PRINTER'S NO. 360
No. 330 Session of 1985
INTRODUCED BY FREEMAN, J. L. WRIGHT, MRKONIC, GRUPPO, RYBAK,
KUKOVICH, McHALE, PRESSMANN, KOSINSKI, ANGSTADT,
E. Z. TAYLOR, DALEY, MORRIS, STAIRS, BATTISTO, McCALL,
BALDWIN, CORNELL, BLAUM, DeLUCA, LAUGHLIN, LASHINGER,
ROBBINS, MICOZZIE, WOZNIAK, LINTON, PETRARCA, CIMINI,
SHOWERS, WILSON, TRELLO, COHEN, PRESTON, HASAY, BURD, CARN,
BORTNER, LEVDANSKY, CAWLEY, BELARDI, JAROLIN AND WAMBACH,
FEBRUARY 13, 1985
REFERRED TO COMMITTEE ON HEALTH AND WELFARE, FEBRUARY 13, 1985
AN ACT
1 Amending the act of November 4, 1983 (P.L.217, No.63), entitled
2 "An act establishing a program of limited pharmaceutical
3 assistance for the elderly; granting powers to and imposing
4 duties on the Department of Aging; establishing a payment
5 system; making provisions for funding; providing for reports;
6 and fixing penalties for violations of the pharmaceutical
7 assistance program," further providing for prescription
8 benefits.
9 The General Assembly of the Commonwealth of Pennsylvania
10 hereby enacts as follows:
11 Section 1. Section 4(e) of the act of November 4, 1983
12 (P.L.217, No.63), known as the Pharmaceutical Assistance
13 Contract for the Elderly Act, is amended to read:
14 Section 4. Responsibilities of Department of Aging.
15 * * *
16 (e) Program criteria.--The program shall include the
17 following criteria:
18 (1) Participating pharmacies are to be paid within 21
1 days of the contracting firm receiving the appropriate
2 substantiation of the transaction. Pharmacies shall be
3 entitled to interest for payment not made within the 21-day
4 period at a rate approved by the Pharmaceutical Assistance
5 Review Board.
6 (2) Collection of the copayment by pharmacies shall be
7 mandatory.
8 (3) Senior citizens participating in the program are not
9 required to maintain records of each transaction.
10 (4) A system of rebates or reimbursements to the
11 participant for pharmaceutical expenses shall be prohibited.
12 (5) The system established shall include a participant
13 copayment schedule of $4 for each prescription for the first
14 year of the contract. The copayment shall increase or
15 decrease on the annual basis by the average percent change of
16 ingredient costs for all prescription drugs plus a
17 differential to raise the copayment to the next highest 25¢
18 increment. In addition, the department may approve a request
19 for increase or decrease in the level of copayment based upon
20 the financial experience and projections of the program and
21 after consultation with the Pharmaceutical Assistance Review
22 Board. The department is prohibited from approving
23 adjustments to the copayment on more than a semiannual basis.
24 (6) The program shall consist of payments to pharmacies
25 on behalf of eligible claimants for the average wholesale
26 cost of legend drugs, insulin, insulin syringes and insulin
27 needles which exceed the copayment and a dispensing fee of at
28 least $2.50. In no case shall the Commonwealth be charged
29 more than the price of the drug at the particular pharmacy on
30 the date of the sale. For the purpose of this act, the
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1 eligible claimant shall be liable to pay the difference
2 between the brand name drug and the generically equivalent
3 drug as approved under the provisions of the act of November
4 24, 1976 (P.L.1163, No.259), referred to as the Generic
5 Equivalent Drug Law. Only the physician may prescribe a
6 nongeneric medication.
7 (7) Prescription benefits for any single prescription
8 shall be limited to a [30-day] 60-day supply of the
9 prescription drug or [100] 200 doses, whichever is less,
10 except that in the case of acute drugs the limitation shall
11 be a [15-day] 30-day supply.
12 (8) Experimental drugs are to be excluded from the
13 program.
14 (9) A system of mail order delivery for prescriptions
15 shall be prohibited under this program.
16 (10) The program must be in place and operational within
17 90 days of the effective date of the contract.
18 * * *
19 Section 2. This act shall take effect in 60 days.
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