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PRINTER'S NO. 1017
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
789
Session of
2017
INTRODUCED BY BROOKS, MENSCH, YUDICHAK AND VULAKOVICH,
JUNE 26, 2017
REFERRED TO AGING AND YOUTH, JUNE 26, 2017
AN ACT
Amending the act of August 26, 1971 (P.L.351, No.91), entitled
"An act providing for a State Lottery and administration
thereof; authorizing the creation of a State Lottery
Commission; prescribing its powers and duties; disposition of
funds; violations and penalties therefor; exemption of prizes
from State and local taxation and making an appropriation,"
in pharmaceutical assistance for the elderly, further
providing for definitions, providing for medication
synchronization, further providing for the board and
providing for medication therapy management.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The definitions of "board" and "income" in
section 502 of the act of August 26, 1971 (P.L.351, No.91),
known as the State Lottery Law, are amended and the section is
amended by adding definitions to read:
Section 502. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
* * *
"Board." The Pharmaceutical Assistance [Review] Advisory
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Board.
* * *
"Income." All income from whatever source derived,
including, but not limited to, salaries, wages, bonuses,
commissions, income from self-employment, alimony, support
money, cash public assistance and relief, the gross amount of
any pensions or annuities, including railroad retirement
benefits, all benefits received under the Social Security Act
(49 Stat. 620, 42 U.S.C. ยง 301 et. seq.) net of amounts withheld
for Medicare Part B premium payment, all benefits received under
State unemployment insurance laws and veterans' disability
payments, all interest received from the Federal Government or
any state government or any instrumentality or political
subdivision thereof, realized capital gains, rentals, workmen's
compensation and the gross amount of loss of time insurance
benefits, life insurance benefits and proceeds, except the first
$10,000 of the total of death benefits payments, and gifts of
cash or property, other than transfers by gift between members
of a household, in excess of a total value of $300, but shall
not include surplus food or other relief in kind supplied by a
government agency, the principal and interest accrued from a
savings bond or property tax rebate nor shall the term include
any State veterans' benefit payments .
* * *
"Medication synchronization." The coordination of
prescription drug filling or refilling by a pharmacy or
dispensing physician for a program participant taking two or
more medications for the purpose of improving medication
adherence.
* * *
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"State veterans' benefit payments." Service-connected
compensation or payments provided to a veteran or an unmarried
surviving spouse of a veteran by a State agency or authorized
under State law.
Section 2. The act is amended by adding a section to read:
Section 515.1. Medication synchronization.
(a) Prorated daily cost-sharing rate.--The program shall
permit and apply a prorated daily cost-sharing rate to
prescription drugs that are dispensed by a pharmacy for less
than a 30 days' supply if the pharmacist or prescriber
determines the fill or refill to be in the best interest of the
program participant and the program participant requests or
agrees to less than a 30 days' supply for the purpose of
medication synchronization.
(b) Denial of coverage prohibited.--
(1) The program may not deny coverage of a prescription
drug that is made in accordance with a plan among the health
plan, individual beneficiary or group plan, a practitioner
and a pharmacist for the purpose of medication
synchronization.
(2) The program shall allow a pharmacy to override any
denial codes indicating that a prescription drug is being
refilled too soon for the purposes of medication
synchronization.
(c) Certain payment structures prohibited.--
(1) The program may not use payment structures
incorporating prorated dispensing fees.
(2) Dispensing fees for partially filled or refilled
prescriptions shall be paid in full for each prescription
drug dispensed, regardless of any prorated copayment for the
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program participant or fee paid for alignment services.
Section 3. Section 520 of the act is amended to read:
Section 520. Board.
(a) Establishment.--The Pharmaceutical Assistance [Review]
Advisory Board is continued to ensure that the program is
providing and continues to provide the assistance intended in a
fiscally responsible manner without excessively hampering the
pharmaceutical industry.
(b) Composition.--The board shall be comprised of the
following [eight] persons:
(1) The Secretary of Aging, who shall serve as its
chairman.
(2) The Secretary of Revenue.
(3) The Secretary of Health.
(4) [Five] Nine public members[, one appointed by the
President pro tempore of the Senate, one appointed by the
Minority Leader of the Senate, one appointed by the Speaker
of the House of Representatives, one appointed by the
Minority Leader of the House of Representatives and one
appointed by the Governor. Those appointed by the legislative
officers shall include two senior citizens who have not been
a part of the pharmaceutical industry to serve as consumer
advocates, one representative of the pharmaceutical industry
and one practicing Pennsylvania pharmacist. The individual
appointed by the Governor must be a physician. A public
member who misses two consecutive meetings without good cause
acceptable to the chairman shall be replaced by the
appointing authority.] appointed as follows:
(i) Four practicing Pennsylvania pharmacists whose
names are jointly submitted by the Pennsylvania
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Pharmacists Association and the Pennsylvania Association
of Chain Drug Stores and then appointed by the following:
(A) One member appointed by the President pro
tempore of the Senate.
(B) One member appointed by the Minority Leader
of the Senate.
(C) One member appointed by the Speaker of the
House of Representatives.
(D) One member appointed by the Minority Leader
of the House of Representatives.
(ii) Five individuals appointed by the Governor that
include the following:
(A) One representative from the pharmaceutical
industry.
(B) Four senior citizens who have not been a
part of the pharmaceutical industry, two of whom may
be senior advocates.
(5) Should a board vacancy not be filled by the
appointing authority within 60 days, the power to appoint an
individual to the vacancy shall be given to the Secretary of
Aging.
(c) Review.--Using the annual report submitted by the
department pursuant to section 2102 and other appropriate data
sources, the board shall conduct an annual review. The board
shall develop recommendations concerning any changes in the
level of copayment, deductible or in the level of fees paid to
participating pharmacists. The board shall review the
department's therapeutic drug utilization review program on an
ongoing basis. The board may also recommend other changes in the
structure of the program and direct the department to enter into
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discussions with the private contractor concerning amendments to
the contract, or the department may enter into such discussion
if it deems necessary. The copayment or deductible schedule
shall only be adjusted on an annual basis.
(c.1) Powers and duties.--The board shall advise on the
following:
(1) The development and implementation of the department
proposals for medication synchronization and medication
therapy management programs and reimbursement methodologies.
(2) Adjustment of the dispensing fee, as needed.
(3) Cost-of-living adjustment increases for medication
synchronization, medication therapy management and the
dispensing fee.
(d) Meetings.--The board shall meet at least two times per
year and not more than four times per year.
Section 4. The act is amended by adding a section to read:
Section 522.1. Medication therapy management.
PACE shall, in consultation with the board, develop a
proposal for a medication therapy management program by using
retail community pharmacies enrolled in the program. PACE, in
consultation with the board, shall submit the proposal to the
General Assembly no later than one year after the effective date
of this section.
Section 5. This act shall take effect immediately.
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