H0946B3933A10665 BIL:EJH 10/19/16 #90 A10665
AMENDMENTS TO HOUSE BILL NO. 946
Sponsor: SENATOR BROWNE
Printer's No. 3933
Amend Bill, page 1, line 3, by striking out "AND" and
inserting a comma
Amend Bill, page 1, line 3, by inserting after "TRANSPARENCY"
and for prescription drugs reimbursed under the PACE and
PACENET program; and making related repeals
Amend Bill, page 21, by inserting after line 30
CHAPTER 7
PACE AND PACENET PROGRAM PAYMENTS
Section 701. 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:
"A-rated generic therapeutically equivalent drug." A drug
product that the Commissioner of Food and Drugs of the United
States Food and Drug Administration has approved as safe and
effective and has determined to be therapeutically equivalent,
as listed in "The Approved Drug Products with Therapeutic
Equivalence Evaluations" (Food and Drug Administration "Orange
Book"), with a specific "A" code designation only.
"Claimant." An eligible person who is enrolled in the
program.
"Department." The Department of Aging of the Commonwealth.
"Less expensive." The lowest net cost to the program. The
net cost shall include the amount paid by the Commonwealth to a
pharmacy for a drug under a current retail pharmacy
reimbursement formula less any discount or rebates, including
those paid during the previous calendar quarter and inclusive of
all dispensing fees.
"NADAC per unit." The current National Average Drug
Acquisition Cost per unit.
"Prescription drug." All drugs requiring a prescription in
this Commonwealth, insulin, insulin syringes and insulin
needles. Experimental drugs or drugs prescribed for wrinkle
removal or hair growth are prohibited.
"Program." The Pharmaceutical Assistance Contract for the
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Elderly (PACE) and the Pharmaceutical Assistance Contract for
the Elderly Needs Enhancement Tier (PACENET) as established by
the act of August 26, 1971 (P.L.351, No.91), known as the State
Lottery Law.
"Provider." A pharmacy, dispensing physician or certified
registered nurse practitioner enrolled as a provider in the
program.
"Wholesale acquisition cost." The cost of a dispensed drug
based upon the price published in a national drug pricing system
in current use by the Department of Aging as the wholesale
acquisition cost of a prescription drug in the most common
package size.
Section 702. Program payment.
In addition to the requirements under section 509 of the act
of August 26, 1971 (P.L.351, No.91), known as the State Lottery
Law, the department shall administer the program in accordance
with the following:
(1) If the NADAC per unit is available, the program
payment shall be the lower of the following amounts:
(i) the NADAC per unit:
(A) with the addition of a professional
dispensing fee of $13 per prescription; and
(B) the subtraction of the copayment; or
(ii) the pharmacy's usual and customary charge for
the drug dispensed with the subtraction of the copayment.
(2) If the NADAC per unit is unavailable, the program
payment shall be the lower of the following amounts:
(i) the wholesale acquisition cost plus 3.2%:
(A) with the addition of a professional
dispensing fee of $13 per prescription; and
(B) the subtraction of the copayment; or
(ii) the pharmacy's usual and customary charge for
the drug dispensed with the subtraction of the copayment.
Section 703. Generic drugs.
(a) General rule.--Notwithstanding any other statute or
regulation, a brand name product shall be dispensed and not
substituted with an A-rated generic therapeutically equivalent
drug if it is less expensive to the program. If a less expensive
A-rated generic therapeutically equivalent drug is available for
dispensing to a claimant, the provider shall dispense the A-
rated generic therapeutically equivalent drug to the claimant.
The department shall reimburse providers based upon the most
current listing of the NADAC per unit plus a professional
dispensing fee of $13 per prescription. The department shall not
reimburse providers for brand name products except in the
following circumstances:
(1) There is no A-rated generic therapeutically
equivalent drug available on the market. This paragraph does
not apply to the lack of availability of an A-rated generic
therapeutically equivalent drug in the providing pharmacy
unless it can be shown to the department that the provider
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made reasonable attempts to obtain the A-rated generic
therapeutically equivalent drug or that there was an
unforeseeable demand and depletion of the supply of the A-
rated generic therapeutically equivalent drug. In either
case, the department shall reimburse the provider for the
NADAC per unit plus a professional dispensing fee of $13 per
prescription.
(2) An A-rated generic therapeutically equivalent drug
is deemed by the department, in consultation with a
utilization review committee, to have too narrow a
therapeutic index for safe and effective dispensing in the
community setting. The department shall notify providing
pharmacies of A-rated generic therapeutically equivalent
drugs that are identified pursuant to this paragraph on a
regular basis.
(3) The Department of Health has determined that a drug
shall not be recognized as an A-rated generic therapeutically
equivalent drug for purpose of substitution under section
5(b) of the act of November 24, 1976 (P.L.1163, No.259),
referred to as the Generic Equivalent Drug Law.
(4) At the time of dispensing, the provider has a
prescription on which the brand name drug dispensed is billed
to the program by the provider at a usual and customary
charge which is equal to or less than the least expensive
usual and customary charge of any A-rated generic
therapeutically equivalent drug reasonably available on the
market to the provider.
(5) The brand name drug is less expensive to the
program.
(b) Generic not accepted.--If a claimant chooses not to
accept the A-rated generic therapeutically equivalent drug
required by subsection (a), the claimant shall be liable for the
copayment and the NADAC per unit.
Amend Bill, page 22, by inserting between lines 2 and 3
Section 1101. Repeals.
Repeals are as follows:
(1) The General Assembly declares that the repeals under
paragraph (2) are necessary to effectuate Chapter 7.
(2) Sections 509(6) and 510(a) and (b) of the act of
August 26, 1971 (P.L.351, No.91), known as the State Lottery
Law, are repealed.
Amend Bill, page 22, line 3, by striking out "1101" and
inserting
1102
Amend Bill, page 22, by inserting between lines 4 and 5
(1) The following provisions shall take effect
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immediately:
(i) This section.
(ii) Chapter 7.
Amend Bill, page 22, line 5, by striking out "(1) THE
ADDITION OF " and inserting
(2)
Amend Bill, page 22, line 7, by striking out "(2)" and
inserting
(3)
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See A10665 in
the context
of HB0946