutical purchase.
16 SUBCHAPTER C
17 PHARMACEUTICAL ASSISTANCE CLEARINGHOUSE
18 Section 361. Definitions.
19 The following words and phrases when used in this subchapter
20 shall have the meanings given to them in this section unless the
21 context clearly indicates otherwise:
22 "Clearinghouse." The Pharmaceutical Assistance Clearinghouse
23 established in section 362.
24 "Department." The Department of Aging of the Commonwealth.
25 "Patient assistance program." A program offered by a
26 pharmaceutical manufacturer under which the manufacturer
27 provides prescription medications at no charge or at a
28 substantially reduced cost. The term does not include the
29 provision of a drug as part of a clinical trial.
30 Section 362. Pharmaceutical Assistance Clearinghouse.
20030H0888B2117 - 24 -
1 (a) Establishment.--Within 120 days of the effective date of
2 this subchapter, the department shall establish the
3 Pharmaceutical Assistance Clearinghouse. Each pharmaceutical
4 manufacturer that does business in this Commonwealth and offers
5 a patient assistance program shall inform the department of all
6 of the following:
7 (1) The existence of the patient assistance program.
8 (2) The eligibility requirements for the patient
9 assistance program.
10 (3) The drugs covered by the patient assistance program.
11 (4) Information, such as a telephone number, which may
12 be used to apply for the patient assistance program.
13 (b) Information.--The clearinghouse shall maintain the
14 information submitted by pharmaceutical manufacturers and make
15 it available to the public.
16 (c) Staff.--The department shall ensure that the
17 clearinghouse is staffed at least during normal business hours.
18 The department shall contract for the services of a school of
19 pharmacy to staff the clearinghouse.
20 Section 363. Toll-free telephone number.
21 The department shall establish a toll-free telephone number
22 through which the members of the public may obtain information
23 from the clearinghouse about available patient assistance
24 programs.
25 Section 364. Assistance available.
26 (a) Direct.--
27 (1) The clearinghouse shall assist any individual in
28 determining whether a patient assistance program is offered
29 for a particular drug and whether the individual may be
30 eligible to obtain the drug through a patient assistance
20030H0888B2117 - 25 -
1 program.
2 (2) The clearinghouse may assist an individual who
3 wishes to apply for a patient assistance program by assisting
4 with the preparation of an application and coordinating
5 communications between the individual's physician and a
6 pharmaceutical manufacturer on behalf of the individual for
7 the purpose of obtaining approval to participate in the
8 patient assistance program.
9 (b) Referrals.--The clearinghouse shall make referrals to
10 any publicly funded program for which it deems a patient
11 eligible.
12 Section 365. Reporting.
13 The department shall report annually to the Governor and the
14 General Assembly on the activities of the clearinghouse. The
15 report shall include:
16 (1) The number of individuals who have been assisted by
17 the clearinghouse.
18 (2) The number and benefits of patient assistance
19 programs listed with the clearinghouse.
20 (3) The number of patients referred to publicly funded
21 programs under section 364(b). Programs under this paragraph
22 include the Pharmaceutical Assistance Contract for the
23 Elderly Program, medical assistance and programs of the
24 Department of Veterans Affairs.
25 (4) Other information deemed relevant by the department.
26 CHAPTER 51
27 MISCELLANEOUS PROVISIONS
28 Section 5101. Federal programs.
29 If the Federal Government enacts programs similar to PACE or
30 PACENET, the State programs shall be construed to only
20030H0888B2117 - 26 -
1 supplement the Federal programs and all persons qualified for
2 coverage under the Federal program shall utilize that Federal
3 program before utilizing any State program.
4 Section 5102. Repeals.
5 (a) Specific.--Chapters 5 and 7 of the act of August 26,
6 1971 (P.L.351, No.91), known as the State Lottery Law, are
7 repealed.
8 (b) General.--All other acts and parts of acts are repealed
9 insofar as they are inconsistent with this act.
10 Section 5103. Effective date.
11 This act shall take effect immediately.
12 SECTION 1. THE DEFINITIONS OF "HCFA" AND "MAXIMUM ANNUAL <--
13 INCOME" IN SECTION 502 OF THE ACT OF AUGUST 26, 1971 (P.L.351,
14 NO.91), KNOWN AS THE STATE LOTTERY LAW, ADDED NOVEMBER 21, 1996
15 (P.L.741, NO.134), ARE AMENDED AND THE SECTION IS AMENDED BY
16 ADDING A DEFINITION TO READ:
17 SECTION 502. DEFINITIONS.
18 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
19 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
20 CONTEXT CLEARLY INDICATES OTHERWISE:
21 * * *
22 "CMS." THE CENTERS FOR MEDICARE AND MEDICAID SERVICES OF THE
23 UNITED STATES.
24 * * *
25 ["HCFA." THE HEALTH CARE FINANCING ADMINISTRATION OF THE
26 UNITED STATES.]
27 "INCOME." ALL INCOME FROM WHATEVER SOURCE DERIVED,
28 INCLUDING, BUT NOT LIMITED TO, SALARIES, WAGES, BONUSES,
29 COMMISSIONS, INCOME FROM SELF-EMPLOYMENT, ALIMONY, SUPPORT
30 MONEY, CASH PUBLIC ASSISTANCE AND RELIEF, THE GROSS AMOUNT OF
20030H0888B2117 - 27 -
1 ANY PENSIONS OR ANNUITIES, INCLUDING RAILROAD RETIREMENT
2 BENEFITS, ALL BENEFITS RECEIVED UNDER THE SOCIAL SECURITY ACT
3 (49 STAT. 620, 42 U.S.C. § 301 ET. SEQ.) (EXCEPT MEDICARE
4 BENEFITS), ALL BENEFITS RECEIVED UNDER STATE UNEMPLOYMENT
5 INSURANCE LAWS AND VETERANS' DISABILITY PAYMENTS, ALL INTEREST
6 RECEIVED FROM THE FEDERAL GOVERNMENT OR ANY STATE GOVERNMENT OR
7 ANY INSTRUMENTALITY OR POLITICAL SUBDIVISION THEREOF, REALIZED
8 CAPITAL GAINS, RENTALS, WORKMEN'S COMPENSATION AND THE GROSS
9 AMOUNT OF LOSS OF TIME INSURANCE BENEFITS, LIFE INSURANCE
10 BENEFITS AND PROCEEDS, EXCEPT THE FIRST [$5,000] $10,000 OF THE
11 TOTAL OF DEATH BENEFITS PAYMENTS, AND GIFTS OF CASH OR PROPERTY,
12 OTHER THAN TRANSFERS BY GIFT BETWEEN MEMBERS OF A HOUSEHOLD, IN
13 EXCESS OF A TOTAL VALUE OF $300, BUT SHALL NOT INCLUDE SURPLUS
14 FOOD OR OTHER RELIEF IN KIND SUPPLIED BY A GOVERNMENT AGENCY OR
15 PROPERTY TAX REBATE.
16 "MAXIMUM ANNUAL INCOME." FOR PACE ELIGIBILITY, THE TERM
17 SHALL MEAN ANNUAL INCOME WHICH SHALL NOT EXCEED [$14,000]
18 $14,500 IN THE CASE OF SINGLE PERSONS NOR [$17,200] $17,700 IN
19 THE CASE OF THE COMBINED ANNUAL INCOME OF PERSONS MARRIED TO
20 EACH OTHER. PERSONS MAY, IN REPORTING INCOME TO THE DEPARTMENT
21 OF AGING, ROUND THE AMOUNT OF EACH SOURCE OF INCOME AND THE
22 INCOME TOTAL TO THE NEAREST WHOLE DOLLAR, WHEREBY ANY AMOUNT
23 WHICH IS LESS THAN 50¢ IS ELIMINATED.
24 * * *
25 SECTION 2. SECTIONS 508(A), 509, 510(A) AND (B), 512, 515,
26 516, 519 AND 520(B) OF THE ACT, ADDED NOVEMBER 21, 1996
27 (P.L.741, NO.134), ARE AMENDED TO READ:
28 SECTION 508. REQUEST FOR PROPOSAL.
29 (A) GENERAL RULE.--THE DEPARTMENT SHALL PREPARE A REQUEST
30 FOR PROPOSAL FOR THE PURPOSE OF PROVIDING PHARMACEUTICAL
20030H0888B2117 - 28 -
1 ASSISTANCE FOR THE ELDERLY WITHIN THIS COMMONWEALTH BEGINNING AT
2 THE EXPIRATION, INCLUDING ANY OPTION YEARS THE DEPARTMENT
3 CHOOSES TO EXERCISE, OF THE CURRENT VENDOR CONTRACT. UPON THE
4 ADOPTION OF THE GENERAL FUND BUDGET, THE DEPARTMENT OF REVENUE
5 SHALL BE AUTHORIZED TO TRANSMIT THE APPROPRIATED FUNDS IN THE
6 STATE LOTTERY FUND TO THE STATE TREASURER TO BE DEPOSITED IN THE
7 PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY FUND. THIS
8 FUND SHALL CONSIST OF APPROPRIATIONS AND INTEREST AND SHALL BE
9 CREATED BY THE STATE TREASURER TO FUND THE OPERATIONS OF THE
10 PROGRAM BY THE DEPARTMENT AND THE PRIVATE CONTRACTOR. FUNDS NOT
11 EXPENDED IN THE FISCAL YEAR IN WHICH THEY WERE APPROPRIATED
12 SHALL NOT LAPSE AND BE AVAILABLE FOR USE IN THE NEXT FISCAL
13 YEAR.
14 * * *
15 SECTION 509. PROGRAM GENERALLY.
16 THE PROGRAM SHALL INCLUDE THE FOLLOWING:
17 (1) PARTICIPATING PHARMACIES SHALL BE PAID WITHIN 21
18 DAYS OF THE CONTRACTING FIRM RECEIVING THE APPROPRIATE
19 SUBSTANTIATION OF THE TRANSACTION. PHARMACIES SHALL BE
20 ENTITLED TO INTEREST FOR PAYMENT NOT MADE WITHIN THE 21-DAY
21 PERIOD AT A RATE APPROVED BY THE BOARD.
22 (2) COLLECTION OF THE COPAYMENT BY PHARMACIES SHALL BE
23 MANDATORY.
24 (3) SENIOR CITIZENS PARTICIPATING IN THE PROGRAM ARE NOT
25 REQUIRED TO MAINTAIN RECORDS OF EACH TRANSACTION.
26 (4) A SYSTEM OF REBATES OR REIMBURSEMENTS TO ELIGIBLE
27 CLAIMANTS FOR PHARMACEUTICAL EXPENSES SHALL BE PROHIBITED.
28 (5) PACE SHALL INCLUDE [A] PARTICIPANT COPAYMENT
29 [SCHEDULE] SCHEDULES FOR EACH PRESCRIPTION, INCLUDING A
30 COPAYMENT FOR GENERIC OR MULTIPLE-SOURCE DRUGS THAT IS LESS
20030H0888B2117 - 29 -
1 THAN THE COPAYMENT FOR SINGLE-SOURCE DRUGS. THE COPAYMENT
2 [MAY INCREASE OR DECREASE] SHALL BE INCREASED OR DECREASED ON
3 AN ANNUAL BASIS BY THE AVERAGE PERCENT CHANGE OF INGREDIENT
4 COSTS FOR ALL PRESCRIPTION DRUGS, PLUS A DIFFERENTIAL TO
5 RAISE THE COPAYMENT TO THE NEXT HIGHEST 25¢ INCREMENT. IN
6 ADDITION, THE DEPARTMENT MAY APPROVE A REQUEST FOR INCREASE
7 OR DECREASE IN THE LEVEL OF COPAYMENT BASED UPON THE
8 FINANCIAL EXPERIENCE AND PROJECTIONS OF PACE AND AFTER
9 CONSULTATION WITH THE BOARD. THE DEPARTMENT IS PROHIBITED
10 FROM APPROVING ADJUSTMENTS TO THE COPAYMENT ON MORE THAN AN
11 ANNUAL BASIS.
12 (6) THE PROGRAM SHALL CONSIST OF PAYMENTS TO PHARMACIES
13 ON BEHALF OF ELIGIBLE CLAIMANTS FOR 90% OF THE AVERAGE
14 WHOLESALE COSTS OF PRESCRIPTION DRUGS WHICH EXCEED THE
15 COPAYMENT, PLUS A DISPENSING FEE OF AT LEAST [$3.50] $4 OR
16 THE DISPENSING FEE ESTABLISHED BY THE DEPARTMENT BY
17 REGULATION, WHICHEVER 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 (8) THE GOVERNOR MAY, BASED UPON CERTIFIED STATE LOTTERY
22 FUND REVENUE THAT IS PROVIDED TO BOTH THE CHAIRMAN AND
23 MINORITY CHAIRMAN OF THE APPROPRIATIONS COMMITTEE OF THE
24 SENATE AND THE CHAIRMAN AND MINORITY CHAIRMAN OF THE
25 APPROPRIATIONS COMMITTEE OF THE HOUSE OF REPRESENTATIVES, AND
26 AFTER CONSULTATION WITH THE BOARD, INCREASE THE ELIGIBILITY
27 LIMITS ABOVE THOSE ESTABLISHED IN THIS CHAPTER.
28 SECTION 510. GENERIC DRUGS.
29 (A) IN GENERAL.--NOTWITHSTANDING ANY OTHER STATUTE OR
30 REGULATION, IF AN A-RATED GENERIC THERAPEUTICALLY EQUIVALENT
20030H0888B2117 - 30 -
1 DRUG IS AVAILABLE FOR DISPENSING TO A CLAIMANT, THE PROVIDER
2 SHALL DISPENSE THE A-RATED GENERIC THERAPEUTICALLY EQUIVALENT
3 DRUG TO THE CLAIMANT. THE DEPARTMENT SHALL NOT REIMBURSE
4 PROVIDERS FOR BRAND NAME PRODUCTS EXCEPT IN THE FOLLOWING
5 CIRCUMSTANCES:
6 (1) THERE IS NO A-RATED GENERIC THERAPEUTICALLY
7 EQUIVALENT DRUG AVAILABLE ON THE MARKET. THIS PARAGRAPH DOES
8 NOT APPLY TO THE LACK OF AVAILABILITY OF AN A-RATED GENERIC
9 THERAPEUTICALLY EQUIVALENT DRUG IN THE PROVIDING PHARMACY
10 UNLESS IT CAN BE SHOWN TO THE DEPARTMENT THAT THE PROVIDER
11 MADE REASONABLE ATTEMPTS TO OBTAIN THE A-RATED GENERIC
12 THERAPEUTICALLY EQUIVALENT DRUG OR THAT THERE WAS AN
13 UNFORESEEABLE DEMAND AND DEPLETION OF THE SUPPLY OF THE A-
14 RATED GENERIC THERAPEUTICALLY EQUIVALENT DRUG. IN EITHER
15 CASE, THE DEPARTMENT SHALL REIMBURSE THE PROVIDER [FOR 90% OF
16 THE AVERAGE WHOLESALE COST PLUS A DISPENSING FEE BASED ON THE
17 LEAST EXPENSIVE A-RATED GENERIC THERAPEUTICALLY EQUIVALENT
18 DRUG FOR THE BRAND DRUG DISPENSED.] BASED UPON THE MOST
19 CURRENT LISTING OF FEDERAL UPPER PAYMENT LIMITS ESTABLISHED
20 UNDER THE MEDICAID PROGRAM AS PROVIDED UNDER FEDERAL
21 REGULATIONS AT 42 CFR 447.332 (RELATING TO UPPER LIMITS FOR
22 MULTIPLE SOURCE DRUGS), IN ACCORDANCE WITH SECTION
23 1902(A)(30)(A) OF THE SOCIAL SECURITY ACT (49 STAT. 620, 42
24 U.S.C. § 1396A(A)(30)(A)), PLUS A DISPENSING FEE. THE
25 DEPARTMENT SHALL REVIEW THE FEDERAL UPPER PAYMENT LIMITS
26 EVERY 12 MONTHS.
27 (2) AN A-RATED GENERIC THERAPEUTICALLY EQUIVALENT DRUG
28 IS DEEMED BY THE DEPARTMENT, IN CONSULTATION WITH A
29 UTILIZATION REVIEW COMMITTEE, TO HAVE TOO NARROW A
30 THERAPEUTIC INDEX FOR SAFE AND EFFECTIVE DISPENSING IN THE
20030H0888B2117 - 31 -
1 COMMUNITY SETTING. THE DEPARTMENT SHALL NOTIFY PROVIDING
2 PHARMACIES OF A-RATED GENERIC THERAPEUTICALLY EQUIVALENT
3 DRUGS THAT ARE IDENTIFIED PURSUANT TO THIS PARAGRAPH ON A
4 REGULAR BASIS.
5 (3) THE DEPARTMENT OF HEALTH HAS DETERMINED THAT A DRUG
6 SHALL NOT BE RECOGNIZED AS AN A-RATED GENERIC THERAPEUTICALLY
7 EQUIVALENT DRUG FOR PURPOSE OF SUBSTITUTION UNDER SECTION
8 5(B) OF THE ACT OF NOVEMBER 24, 1976 (P.L.1163, NO.259),
9 REFERRED TO AS THE GENERIC EQUIVALENT DRUG LAW.
10 (4) AT THE TIME OF DISPENSING, THE PROVIDER HAS A
11 PRESCRIPTION ON WHICH THE BRAND NAME DRUG DISPENSED IS BILLED
12 TO THE PROGRAM BY THE PROVIDER AT A USUAL AND CUSTOMARY
13 CHARGE WHICH IS EQUAL TO OR LESS THAN THE LEAST EXPENSIVE
14 USUAL AND CUSTOMARY CHARGE OF ANY A-RATED GENERIC
15 THERAPEUTICALLY EQUIVALENT DRUG REASONABLY AVAILABLE ON THE
16 MARKET TO THE PROVIDER.
17 (B) GENERIC NOT ACCEPTED.--[IF] EXCEPT AS PROVIDED IN
18 CHAPTER 6 IF A CLAIMANT CHOOSES NOT TO ACCEPT THE A-RATED
19 GENERIC THERAPEUTICALLY EQUIVALENT DRUG REQUIRED BY SUBSECTION
20 (A), THE CLAIMANT SHALL BE LIABLE FOR THE COPAYMENT AND 70% OF
21 THE AVERAGE WHOLESALE COST OF THE BRAND NAME DRUG.
22 * * *
23 SECTION 512. RESTRICTED FORMULARY.
24 THE DEPARTMENT MAY ESTABLISH A RESTRICTED FORMULARY OF THE
25 DRUGS WHICH WILL NOT BE REIMBURSED BY THE PROGRAM. THIS
26 FORMULARY SHALL INCLUDE ONLY EXPERIMENTAL DRUGS AND DRUGS ON THE
27 DRUG EFFICACY STUDY IMPLEMENTATION LIST PREPARED BY [THE HEALTH
28 CARE FINANCE ADMINISTRATION] CMS. A MEDICAL EXCEPTION MAY BE
29 PERMITTED BY THE DEPARTMENT FOR REIMBURSEMENT OF A DRUG ON THE
30 DRUG EFFICACY STUDY IMPLEMENTATION LIST UPON DECLARATION OF ITS
20030H0888B2117 - 32 -
1 NECESSITY ON THE PRESCRIPTION BY THE TREATING PHYSICIAN, EXCEPT
2 THAT, FOR DESI DRUGS FOR WHICH THE FDA HAS ISSUED A NOTICE FOR
3 OPPORTUNITY HEARING (NOOH) FOR THE PURPOSE OF WITHDRAWING THE
4 NEW DRUG APPLICATION APPROVED FOR THAT DRUG, REIMBURSEMENT
5 COVERAGE SHALL BE DISCONTINUED UNDER THE PROVISIONS OF THIS
6 CHAPTER.
7 SECTION 515. REIMBURSEMENT.
8 FOR-PROFIT THIRD-PARTY INSURERS, HEALTH MAINTENANCE
9 ORGANIZATIONS AND NOT-FOR-PROFIT PRESCRIPTION PLANS SHALL BE
10 RESPONSIBLE FOR ANY PAYMENTS MADE TO A PROVIDING PHARMACY ON
11 BEHALF OF A CLAIMANT COVERED BY SUCH A THIRD PARTY.
12 SECTION 516. NONLIABILITY.
13 (A) [PERSONS RENDERING SERVICE] GENERAL RULE.--ANY PERSON
14 RENDERING SERVICE AS A MEMBER OF A UTILIZATION REVIEW COMMITTEE
15 FOR THIS PROGRAM SHALL NOT BE LIABLE FOR ANY CIVIL DAMAGES AS A
16 RESULT OF ANY ACTS OR OMISSIONS IN RENDERING THE SERVICE AS A
17 MEMBER OF ANY SUCH COMMITTEE EXCEPT ANY ACTS OR OMISSIONS
18 INTENTIONALLY DESIGNED TO HARM OR ANY GROSSLY NEGLIGENT ACTS OR
19 OMISSIONS WHICH RESULT IN HARM TO THE PERSON RECEIVING SUCH
20 SERVICE.
21 (B) [OFFICER AND EMPLOYEES OF DEPARTMENT] DEPARTMENT
22 PERSONNEL.--ANY OFFICER OR EMPLOYEE OF THE DEPARTMENT RENDERING
23 SERVICE AS A MEMBER OF A UTILIZATION REVIEW COMMITTEE FOR THIS
24 PROGRAM SHALL NOT BE LIABLE FOR ANY CIVIL DAMAGES AS A RESULT OF
25 ANY ACTS OR OMISSIONS IN RENDERING THE SERVICE AS A MEMBER OF
26 ANY SUCH COMMITTEE OR AS A RESULT OF ANY DECISION OR ACTION IN
27 CONNECTION WITH THE PROGRAM EXCEPT ANY ACTS OR OMISSIONS
28 INTENTIONALLY DESIGNED TO HARM OR ANY GROSSLY NEGLIGENT ACTS OR
29 OMISSIONS WHICH RESULT IN HARM TO THE PERSON RECEIVING SUCH
30 SERVICE.
20030H0888B2117 - 33 -
1 SECTION 519. THE PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE
2 ELDERLY NEEDS ENHANCEMENT TIER.
3 (A) ESTABLISHMENT.--THERE IS HEREBY ESTABLISHED WITHIN THE
4 DEPARTMENT A PROGRAM TO BE KNOWN AS THE PHARMACEUTICAL
5 ASSISTANCE CONTRACT FOR THE ELDERLY NEEDS ENHANCEMENT TIER
6 (PACENET).
7 (B) PACENET ELIGIBILITY.--A CLAIMANT WITH AN ANNUAL INCOME
8 OF NOT LESS THAN [$14,000] $14,500 AND NOT MORE THAN [$16,000]
9 $22,500 IN THE CASE OF A SINGLE PERSON AND OF NOT LESS THAN
10 [$17,200] $17,700 AND NOT MORE THAN [$19,200] $30,500 IN THE
11 CASE OF THE COMBINED INCOME OF PERSONS MARRIED TO EACH OTHER
12 SHALL BE ELIGIBLE FOR ENHANCED PHARMACEUTICAL ASSISTANCE UNDER
13 THIS SECTION. A PERSON MAY, IN REPORTING INCOME TO THE
14 DEPARTMENT, ROUND THE AMOUNT OF EACH SOURCE OF INCOME AND THE
15 INCOME TOTAL TO THE NEAREST WHOLE DOLLAR, WHEREBY ANY AMOUNT
16 WHICH IS LESS THAN 50¢ IS ELIMINATED.
17 (C) DEDUCTIBLE.--UPON ENROLLMENT IN PACENET, ELIGIBLE
18 CLAIMANTS IN THE INCOME RANGES SET FORTH IN SUBSECTION (B) SHALL
19 BE REQUIRED TO MEET [AN ANNUAL] A DEDUCTIBLE IN UNREIMBURSED
20 PRESCRIPTION DRUG EXPENSES OF [$500] $40 PER PERSON[.] PER
21 MONTH. THE $40 MONTHLY DEDUCTIBLE SHALL BE CUMULATIVE AND SHALL
22 BE APPLIED TO SUBSEQUENT MONTHS TO DETERMINE ELIGIBILITY. THE
23 CUMULATIVE DEDUCTIBLE SHALL BE DETERMINED ON A CALENDAR YEAR
24 BASIS FOR AN ANNUAL TOTAL DEDUCTIBLE NOT TO EXCEED $480 IN A
25 YEAR. TO QUALIFY FOR THE DEDUCTIBLE SET FORTH IN THIS SUBSECTION
26 THE PRESCRIPTION DRUG MUST BE PURCHASED FOR THE USE OF THE
27 ELIGIBLE CLAIMANT FROM A PROVIDER AS DEFINED IN THIS CHAPTER.
28 THE DEPARTMENT, AFTER CONSULTATION WITH THE BOARD, [MAY] SHALL
29 APPROVE AN ADJUSTMENT IN THE DEDUCTIBLE ON AN ANNUAL BASIS.
30 (D) COPAYMENT.--FOR ELIGIBLE CLAIMANTS UNDER THIS SECTION,
20030H0888B2117 - 34 -
1 THE COPAYMENT SCHEDULE, WHICH [MAY] SHALL BE ADJUSTED BY THE
2 DEPARTMENT ON AN ANNUAL BASIS AFTER CONSULTATION WITH THE BOARD,
3 SHALL BE:
4 (I) EIGHT DOLLARS FOR NONINNOVATOR MULTIPLE SOURCE
5 DRUGS AS DEFINED IN SECTION 702; OR
6 (II) FIFTEEN DOLLARS FOR SINGLE-SOURCE DRUGS AND
7 INNOVATOR MULTIPLE-SOURCE DRUGS AS DEFINED IN SECTION
8 702.
9 SECTION 520. BOARD.
10 * * *
11 (B) COMPOSITION.--THE BOARD SHALL BE COMPRISED OF THE
12 FOLLOWING EIGHT PERSONS:
13 (1) THE SECRETARY OF AGING, WHO SHALL SERVE AS ITS
14 CHAIRMAN.
15 (2) THE SECRETARY OF REVENUE.
16 (3) THE SECRETARY OF HEALTH.
17 (4) FIVE PUBLIC MEMBERS, ONE APPOINTED BY THE PRESIDENT
18 PRO TEMPORE OF THE SENATE, ONE APPOINTED BY THE MINORITY
19 LEADER OF THE SENATE, ONE APPOINTED BY THE SPEAKER OF THE
20 HOUSE OF REPRESENTATIVES, ONE APPOINTED BY THE MINORITY
21 LEADER OF THE HOUSE OF REPRESENTATIVES AND ONE APPOINTED BY
22 THE GOVERNOR. THOSE APPOINTED BY THE LEGISLATIVE OFFICERS
23 SHALL INCLUDE TWO SENIOR CITIZENS WHO HAVE NOT BEEN A PART OF
24 THE PHARMACEUTICAL INDUSTRY TO SERVE AS CONSUMER ADVOCATES
25 [AND TWO REPRESENTATIVES], ONE REPRESENTATIVE OF THE
26 PHARMACEUTICAL INDUSTRY[, AT LEAST ONE OF WHOM IS A] AND ONE
27 PRACTICING PENNSYLVANIA PHARMACIST. THE INDIVIDUAL APPOINTED
28 BY THE GOVERNOR MUST BE A PHYSICIAN. A PUBLIC MEMBER WHO
29 MISSES TWO CONSECUTIVE MEETINGS WITHOUT GOOD CAUSE ACCEPTABLE
30 TO THE CHAIRMAN SHALL BE REPLACED BY THE APPOINTING
20030H0888B2117 - 35 -
1 AUTHORITY.
2 * * *
3 SECTION 3. THE ACT IS AMENDED BY ADDING A SECTION TO READ:
4 SECTION 520.1. PACE AND PACENET ELIGIBILITY ADVISORY COMMITTEE.
5 (A) ESTABLISHMENT.--THERE IS ESTABLISHED IN THE DEPARTMENT
6 THE PACE AND PACENET ELIGIBILITY ADVISORY COMMITTEE.
7 (B) COMPOSITION.--THE ELIGIBILITY ADVISORY COMMITTEE SHALL
8 CONSIST OF FOUR MEMBERS WHO SHALL BE MEMBERS OF THE GENERAL
9 ASSEMBLY AND A CHAIRMAN WHO SHALL BE APPOINTED BY THE GOVERNOR.
10 THE MEMBERS OF THE GENERAL ASSEMBLY SHALL BE APPOINTED AS
11 FOLLOWS:
12 (1) ONE MEMBER APPOINTED BY THE PRESIDENT PRO TEMPORE OF
13 THE SENATE.
14 (2) ONE MEMBER APPOINTED BY THE MINORITY LEADER OF THE
15 SENATE.
16 (3) ONE MEMBER APPOINTED BY THE SPEAKER OF THE HOUSE OF
17 REPRESENTATIVES.
18 (4) ONE MEMBER APPOINTED BY THE MINORITY LEADER OF THE
19 HOUSE OF REPRESENTATIVES.
20 (C) CHAIRMAN.--NOTHING IN THIS SECTION SHALL BE CONSTRUED AS
21 PROHIBITING THE GOVERNOR FROM APPOINTING A MEMBER OF THE GENERAL
22 ASSEMBLY AS CHAIRMAN .
23 (D) TERM.--MEMBERS SHALL SERVE AT THE PLEASURE OF THE
24 APPOINTING AUTHORITY.
25 (E) EXPENSES.--MEMBERS OF THE ADVISORY COMMITTEE SHALL SERVE
26 WITHOUT COMPENSATION BUT SHALL BE REIMBURSED FOR ACTUAL AND
27 REASONABLE EXPENSES INCURRED IN THE PERFORMANCE OF THEIR
28 OFFICIAL DUTIES.
29 (F) DESIGNEE.--A DESIGNEE DESIGNATED BY A MEMBER UNDER
30 SUBSECTION (B)(1), (2), (3) AND (4) MAY VOTE AND OTHERWISE ACT
20030H0888B2117 - 36 -
1 ON BEHALF OF THE MEMBER. THE DESIGNATION MUST BE IN WRITING AND
2 BE DELIVERED TO THE ADVISORY COMMITTEE. THE DESIGNATION SHALL
3 CONTINUE IN EFFECT UNTIL REVOKED OR AMENDED IN WRITING.
4 (G) QUORUM.--A MAJORITY OF THE MEMBERS OF THE ADVISORY
5 COMMITTEE THEN SERVING SHALL CONSTITUTE A QUORUM OF THE ADVISORY
6 COMMITTEE. ONLY A MEMBER OR A DESIGNEE WHO IS PHYSICALLY PRESENT
7 AT A MEETING OR ABLE TO PARTICIPATE FULLY IN THE DELIBERATIONS
8 BY APPROPRIATE TELECOMMUNICATIONS MEANS SHALL COUNT TOWARD A
9 QUORUM OF THE ADVISORY COMMITTEE.
10 (H) RESPONSIBILITIES.--THE ADVISORY COMMITTEE SHALL STUDY
11 THE FEASIBILITY OF EXPANSIONS AND OTHER CHANGES TO ELIGIBILITY
12 UNDER THE PACE PROGRAM AND MAKE RECOMMENDATIONS TO THE GOVERNOR
13 AND THE DEPARTMENT ON AN ANNUAL BASIS. IN ADDITION, THE ADVISORY
14 COMMITTEE MAY STUDY AND PARTICIPATE, WITH THE APPROVAL OF THE
15 GOVERNOR AND THE DEPARTMENT, IN ADVOCATING AT OTHER LEVELS OF
16 GOVERNMENT PROPOSED CHANGES IN THE PROVISION OF PHARMACEUTICAL
17 BENEFITS TO SENIOR CITIZENS. THE COMMITTEE MAY ALSO MAKE
18 RECOMMENDATIONS WITH RESPECT TO THE TERMS AND CONDITIONS UNDER
19 WHICH PHARMACEUTICAL COMPANIES PARTICIPATE IN COMMONWEALTH
20 HEALTH CARE PROGRAMS FOR THE ELDERLY.
21 SECTION 4. SECTIONS 521(D) AND 522 OF THE ACT, ADDED
22 NOVEMBER 21, 1996 (P.L.741, NO.134), ARE AMENDED TO READ:
23 SECTION 521. PENALTIES.
24 * * *
25 (D) [REPAYMENT OF GAIN] REPARATION.--ANY PROVIDER, RECIPIENT
26 OR OTHER PERSON WHO IS FOUND GUILTY OF A CRIME FOR VIOLATING
27 THIS CHAPTER SHALL REPAY THREE TIMES THE VALUE OF THE MATERIAL
28 GAIN RECEIVED. IN ADDITION TO THE CIVIL PENALTY AUTHORIZED
29 PURSUANT TO SUBSECTION (B), THE DEPARTMENT MAY REQUIRE THE
30 PROVIDER, RECIPIENT OR OTHER PERSON TO REPAY UP TO THREE TIMES
20030H0888B2117 - 37 -
1 THE VALUE OF ANY MATERIAL GAIN TO PACE OR PACENET.
2 SECTION 522. PRESCRIPTION DRUG EDUCATION PROGRAM.
3 THE DEPARTMENT, IN COOPERATION WITH THE DEPARTMENT OF HEALTH,
4 SHALL DEVELOP AND IMPLEMENT A STATEWIDE PRESCRIPTION DRUG
5 EDUCATION PROGRAM DESIGNED TO INFORM OLDER ADULTS OF THE DANGERS
6 OF PRESCRIPTION DRUG ABUSE AND MISUSE. THE PRESCRIPTION DRUG
7 EDUCATION PROGRAM SHALL INCLUDE, BUT NOT BE LIMITED TO,
8 INFORMATION CONCERNING THE FOLLOWING:
9 (1) THE HAZARDS OF PRESCRIPTION DRUG OVERDOSE.
10 (2) THE POTENTIAL DANGERS OF MIXING PRESCRIPTION DRUGS.
11 (3) THE DANGER OF RETAINING UNUSED PRESCRIPTION DRUGS
12 AFTER THE NEED TO TAKE THEM NO LONGER EXISTS.
13 (4) THE NECESSITY TO CAREFULLY QUESTION PHYSICIANS AND
14 PHARMACISTS CONCERNING THE EFFECTS OF TAKING PRESCRIPTION
15 DRUGS[, INCLUDING THE DIFFERENCES BETWEEN BRAND-NAME DRUGS
16 AND GENERICALLY EQUIVALENT DRUGS].
17 (5) THE ADVISABILITY OF MAINTAINING A PRESCRIPTION DRUG
18 PROFILE OR OTHER RECORD OF PRESCRIPTION DRUG DOSAGE AND
19 FREQUENCY OF DOSAGE.
20 (6) THE DESIRABILITY OF ADVISING FAMILY MEMBERS OF THE
21 TYPES AND PROPER DOSAGE OF PRESCRIPTION DRUGS WHICH ARE BEING
22 TAKEN.
23 (7) THE DANGERS OF TAKING PRESCRIPTION DRUGS IN EXCESS
24 OF PRESCRIBED DOSAGES.
25 (8) THE NEED TO OBTAIN COMPLETE, DETAILED DIRECTIONS
26 FROM THE PHYSICIAN OR PHARMACIST CONCERNING THE TIME PERIOD A
27 PRESCRIPTION DRUG SHOULD BE TAKEN.
28 SECTION 5. THE ACT IS AMENDED BY ADDING A CHAPTER TO READ:
29 CHAPTER 6
30 PHARMACY BEST PRACTICES AND COST CONTROL PROGRAM
20030H0888B2117 - 38 -
1 SECTION 601. DEFINITIONS.
2 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
3 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
4 CONTEXT CLEARLY INDICATES OTHERWISE:
5 "COMMITTEE." THE PHARMACY BEST PRACTICES AND COST CONTROL
6 ADVISORY COMMITTEE ESTABLISHED IN SECTION 602.
7 "DEPARTMENT." THE DEPARTMENT OF AGING OF THE COMMONWEALTH.
8 "PROGRAM." THE PHARMACY BEST PRACTICES AND COST CONTROL
9 PROGRAM ESTABLISHED IN SECTION 603.
10 "SECRETARY." THE SECRETARY OF AGING OF THE COMMONWEALTH.
11 SECTION 602. ADVISORY COMMITTEE.
12 (A) ESTABLISHMENT.--THE PHARMACY BEST PRACTICES AND COST
13 CONTROL ADVISORY COMMITTEE IS ESTABLISHED IN THE DEPARTMENT.
14 (B) MEMBERS.--THE COMMITTEE IS COMPRISED OF THE FOLLOWING
15 PENNSYLVANIA RESIDENTS:
16 (1) THE SECRETARY OR A DESIGNEE, WHO SHALL SERVE AS
17 CHAIRPERSON.
18 (2) FOUR MEMBERS APPOINTED BY THE GOVERNOR. ONE MEMBER
19 UNDER THIS PARAGRAPH MUST POSSESS EXPERTISE IN MEDICINE, ONE
20 MEMBER MUST POSSESS EXPERTISE IN HEALTH CARE, ONE MEMBER MUST
21 POSSESS EXPERTISE IN PHARMACY AND ONE MEMBER MUST POSSESS
22 EXPERTISE IN THE PHARMACEUTICAL INDUSTRY.
23 (3) ONE MEMBER APPOINTED BY THE PRESIDENT PRO TEMPORE OF
24 THE SENATE AND ONE MEMBER APPOINTED BY THE MINORITY LEADER OF
25 THE SENATE.
26 (4) ONE MEMBER APPOINTED BY THE SPEAKER OF THE HOUSE OF
27 REPRESENTATIVES AND ONE MEMBER APPOINTED BY THE MINORITY
28 LEADER OF THE HOUSE OF REPRESENTATIVES.
29 (C) TERMS.--TERMS ARE AS FOLLOWS:
30 (1) THE SECRETARY SHALL SERVE EX OFFICIO.
20030H0888B2117 - 39 -
1 (2) A MEMBER UNDER SUBSECTION (B)(2) SHALL SERVE A TERM
2 OF SIX YEARS.
3 (3) A MEMBER UNDER SUBSECTION (B)(3) SHALL SERVE A TERM
4 OF FOUR YEARS BUT MAY BE REMOVED AT THE PLEASURE OF THE
5 APPOINTING AUTHORITY.
6 (4) A MEMBER UNDER SUBSECTION (B)(4) SHALL SERVE A TERM
7 OF TWO YEARS BUT MAY BE REMOVED AT THE PLEASURE OF THE
8 APPOINTING AUTHORITY.
9 (5) AN APPOINTMENT TO FILL A VACANCY SHALL BE FOR THE
10 PERIOD OF THE UNEXPIRED TERM OR UNTIL A SUCCESSOR IS
11 APPOINTED AND QUALIFIED.
12 (D) QUORUM.--A MAJORITY OF THE MEMBERS OF THE COMMITTEE
13 CONSTITUTES A QUORUM.
14 (E) COMPENSATION.--MEMBERS SHALL RECEIVE NO PAYMENT FOR
15 THEIR SERVICES. MEMBERS WHO ARE NOT EMPLOYEES OF STATE
16 GOVERNMENT SHALL BE REIMBURSED FOR NECESSARY AND REASONABLE
17 EXPENSES INCURRED IN THE COURSE OF THEIR OFFICIAL DUTIES.
18 (F) MEETINGS.--MEETINGS OF THIS COMMITTEE SHALL BE HELD IN
19 PUBLIC PURSUANT TO 65 PA.S.C. CH. 7 (RELATING TO PUBLIC
20 MEETINGS).
21 SECTION 603. PROGRAM.
22 (A) ESTABLISHMENT.--THE SECRETARY SHALL ESTABLISH A PHARMACY
23 BEST PRACTICES AND COST CONTROL PROGRAM FOR PACE AND PACENET
24 ENROLLEES DESIGNED TO REDUCE THE COST OF PROVIDING PRESCRIPTION
25 DRUGS, WHILE MAINTAINING HIGH QUALITY IN PRESCRIPTION DRUG
26 THERAPIES. THE PROGRAM SHALL INCLUDE ALL OF THE FOLLOWING:
27 (1) A LIST OF COVERED PRESCRIPTION DRUGS UNDER SECTION
28 509 IN THE PROGRAM SELECTED BY THE DEPARTMENT UPON
29 RECOMMENDATIONS BY THE COMMITTEE.
30 (2) A DRUG UTILIZATION REVIEW PROCEDURE, INCLUDING A
20030H0888B2117 - 40 -
1 PRESCRIPTION REVIEW PROCESS FOR COPAYMENT SCHEDULES.
2 (3) EDUCATION PROGRAMS DESIGNED TO PROVIDE INFORMATION
3 AND EDUCATION ON THE THERAPEUTIC AND COST-EFFECTIVE
4 UTILIZATION OF PRESCRIPTION DRUGS TO PHYSICIANS, PHARMACISTS
5 AND OTHER HEALTH CARE PROFESSIONALS AUTHORIZED TO PRESCRIBE
6 AND DISPENSE PRESCRIPTION DRUGS.
7 (B) POOLING.--THE SECRETARY SHALL EVALUATE THE BENEFITS OF
8 PARTICIPATING, BUT IS NOT REQUIRED TO PARTICIPATE, IN JOINT
9 PRESCRIPTION DRUG PURCHASING AGREEMENTS OR POOLING ARRANGEMENTS
10 WITH OTHER STATES. SUCH ACTIONS SHALL INCLUDE:
11 (1) THE EXECUTION OF ANY LAWFUL JOINT PURCHASING OR
12 POOLING AGREEMENTS WITH OTHER PARTICIPATING STATES WHICH THE
13 SECRETARY DETERMINES WILL LOWER THE MEDICAID COST OF
14 PRESCRIPTION DRUGS WHILE MAINTAINING HIGH QUALITY IN
15 PRESCRIPTION DRUG THERAPIES.
16 (2) RENEGOTIATION AND AMENDMENT OF EXISTING CONTRACTS TO
17 WHICH THE DEPARTMENT IS A PARTY IF RENEGOTIATION AND
18 AMENDMENT WILL BE OF ECONOMIC BENEFIT TO THE DEPARTMENT.
19 (3) A QUARTERLY REPORT TO THE COMMITTEE ON THE
20 DEPARTMENT'S PROGRESS IN SECURING PARTICIPATION IN JOINT
21 PURCHASING OR POOLING AGREEMENTS.
22 (C) AUTHORIZED COVERAGE.--THE PROGRAM SHALL AUTHORIZE
23 COPAYMENTS SCHEDULES FOR EACH PRESCRIPTION DRUG. WHEN A
24 PATIENT'S HEALTH CARE PROVIDER PRESCRIBES A PRESCRIPTION DRUG AT
25 THE HIGHER COPAYMENT SCHEDULE, THE LOWER COPAYMENT SHALL APPLY
26 FOR ONE YEAR WHEN ANY OF THE FOLLOWING CONDITIONS ARE MET:
27 (1) THE PREFERRED CHOICE HAS NOT BEEN EFFECTIVE OR, WITH
28 REASONABLE CERTAINTY, IS NOT EXPECTED TO BE EFFECTIVE IN
29 TREATING THE PATIENT'S CONDITION.
30 (2) THE PREFERRED CHOICE CAUSES OR IS REASONABLY
20030H0888B2117 - 41 -
1 EXPECTED TO CAUSE ADVERSE OR HARMFUL REACTIONS IN THE
2 PATIENT.
3 (3) OTHER CLINICAL CRITERIA RECOMMENDED BY THE COMMITTEE
4 AND APPROVED BY THE DEPARTMENT.
5 (D) BRAND NECESSARY.--IF THE PRESCRIBER DOES NOT WISH
6 SUBSTITUTION TO TAKE PLACE, THE PRESCRIBER SHALL WRITE "BRAND
7 NECESSARY" OR "NO SUBSTITUTION" IN THE PRESCRIBER'S OWN
8 HANDWRITING ON THE PRESCRIPTION BLANK, TOGETHER WITH A WRITTEN
9 STATEMENT THAT THE GENERIC OR THE EQUIVALENT HAS NOT BEEN
10 EFFECTIVE, OR WITH REASONABLE CERTAINTY IS NOT EXPECTED TO BE
11 EFFECTIVE, IN TREATING THE PATIENT'S MEDICAL CONDITION OR CAUSES
12 OR IS REASONABLY EXPECTED TO CAUSE ADVERSE OR HARMFUL REACTIONS
13 IN THE PATIENT. IN THE CASE OF AN UNWRITTEN PRESCRIPTION, THERE
14 SHALL BE NO SUBSTITUTION IF THE PRESCRIBER EXPRESSLY INDICATES
15 TO THE PHARMACIST THAT THE BRAND NAME DRUG IS NECESSARY AND
16 SUBSTITUTION IS NOT ALLOWED BECAUSE THE GENERIC OR THE
17 EQUIVALENT HAS NOT BEEN EFFECTIVE, OR WITH REASONABLE CERTAINTY
18 IS NOT EXPECTED TO BE EFFECTIVE, IN TREATING THE PATIENT'S
19 MEDICAL CONDITION OR CAUSES OR IS REASONABLY EXPECTED TO CAUSE
20 ADVERSE OR HARMFUL REACTIONS IN THE PATIENT. APPROVAL UNDER THIS
21 SECTION SHALL BE VALID FOR ONE YEAR.
22 (E) EXCLUSIONS.--THE DEPARTMENT, WITH RECOMMENDATIONS FROM
23 THE COMMITTEE, SHALL DETERMINE DISEASES AND THERAPEUTIC CLASSES
24 RELATING TO TREATMENT FOR DISEASES EXCLUDED FROM THE PROGRAM AT
25 THE TIME THE PROGRAM UNDER THIS SECTION IS IMPLEMENTED.
26 (F) RESPONSE.--THE PROGRAM'S PRESCRIBER-INDICATED PRIOR
27 AUTHORIZATION PROCESS SHALL ENSURE THAT THERE WILL BE A RESPONSE
28 TO A REQUEST FOR PRIOR AUTHORIZATION BY TELEPHONE OR OTHER
29 TELECOMMUNICATION DEVICE WITHIN 12 HOURS AFTER RECEIPT OF THE
30 REQUEST FOR PRIOR AUTHORIZATION AND THAT A MINIMUM OF A 72-HOUR
20030H0888B2117 - 42 -
1 SUPPLY OF THE DRUG PRESCRIBED WILL BE PROVIDED IN AN EMERGENCY
2 OR WHEN THE PROGRAM DOES NOT PROVIDE A RESPONSE WITHIN 12 HOURS.
3 THE PRIOR AUTHORIZATION PROCESS SHALL BE DESIGNED TO MINIMIZE
4 ADMINISTRATIVE BURDENS ON PRESCRIBERS, PHARMACISTS AND
5 CONSUMERS.
6 (G) PROCEDURE.--THE PROGRAM SHALL ESTABLISH PROCEDURES FOR
7 THE TIMELY REVIEW OF PRESCRIPTION DRUGS NEWLY APPROVED BY THE
8 FOOD AND DRUG ADMINISTRATION, INCLUDING PROCEDURES FOR THE
9 REVIEW OF NEWLY APPROVED PRESCRIPTION DRUGS IN EMERGENCY
10 CIRCUMSTANCES.
11 (H) REPORTS.--THE DEPARTMENT SHALL SUBMIT ANNUAL REPORTS ON
12 THE PROGRAM UNDER SUBSECTION (A) TO THE AGING AND YOUTH
13 COMMITTEE, THE APPROPRIATIONS COMMITTEE AND THE PUBLIC HEALTH
14 AND WELFARE COMMITTEE OF THE SENATE AND THE AGING AND OLDER
15 ADULT SERVICES COMMITTEE, THE APPROPRIATIONS COMMITTEE AND THE
16 HEALTH AND HUMAN SERVICES COMMITTEE OF THE HOUSE OF
17 REPRESENTATIVES. THE REPORTS SHALL INCLUDE CLASSES OF DRUGS,
18 EXCEPTIONS, COST EFFECTIVENESS, MOVEMENT OF MARKET SHARE AND
19 INCREASED UTILIZATION OF GENERIC DRUGS.
20 SECTION 604. RESTRICTION OR SUBSTITUTION PROCESS.
21 (A) GENERAL RULE.--THE PROVISIONS OF THIS CHAPTER SHALL NOT
22 PERMIT THE PROGRAM TO DEVELOP ANY DRUG FORMULARY, PRIOR OR
23 RETROACTIVE APPROVAL SYSTEM, INCLUDING HIGHER COPAYMENTS, OR ANY
24 OTHER SIMILAR RESTRICTION OR SUBSTITUTION PROCESS FOR:
25 (1) PSYCHOTROPIC DRUGS.
26 (2) DRUGS USED IN THE TREATMENT OF HUMAN
27 IMMUNODEFICIENCY VIRUS, ACQUIRED IMMUNE DEFICIENCY SYNDROME
28 OR OPPORTUNISTIC INFECTIONS.
29 (B) DEFINITION.--AS USED IN THIS SECTION, THE TERM
30 "PSYCHOTROPIC DRUG" MEANS A DRUG USED TO TREAT A MENTAL
20030H0888B2117 - 43 -
1 DISORDER.
2 SECTION 6. SECTION 701 OF THE ACT IS AMENDED TO READ:
3 [SECTION 701. DECLARATION OF POLICY.
4 THE GENERAL ASSEMBLY FINDS AND DECLARES AS FOLLOWS:
5 (1) THE COMMONWEALTH, THROUGH ASSISTANCE PROGRAMS
6 ENACTED FOR THE BENEFIT OF ITS CITIZENS, IS THE LARGEST
7 SINGLE PAYOR OF PRESCRIPTION MEDICATIONS IN PENNSYLVANIA.
8 (2) IN ORDER TO ENSURE THAT THE COMMONWEALTH, IN
9 EXPENDING MONEY ON BEHALF OF ITS CITIZENS, IS NOT UNDULY
10 HARMED BY BEING REQUIRED TO PAY A PRICE FOR PHARMACEUTICAL
11 PRODUCTS PURCHASED FROM MANUFACTURERS IN EXCESS OF THAT
12 ESTABLISHED FOR OTHER PURCHASERS AND REIMBURSERS OF THESE
13 PRODUCTS AND TO ENSURE THAT THE COMMONWEALTH CAN EFFICIENTLY
14 AND PRUDENTLY EXPEND ITS MONEY AND MAXIMIZE ITS ABILITY TO
15 PROVIDE FOR THE HEALTH AND WELFARE OF AS MANY OF ITS NEEDY
16 CITIZENS AS POSSIBLE, IT IS REASONABLE, NECESSARY AND IN THE
17 PUBLIC INTEREST TO REQUIRE THAT PHARMACEUTICAL MANUFACTURERS
18 OFFER A DISCOUNT TO THE COMMONWEALTH FOR PHARMACEUTICAL
19 PRODUCTS PURCHASED OR REIMBURSED THROUGH STATE AGENCIES.
20 (3) IT IS IN THE PUBLIC INTEREST FOR PHARMACEUTICAL
21 MANUFACTURERS TO PROVIDE THE COMMONWEALTH WITH DATA RELATING
22 TO THE PRICE OF PHARMACEUTICAL PRODUCTS SOLD BY THE
23 MANUFACTURER TO PUBLIC BODIES, HOSPITALS, FOR-PROFIT OR
24 NONPROFIT ORGANIZATIONS, OTHER MANUFACTURERS OR WHOLESALERS
25 DOING BUSINESS IN THIS COMMONWEALTH IN ORDER TO ENSURE THAT
26 THE COMMONWEALTH CAN DETERMINE THAT IT IS BEING PROVIDED WITH
27 THE BEST PRICES OFFERED BY THE MANUFACTURER.
28 (4) ON A NATIONAL LEVEL, THERE HAS BEEN A RECOGNITION
29 THAT THE NEED FOR DISCOUNTS TO STATE MEDICAID AGENCIES, WHICH
30 REIMBURSE FOR A HIGH VOLUME OF PHARMACEUTICAL PRODUCTS,
20030H0888B2117 - 44 -
1 EXISTS.
2 (5) ON A STATE LEVEL, THE GENERAL ASSEMBLY RECOGNIZES
3 THAT IT IS IN THE BEST INTEREST OF ITS CITIZENS TO PROVIDE
4 PHARMACEUTICAL ASSISTANCE IN A REASONABLE AND COST-EFFICIENT
5 MANNER.
6 (6) DRUG PRICE INFLATION HAS CAUSED AN INCREASE IN THE
7 AMOUNT OF PUBLIC FUNDS EXPENDED BY PACE AND GENERAL
8 ASSISTANCE.]
9 SECTION 7. SECTION 702 OF THE ACT IS AMENDED BY ADDING A
10 DEFINITION TO READ:
11 SECTION 702. DEFINITIONS.
12 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
13 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
14 CONTEXT CLEARLY INDICATES OTHERWISE:
15 * * *
16 "BEST PRICE." THE LOWEST PRICE AVAILABLE FROM THE
17 MANUFACTURER DURING THE REBATE PERIOD TO ANY WHOLESALER,
18 RETAILER, PROVIDER, HEALTH MAINTENANCE ORGANIZATION, NONPROFIT
19 ENTITY OR ANY GOVERNMENTAL ENTITY SUBJECT TO THE EXCLUSIONS AND
20 SPECIAL RULES SET FORTH IN SECTIONS 1902 AND 1927(C)(1)(C) OF
21 THE SOCIAL SECURITY ACT (49 STAT. 620, 42 U.S.C. §§1396C, 1396R-
22 8(C)(1)(C)).
23 * * *
24 SECTION 8. SECTIONS 703(E), 704(C)(1) AND 705(A) AND (B) OF
25 THE ACT, ADDED NOVEMBER 21, 1996 (P.L.741, NO.134), ARE AMENDED
26 TO READ:
27 SECTION 703. REBATE AGREEMENT.
28 * * *
29 (E) DRUG FORMULARY.--EXCEPT AS PROVIDED IN SECTION 512 AND
30 CHAPTER 6, THERE SHALL BE NO DRUG FORMULARY, PRIOR OR
20030H0888B2117 - 45 -
1 RETROACTIVE APPROVAL SYSTEM OR ANY SIMILAR RESTRICTION IMPOSED
2 ON THE COVERAGE OF OUTPATIENT DRUGS MADE BY MANUFACTURERS WHO
3 HAVE AGREEMENTS IN EFFECT WITH THE COMMONWEALTH TO PAY REBATES
4 FOR DRUGS UTILIZED IN PACE AND PACENET, PROVIDED THAT SUCH
5 OUTPATIENT DRUGS WERE APPROVED FOR MARKETING BY THE FOOD AND
6 DRUG ADMINISTRATION. THIS SUBSECTION SHALL NOT APPLY TO ANY ACT
7 TAKEN BY THE DEPARTMENT PURSUANT TO ITS THERAPEUTIC DRUG
8 UTILIZATION REVIEW PROGRAM UNDER SECTION 505.
9 SECTION 704. TERMS OF REBATE AGREEMENT.
10 * * *
11 (C) MANUFACTURER PROVISION OF PRICE INFORMATION.--
12 (1) EACH MANUFACTURER WITH AN AGREEMENT IN EFFECT UNDER
13 THIS CHAPTER SHALL REPORT THE AVERAGE MANUFACTURER PRICE AND
14 THE BEST PRICE FOR ALL COVERED PRESCRIPTION DRUGS PRODUCED BY
15 THAT MANUFACTURER TO THE DEPARTMENT NOT LATER THAN 30 DAYS
16 AFTER THE LAST DAY OF EACH QUARTER.
17 * * *
18 SECTION 705. AMOUNT OF REBATE.
19 (A) SINGLE-SOURCE DRUGS AND INNOVATOR MULTIPLE-SOURCE
20 DRUGS.--WITH RESPECT TO SINGLE-SOURCE DRUGS AND INNOVATOR
21 MULTIPLE-SOURCE DRUGS, EACH MANUFACTURER SHALL REMIT A REBATE TO
22 THE COMMONWEALTH PURSUANT TO THE DETERMINATION ESTABLISHED BY
23 SECTION 1927(C)(1)(C) OF THE SOCIAL SECURITY ACT (49 STAT. 620,
24 42 U.S.C. § 1396R-8(C)(1)(C)). [EXCEPT AS OTHERWISE PROVIDED IN
25 THIS SECTION, THE AMOUNT OF THE REBATE TO THE COMMONWEALTH PER
26 CALENDAR QUARTER WITH RESPECT TO EACH DOSAGE FORM AND STRENGTH
27 OF SINGLE-SOURCE DRUGS AND INNOVATOR MULTIPLE-SOURCE DRUGS SHALL
28 BE AS FOLLOWS:
29 (1) FOR QUARTERS BEGINNING AFTER SEPTEMBER 30, 1992, AND
30 ENDING BEFORE JANUARY 1, 1997, THE PRODUCT OF THE TOTAL
20030H0888B2117 - 46 -
1 NUMBER OF UNITS OF EACH DOSAGE FORM AND STRENGTH REIMBURSED
2 BY PACE AND GENERAL ASSISTANCE IN THE QUARTER AND THE
3 DIFFERENCE BETWEEN THE AVERAGE MANUFACTURER PRICE AND 85% OF
4 THAT PRICE, AFTER DEDUCTING CUSTOMARY PROMPT PAYMENT
5 DISCOUNTS, FOR THE QUARTER.
6 (2) FOR QUARTERS BEGINNING AFTER DECEMBER 31, 1996, THE
7 PRODUCT OF THE TOTAL NUMBER OF UNITS OF EACH DOSAGE FORM AND
8 STRENGTH REIMBURSED BY PACE, PACENET AND DESIGNATED
9 PHARMACEUTICAL PROGRAMS IN THE QUARTER AND THE DIFFERENCE
10 BETWEEN THE AVERAGE MANUFACTURER PRICE AND 83% OF THAT PRICE,
11 AFTER DEDUCTING CUSTOMARY PROMPT PAYMENT DISCOUNTS.]
12 (B) REBATE FOR OTHER DRUGS.--
13 [(1) THE AMOUNT OF THE REBATE TO THE COMMONWEALTH FOR A
14 CALENDAR QUARTER WITH RESPECT TO COVERED PRESCRIPTION DRUGS
15 WHICH ARE NONINNOVATOR MULTIPLE-SOURCE DRUGS SHALL BE EQUAL
16 TO THE PRODUCT OF:
17 (I) THE APPLICABLE PERCENTAGE OF THE AVERAGE
18 MANUFACTURER PRICE, AFTER DEDUCTING CUSTOMARY PROMPT
19 PAYMENT DISCOUNTS, FOR EACH DOSAGE FORM AND STRENGTH OF
20 SUCH DRUGS FOR THE QUARTER; AND
21 (II) THE NUMBER OF UNITS OF SUCH FORM AND DOSAGE
22 REIMBURSED BY PACE AND GENERAL ASSISTANCE IN THE QUARTER.
23 (2) FOR THE PURPOSES OF PARAGRAPH (1), THE APPLICABLE
24 PERCENTAGE FOR CALENDAR QUARTERS BEGINNING AFTER SEPTEMBER
25 30, 1992, AND ENDING BEFORE JANUARY 1, 1997, IS 11%.] WITH
26 RESPECT TO COVERED PRESCRIPTION DRUGS WHICH ARE NONINNOVATOR
27 MULTIPLE-SOURCE DRUGS, EACH MANUFACTURER SHALL REMIT A REBATE
28 TO THE COMMONWEALTH PURSUANT TO THE DETERMINATION ESTABLISHED
29 BY SECTION 1927(C)(1)(C) OF THE SOCIAL SECURITY ACT.
30 * * *
20030H0888B2117 - 47 -
1 SECTION 9. THE ACT IS AMENDED BY ADDING A CHAPTER TO READ:
2 CHAPTER 8
3 PHARMACEUTICAL ASSISTANCE CLEARINGHOUSE
4 SECTION 801. DEFINITIONS.
5 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
6 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
7 CONTEXT CLEARLY INDICATES OTHERWISE:
8 "CLEARINGHOUSE." THE PHARMACEUTICAL ASSISTANCE CLEARINGHOUSE
9 ESTABLISHED IN SECTION 802.
10 "DEPARTMENT." THE DEPARTMENT OF AGING OF THE COMMONWEALTH.
11 "PATIENT ASSISTANCE PROGRAM." A PROGRAM OFFERED BY A
12 PHARMACEUTICAL MANUFACTURER UNDER WHICH THE MANUFACTURER
13 PROVIDES PRESCRIPTION MEDICATIONS AT NO CHARGE OR AT A
14 SUBSTANTIALLY REDUCED COST. THE TERM DOES NOT INCLUDE THE
15 PROVISION OF A DRUG AS PART OF A CLINICAL TRIAL.
16 SECTION 802. PHARMACEUTICAL ASSISTANCE CLEARINGHOUSE.
17 (A) ESTABLISHMENT.--WITHIN 120 DAYS OF THE EFFECTIVE DATE OF
18 THIS CHAPTER, THE DEPARTMENT SHALL ESTABLISH THE PHARMACEUTICAL
19 ASSISTANCE CLEARINGHOUSE. EACH PHARMACEUTICAL MANUFACTURER THAT
20 DOES BUSINESS IN THIS COMMONWEALTH AND OFFERS A PATIENT
21 ASSISTANCE PROGRAM SHALL INFORM THE DEPARTMENT OF ALL OF THE
22 FOLLOWING:
23 (1) THE EXISTENCE OF THE PATIENT ASSISTANCE PROGRAM.
24 (2) THE ELIGIBILITY REQUIREMENTS FOR THE PATIENT
25 ASSISTANCE PROGRAM.
26 (3) THE DRUGS COVERED BY THE PATIENT ASSISTANCE PROGRAM.
27 (4) INFORMATION, SUCH AS A TELEPHONE NUMBER, WHICH MAY
28 BE USED TO APPLY FOR A PATIENT ASSISTANCE PROGRAM.
29 (B) INFORMATION.--THE CLEARINGHOUSE SHALL MAINTAIN THE
30 INFORMATION SUBMITTED BY PHARMACEUTICAL MANUFACTURERS AND MAKE
20030H0888B2117 - 48 -
1 IT AVAILABLE TO THE PUBLIC.
2 (C) STAFF.--THE DEPARTMENT SHALL ENSURE THAT THE
3 CLEARINGHOUSE IS STAFFED AT LEAST DURING NORMAL BUSINESS HOURS.
4 THE DEPARTMENT SHALL CONTRACT FOR THE SERVICES OF A SCHOOL OF
5 PHARMACY TO STAFF THE CLEARINGHOUSE.
6 SECTION 803. TOLL-FREE TELEPHONE NUMBER.
7 THE DEPARTMENT SHALL ESTABLISH A TOLL-FREE TELEPHONE NUMBER
8 THROUGH WHICH MEMBERS OF THE PUBLIC MAY OBTAIN INFORMATION FROM
9 THE CLEARINGHOUSE ABOUT AVAILABLE PATIENT ASSISTANCE PROGRAMS.
10 SECTION 804. ASSISTANCE AVAILABLE.
11 (A) DIRECT.--
12 (1) THE CLEARINGHOUSE SHALL ASSIST WITHOUT CHARGE AN
13 INDIVIDUAL IN DETERMINING WHETHER A PATIENT ASSISTANCE
14 PROGRAM IS OFFERED FOR A PARTICULAR DRUG AND WHETHER THE
15 INDIVIDUAL MAY BE ELIGIBLE TO OBTAIN THE DRUG THROUGH A
16 PATIENT ASSISTANCE PROGRAM.
17 (2) THE CLEARINGHOUSE MAY ASSIST WITHOUT CHARGE AN
18 INDIVIDUAL WHO WISHES TO APPLY FOR A PATIENT ASSISTANCE
19 PROGRAM BY ASSISTING WITH THE PREPARATION OF AN APPLICATION
20 AND COORDINATING COMMUNICATIONS BETWEEN THE INDIVIDUAL'S
21 PHYSICIAN AND A PHARMACEUTICAL MANUFACTURER ON BEHALF OF THE
22 INDIVIDUAL FOR THE PURPOSE OF OBTAINING APPROVAL TO
23 PARTICIPATE IN THE PATIENT ASSISTANCE PROGRAM.
24 (B) REFERRALS.--THE CLEARINGHOUSE SHALL MAKE REFERRALS TO
25 ANY PUBLICLY FUNDED PROGRAM FOR WHICH IT DEEMS A PATIENT
26 ELIGIBLE.
27 SECTION 805. REPORTING.
28 THE DEPARTMENT SHALL REPORT ANNUALLY TO THE GOVERNOR AND THE
29 GENERAL ASSEMBLY ON THE ACTIVITIES OF THE CLEARINGHOUSE. THE
30 REPORT SHALL INCLUDE:
20030H0888B2117 - 49 -
1 (1) THE NUMBER OF INDIVIDUALS WHO HAVE BEEN ASSISTED BY
2 THE CLEARINGHOUSE UNDER SECTION 804(A)(1) AND THE NUMBER OF
3 SUCH INDIVIDUALS UNDER SECTION 804(A)(2).
4 (2) THE NUMBER AND BENEFITS OF PATIENT ASSISTANCE
5 PROGRAMS LISTED WITH THE CLEARINGHOUSE.
6 (3) THE NUMBER OF PATIENTS REFERRED TO PUBLICLY FUNDED
7 PROGRAMS UNDER SECTION 804(B). PROGRAMS UNDER THIS PARAGRAPH
8 INCLUDE, BUT ARE NOT LIMITED TO, THE PHARMACEUTICAL
9 ASSISTANCE CONTRACT FOR THE ELDERLY PROGRAM, MEDICAL
10 ASSISTANCE AND PROGRAMS OF THE DEPARTMENT OF VETERANS
11 AFFAIRS.
12 (4) OTHER INFORMATION DEEMED RELEVANT BY THE DEPARTMENT.
13 SECTION 806. INTERNET AVAILABILITY OF INFORMATION.
14 THE DEPARTMENT SHALL MAINTAIN AND PROVIDE TO THE PUBLIC THE
15 INFORMATION UNDER THIS CHAPTER ON ITS WORLD WIDE WEB SITE. THE
16 DEPARTMENT SHALL ALSO PROVIDE TO APPROPRIATE ORGANIZATIONS THE
17 INFORMATION NECESSARY FOR THE ORGANIZATIONS TO ESTABLISH A LINK
18 TO THE LOCATION OF CLEARINGHOUSE INFORMATION ON THE DEPARTMENT'S
19 WORLD WIDE WEB SITE.
20 SECTION 10. SECTION 2102(A) OF THE ACT, ADDED NOVEMBER 21,
21 1996 (P.L.741, NO.134), IS AMENDED TO READ:
22 SECTION 2102. ANNUAL REPORT TO GENERAL ASSEMBLY.
23 (A) SUBMISSION OF REPORT.--THE DEPARTMENT SHALL SUBMIT A
24 REPORT NO LATER THAN APRIL 1 OF EACH YEAR TO THE CHAIRMAN AND
25 MINORITY CHAIRMAN OF THE AGING AND YOUTH COMMITTEE OF THE
26 SENATE, THE CHAIRMAN AND MINORITY CHAIRMAN OF THE AGING AND
27 [YOUTH] OLDER ADULT SERVICES COMMITTEE OF THE HOUSE OF
28 REPRESENTATIVES AND THE PHARMACEUTICAL ASSISTANCE REVIEW BOARD.
29 * * *
30 SECTION 11. THE ACT IS AMENDED BY ADDING SECTIONS TO READ:
20030H0888B2117 - 50 -
1 SECTION 2103. FEDERAL PROGRAMS.
2 IF THE FEDERAL GOVERNMENT ENACTS PROGRAMS SIMILAR TO PACE OR
3 PACENET, THE STATE PROGRAMS SHALL BE CONSTRUED TO ONLY
4 SUPPLEMENT THE FEDERAL PROGRAMS AND ALL PERSONS QUALIFIED FOR
5 COVERAGE UNDER THE FEDERAL PROGRAM SHALL UTILIZE THAT FEDERAL
6 PROGRAM BEFORE UTILIZING ANY STATE PROGRAM.
7 SECTION 2104. PHARMACY BENEFITS ADMINISTRATOR STUDY.
8 (A) STUDY.--THE DEPARTMENT OF AGING SHALL CONDUCT A STUDY ON
9 THE EFFECTS WITHIN THE PACE AND PACENET PROGRAMS OF IMPLEMENTING
10 A PHARMACY BENEFITS ADMINISTRATOR COMPONENT. THE STUDY SHALL
11 EXAMINE THE ABILITY OF THE PHARMACY BENEFITS ADMINISTRATOR TO DO
12 THE FOLLOWING:
13 (1) NEGOTIATE REBATES ON BEHALF OF THE PLAN.
14 (2) CREATE A DRUG CRITERIA FOR ENROLLMENT WITHIN THE
15 PROGRAM.
16 (3) CONTRACT WITH PROVIDERS.
17 (4) CONDUCT ENROLLMENT ADJUDICATION ON BEHALF OF
18 APPLICANTS.
19 (B) REPORT.--THE DEPARTMENT SHALL SUBMIT A REPORT NO LATER
20 THAN ONE YEAR FROM THE EFFECTIVE DATE OF THIS SECTION TO THE
21 CHAIRMAN AND MINORITY CHAIRMAN OF THE AGING AND YOUTH COMMITTEE
22 OF THE SENATE, THE CHAIRMAN AND MINORITY CHAIRMAN OF THE AGING
23 AND OLDER ADULT SERVICES COMMITTEE OF THE HOUSE OF
24 REPRESENTATIVES AND THE PHARMACEUTICAL ASSISTANCE REVIEW BOARD.
25 SECTION 12. THE DEPARTMENT OF AGING MAY USE A PACE OR
26 PACENET PROGRAM APPLICANT'S MOST RECENT INCOME INFORMATION TO
27 DETERMINE PROGRAM ELIGIBILITY UNTIL APRIL 1, 2004.
28 SECTION 13. THIS ACT SHALL TAKE EFFECT AS FOLLOWS:
29 (1) THE FOLLOWING PROVISIONS SHALL TAKE EFFECT JANUARY
30 1, 2004:
20030H0888B2117 - 51 -
1 (I) THE AMENDMENT OR ADDITION OF THE DEFINITIONS OF
2 "CMS," "HFCA" AND "MAXIMUM ANNUAL INCOME" IN SECTION 502
3 OF THE ACT.
4 (II) THE AMENDMENT OF SECTION 519 OF THE ACT.
5 (2) THE REMAINDER OF THIS ACT SHALL TAKE EFFECT
6 IMMEDIATELY.
E14L67VDL/20030H0888B2117 - 52 -