H0270B0949A10067 DMS:EJH 10/09/18 #90 A10067
AMENDMENTS TO HOUSE BILL NO. 270
Sponsor: REPRESENTATIVE FARRY
Printer's No. 949
Amend Bill, page 1, line 11, by striking out "and" where it
occurs the second time and inserting a comma
Amend Bill, page 1, line 12, by inserting after "management"
and further providing for coordination of benefits
Amend Bill, page 1, lines 17 and 18, by striking out "a
definition" and inserting
definitions
Amend Bill, page 2, by inserting between lines 6 and 7
"LEP" or "late enrollment penalty." The amount added to the
Part D plan premium of either:
(1) an individual who did not obtain creditable
prescription drug coverage as defined under 42 CFR ยง 423.56
(relating to procedures to determine and document creditable
status of prescription drug coverage) when the individual was
first eligible for Part D; or
(2) an individual who had a break in creditable
prescription drug coverage of at least 63 consecutive days
and that is considered a part of the plan premium.
* * *
"Maintenance medication." A medication prescribed for a
chronic, long-term condition and taken on a regular, recurring
basis.
Amend Bill, page 2, line 15, by striking out "rate" and
inserting
fees
Amend Bill, page 2, line 16, by striking out "rate" and
inserting
fee
Amend Bill, page 2, line 22, by inserting after
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"synchronization."
The program may not use payment structures incorporating
prorated dispensing fees.
(b) Full payment.--Dispensing fees for a partial supply or
refilled prescription shall be paid in full for each maintenance
medication dispensed, regardless of any prorated copay for the
beneficiary or fee paid for alignment services.
(c) Partial supply.--The program may not deny coverage for
the dispensing of a maintenance medication that is dispensed by
a network pharmacy on the basis that the dispensing is for a
partial supply if the prescriber or pharmacist determines the
fill or refill is in the best interest of the patient and the
patient requests or agrees to a partial supply for the purpose
of medication synchronization.
(d) Annual limitation.--The fill or refill under this
section shall be limited to three times a year for each
maintenance medication for a covered individual. For each
clinically necessary synchronization thereafter, approval may be
required at the discretion of the program.
Amend Bill, page 2, line 23, by striking out "(b)" and
inserting
(e)
Amend Bill, page 2, line 23, by striking out "The" and
inserting
Subject to section 520(c.1), the
Amend Bill, page 2, line 26, by striking out the period after
"synchronization" and inserting
utilizing the submission clarification and message codes as
adopted by the National Council for Prescription Drug Programs
or alternative codes provided by the program.
(f) Exemption.--This section does not apply to prescription
drugs that are either:
(1) unit-of-use packaging for which medication
synchronization is not possible; or
(2) controlled substances classified in Schedule II
under section 4(2) of the act of April 14, 1972 (P.L.233,
No.64), known as The Controlled Substance, Drug, Device and
Cosmetic Act.
Amend Bill, page 3, line 3, by striking out "$31,000" and
inserting
$27,500
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Amend Bill, page 3, line 5, by striking out "$41,000" and
inserting
$35,500
Amend Bill, page 5, line 5, by inserting a bracket before the
comma after "copayment"
Amend Bill, page 5, line 5, by inserting after "copayment,"
] or
Amend Bill, page 5, line 5, by inserting a bracket before
"or"
Amend Bill, page 5, line 6, by inserting a bracket after
"pharmacists"
Amend Bill, page 5, lines 16 and 17, by striking out "the
department proposals for "
Amend Bill, page 6, line 1, by striking out "one year" and
inserting
six months
Amend Bill, page 6, by inserting between lines 2 and 3
Section 5. Section 534 of the act is amended by adding a
subsection to read:
Section 534. Coordination of benefits.
* * *
(c.1) Authorization.--The department may pay the LEP of Part
D enrollees in excess of the regional benchmark premium.
* * *
Amend Bill, page 6, line 3, by striking out "5" and inserting
6
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See A10067 in
the context
of HB0270