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
2016/90BIL/HB0946A10665 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51