Regular Session 2017-2018 Senate Bill 0789 P.N. 1017

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

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. § 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.

(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.

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.

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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