PRINTER'S NO. 3619
No. 2733 Session of 1994
INTRODUCED BY BLAUM, LEDERER, GEORGE, VEON, HASAY, TANGRETTI,
BELARDI, LAUB, McCALL, TRICH, JAROLIN, TIGUE, ROONEY, BEBKO-
JONES, DERMODY, STISH, MUNDY, DeLUCA, PLATTS, J. TAYLOR,
SURRA, GORDNER, RICHARDSON, RUDY, BELFANTI, BUNT, BURNS,
CESSAR, L. I. COHEN, CORNELL, COY, FAJT, FEE, GIGLIOTTI,
GRUITZA, HALUSKA, KASUNIC, KENNEY, LAUGHLIN, LEVDANSKY,
LUCYK, McGEEHAN, MELIO, MICOZZIE, PESCI, PISTELLA, ROBERTS,
SCRIMENTI, B. SMITH, STABACK, E. Z. TAYLOR, TRELLO, VAN HORNE
AND D. R. WRIGHT, MAY 16, 1994
REFERRED TO COMMITTEE ON AGING AND YOUTH, MAY 16, 1994
AN ACT
1 Amending the act of August 14, 1991 (P.L.342, No.36), entitled
2 "An act providing for the preservation of the State Lottery
3 Fund; further providing for pharmaceutical assistance for the
4 elderly; further providing for transportation assistance to
5 the elderly; providing for pharmaceutical purchasing;
6 conferring powers and duties upon the Department of Aging,
7 the Department of Revenue and the Department of
8 Transportation; imposing penalties; and making repeals,"
9 further providing for the maximum annual income of eligible
10 claimants for pharmaceutical assistance, for use of brand
11 name drugs and for rebates.
12 The General Assembly of the Commonwealth of Pennsylvania
13 hereby enacts as follows:
14 Section 1. The definition of "maximum annual income" in
15 section 302 of the act of August 14, 1991 (P.L.342, No.36),
16 known as the Lottery Fund Preservation Act, is amended to read:
17 Section 302. Definitions.
18 The following words and phrases when used in this chapter
19 shall have the meanings given to them in this section unless the
1 context clearly indicates otherwise:
2 * * *
3 "Maximum annual income." Annual income as determined by the
4 department[.
5 (1) Except as provided in paragraph (2), such amount
6 shall not exceed $13,000 in the case of single persons nor
7 $16,200 in the case of the combined annual income of married
8 persons.
9 (2) If this chapter takes effect before September 1,
10 1991, the following shall apply:
11 (i) Before September 1, 1991, such amount shall not
12 exceed $12,000 in the case of single persons nor $15,000
13 in the case of the combined annual income of married
14 persons.
15 (ii) After August 31, 1991], such amount [shall] not
16 to exceed [$13,000] $14,000 in the case of single persons
17 nor [$16,200] $17,200 in the case of the combined annual
18 income of married persons.
19 * * *
20 Section 2. Sections 303(h)(9) and (10) and 605(a) of the
21 act, amended or added December 9, 1992 (P.L.792, No.128), are
22 amended to read:
23 Section 303. Responsibilities of department.
24 * * *
25 (h) Program criteria.--The program shall include the
26 following criteria:
27 * * *
28 (9) Notwithstanding any other statute or regulation, if
29 an A-rated generic therapeutically equivalent drug is
30 available for dispensing to a claimant, the provider shall
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1 dispense the A-rated generic therapeutically equivalent drug
2 to the claimant. The department shall not reimburse providers
3 for brand name products except in the following
4 circumstances:
5 (i) There is no A-rated generic therapeutically
6 equivalent drug available on the market. This
7 subparagraph does not apply to the lack of availability
8 of an A-rated generic therapeutically equivalent drug in
9 the providing pharmacy, unless it can be shown to the
10 department that the provider made reasonable attempts to
11 obtain the A-rated generic therapeutically equivalent
12 drug or that there was an unforeseeable demand and
13 depletion of the supply of the A-rated generic
14 therapeutically equivalent drug. In either case, the
15 department shall reimburse the provider for the average
16 wholesale cost plus a dispensing fee based on the least
17 expensive A-rated generic therapeutically equivalent drug
18 for the brand drug dispensed.
19 (ii) An A-rated generic therapeutically equivalent
20 drug is deemed by the department, in consultation with a
21 utilization review committee, to have too narrow a
22 therapeutic index for safe and effective dispensing in
23 the community setting. The department shall notify
24 providing pharmacies of A-rated generic therapeutically
25 equivalent drugs that are identified pursuant to this
26 subparagraph on a regular basis.
27 (iii) The Department of Health has determined that a
28 drug shall not be recognized as an A-rated generic
29 therapeutically equivalent drug for purpose of
30 substitution under section 5(b) of the act of November
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1 24, 1976 (P.L.1163, No.259), referred to as the Generic
2 Equivalent Drug Law.
3 (iv) At the time of dispensing, the provider has a
4 prescription on which the brand name drug dispensed is
5 billed to the program by the provider at a usual and
6 customary charge which is equal to or less than the least
7 expensive usual and customary charge of any A-rated
8 generic therapeutically equivalent drug reasonably
9 available on the market to the provider.
10 [(v) At the time of dispensing, the provider has a
11 prescription on which the prescriber has handwritten
12 "brand necessary" or "brand medically necessary" on the
13 prescription.]
14 (10) If a claimant chooses not to accept the A-rated
15 generic therapeutically equivalent drug required by paragraph
16 (9), the claimant shall be liable for the copayment and 70%
17 of the average wholesale cost of the brand name drug. This
18 paragraph shall not apply if the prescriber can demonstrate
19 in writing on a form provided by the Department of Aging
20 that:
21 (i) The claimant is in danger of an adverse reaction
22 from use of the generic therapeutically equivalent drug
23 required under paragraph (9).
24 (ii) Use of the prescribed brand name drug would
25 eliminate the danger of the adverse reaction.
26 * * *
27 Section 605. Amount of rebate.
28 (a) Single-source drugs and innovator multiple-source
29 drugs.--With respect to single-source drugs and innovator
30 multiple-source drugs, each manufacturer shall remit a rebate to
19940H2733B3619 - 4 -
1 the Commonwealth. Except as otherwise provided in this section,
2 the amount of the rebate to the Commonwealth per calendar
3 quarter with respect to each dosage form and strength of single-
4 source drugs and innovator multiple-source drugs shall be as
5 follows:
6 (1) For quarters beginning after December 31, 1990, and
7 ending before October 1, 1992, the product of the total
8 number of units of each dosage form and strength reimbursed
9 by the PACE Program and the General Assistance Program in the
10 quarter and the difference between the average manufacturer
11 price and 87.5% of that price, after deducting customary
12 prompt payment discounts, for the quarter.
13 (2) For quarters beginning after September 30, 1992, the
14 product of the total number of units of each dosage form and
15 strength reimbursed by the PACE Program and the General
16 Assistance Program in the quarter and the difference between
17 the average manufacturer price and [85%] 83% of that price,
18 after deducting customary prompt payment discounts, for the
19 quarter.
20 * * *
21 Section 3. This act shall apply to calendar year 1995 and
22 each year thereafter.
23 Section 4. This act shall take effect immediately.
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