PRIOR PRINTER'S NOS. 577, 926, 3911, PRINTER'S NO. 4238
3915
No. 544 Session of 1995
INTRODUCED BY ALLEN, BOYES, TRELLO, NYCE, BELFANTI, PHILLIPS,
ARGALL, FAIRCHILD, CLARK, JAMES, MAITLAND, TULLI, MICOZZIE,
M. COHEN, STABACK, FICHTER, OLASZ, PETRONE, KAISER, HORSEY,
MASLAND, LYNCH, VAN HORNE, McCALL, RAYMOND, BROWN, BUNT,
MARKOSEK, HENNESSEY, CIVERA, BROWNE, HESS, GEIST, SEMMEL,
DENT, MERRY, D. W. SNYDER, KING, HARHART, HUTCHINSON, ZUG,
HANNA, SCRIMENTI, HABAY, RUBLEY, GANNON, SAYLOR, GRUPPO AND
NAILOR, FEBRUARY 2, 1995
AMENDMENTS TO SENATE AMENDMENTS, HOUSE OF REPRESENTATIVES,
NOVEMBER 18, 1996
AN ACT
1 Amending the act of August 26, 1971 (P.L.351, No.91), entitled <--
2 "An act providing for a State Lottery and administration
3 thereof; authorizing the creation of a State Lottery
4 Commission; prescribing its powers and duties; disposition of
5 funds; violations and penalties therefor; exemption of prizes
6 from State and local taxation and making an appropriation,"
7 further providing for the powers and duties of the Secretary
8 of Revenue and for assignability of prizes drawn; providing
9 for a temporary PACE moratorium; and making a repeal.
10 AMENDING THE ACT OF AUGUST 26, 1971 (P.L.351, NO.91), ENTITLED <--
11 "AN ACT PROVIDING FOR A STATE LOTTERY AND ADMINISTRATION
12 THEREOF; AUTHORIZING THE CREATION OF A STATE LOTTERY
13 COMMISSION; PRESCRIBING ITS POWERS AND DUTIES; DISPOSITION OF
14 FUNDS; VIOLATIONS AND PENALTIES THEREFOR; EXEMPTION OF PRIZES
15 FROM STATE AND LOCAL TAXATION AND MAKING AN APPROPRIATION,"
16 TRANSFERRING PROVISIONS RELATING TO THE STATE LOTTERY FUND;
17 PROVIDING FOR PHARMACEUTICAL ASSISTANCE FOR THE ELDERLY, FOR
18 TRANSPORTATION ASSISTANCE TO THE ELDERLY AND FOR
19 PHARMACEUTICAL PURCHASING; CONFERRING POWERS AND DUTIES UPON
20 THE DEPARTMENT OF AGING, THE DEPARTMENT OF REVENUE AND THE
21 DEPARTMENT OF TRANSPORTATION; IMPOSING PENALTIES; MAKING
22 EDITORIAL CHANGES; AND MAKING REPEALS.
23 TABLE OF CONTENTS
24 CHAPTER 1. GENERAL PROVISIONS
25 SECTION 101. SHORT TITLE.
26 CHAPTER 3. STATE LOTTERY
1 SECTION 301. STATEMENT OF PURPOSE.
2 SECTION 302. DEFINITIONS.
3 SECTION 303. POWERS AND DUTIES OF SECRETARY.
4 SECTION 304. COMMERCIAL ADVERTISING.
5 SECTION 305. LOTTERY SALES AGENTS.
6 SECTION 306. ASSIGNABILITY OF PRIZES DRAWN.
7 SECTION 307. TICKET SALES.
8 SECTION 308. COMPACT TO SELL TICKETS.
9 SECTION 309. CERTAIN SALES PROHIBITED.
10 SECTION 310. OTHER LAWS INAPPLICABLE.
11 SECTION 311. DISPOSITION OF FUNDS.
12 SECTION 312. TAX EXEMPTION.
13 SECTION 313. UNCLAIMED PRIZE MONEY.
14 SECTION 314. DEPOSITS AND TRANSACTIONS.
15 CHAPTER 5. PHARMACEUTICAL ASSISTANCE FOR THE ELDERLY
16 SECTION 501. LEGISLATIVE FINDINGS.
17 SECTION 502. DEFINITIONS.
18 SECTION 503. DETERMINATION OF ELIGIBILITY.
19 SECTION 504. PHYSICIAN AND PHARMACY PARTICIPATION.
20 SECTION 505. DRUG UTILIZATION REVIEW SYSTEM.
21 SECTION 506. REDUCED ASSISTANCE.
22 SECTION 507. REBATES FOR EXPENSES PROHIBITED.
23 SECTION 508. REQUEST FOR PROPOSAL.
24 SECTION 509. PROGRAM GENERALLY.
25 SECTION 510. GENERIC DRUGS.
26 SECTION 511. SUPPLY.
27 SECTION 512. RESTRICTED FORMULARY.
28 SECTION 513. MAIL ORDER SYSTEM.
29 SECTION 514. INDICATION OF PRICE.
30 SECTION 515. REIMBURSEMENT.
31 SECTION 516. NONLIABILITY.
32 SECTION 517. INCOME VERIFICATION.
33 SECTION 518. CONTRACT.
34 SECTION 519. THE PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE
35 ELDERLY NEEDS ENHANCEMENT TIER.
36 SECTION 520. BOARD.
37 SECTION 521. PENALTIES.
38 SECTION 522. PRESCRIPTION DRUG EDUCATION PROGRAM.
39 CHAPTER 7. PRUDENT PHARMACEUTICAL PURCHASING
40 SECTION 701. DECLARATION OF POLICY.
41 SECTION 702. DEFINITIONS.
42 SECTION 703. REBATE AGREEMENT.
43 SECTION 704. TERMS OF REBATE AGREEMENT.
44 SECTION 705. AMOUNT OF REBATE.
45 SECTION 706. EXCESSIVE PHARMACEUTICAL PRICE INFLATION
46 DISCOUNT.
47 SECTION 707. LOWERED BEST PRICE.
48 SECTION 708. EXEMPTION.
49 SECTION 709. DISPOSITION OF FUNDS.
50 CHAPTER 9. TRANSPORTATION SERVICES
51 SECTION 901. DEFINITIONS.
52 SECTION 902. DEPARTMENT OF TRANSPORTATION.
53 SECTION 903. COMMUTER RAIL FARE.
54 SECTION 904. SHARED-RIDE TRANSPORTATION.
55 SECTION 905. GRANTS.
56 CHAPTER 21. MISCELLANEOUS PROVISIONS
57 SECTION 2101. SAVINGS.
58 SECTION 2102. REPORT.
59 The General Assembly of the Commonwealth of Pennsylvania
19950H0544B4238 - 2 -
1 hereby enacts as follows:
2 Section 1. Sections 6(a)(5) and 8 of the act of August 26, <--
3 1971 (P.L.351, No.91), known as the State Lottery Law, are
4 amended to read:
5 Section 6. Powers and Duties of the Secretary of Revenue.--
6 (a) In addition to the powers and duties provided by law and
7 "The Administrative Code of 1929," the Secretary of Revenue
8 shall have the power and it shall be his duty to operate and
9 administer the lottery, and to promulgate rules and regulations
10 governing the establishment and operation thereof, including but
11 not limited to:
12 * * *
13 (5) The manner of payment of prizes to the holders of
14 winning tickets or shares: Provided, however, That for new non-
15 multistate on-line, parimutuel games with prizes of one million
16 dollars ($1,000,000) or more and payable in more than one
17 installment, the player shall have the option at the time of
18 purchase to accept, as full payment of the player's share of the
19 prize won, a lump sum of the prize money allocated to the first
20 place prize category, divided equally by the number of tickets
21 determined by the lottery to be entitled to claim a first place
22 prize: Provided, That the player specified the lump-sum option
23 at the time of purchase and received a mark on the ticket
24 confirming such request. In such cases where the prize pool for
25 the first place prize is not sufficient to fund the guaranteed
26 lump-sum prize as announced by the lottery, the prize pool shall
27 be increased as necessary by the lottery. Players shall be bound
28 by their pre-winning choice.
29 * * *
30 Section 8. Assignability of Prizes Drawn.--[No] (a) The
19950H0544B4238 - 3 -
1 right of any person to a prize drawn shall be assignable[,
2 except that payment] under the following limited circumstances:
3 (1) Payment of any prize drawn may be paid to the estate of
4 a deceased prize winner[, and, except that].
5 (2) Payment of any prize drawn may be made to any person
6 pursuant to an appropriate judicial order. [may be paid the
7 prize to which the winner is entitled. The secretary shall be
8 discharged of all further liability upon payment of a prize
9 pursuant to this section.]
10 (3) Payment of any prize drawn may be made to any person
11 pursuant to a voluntary assignment of the right to receive
12 future prize payments, in whole or in part, if the assignment is
13 made to a person or entity designated pursuant to an appropriate
14 judicial order of the court of common pleas located in either
15 the judicial district where the assignor resides or where the
16 division's headquarters are located. Under this paragraph, the
17 court shall issue an order approving the assignment and
18 directing the secretary to pay the assignee all future prize
19 payments, in whole or in part, if:
20 (i) the assignment is in writing, executed by the assignor
21 and subject to the laws of this Commonwealth;
22 (ii) the assignor provides a sworn affidavit to the court
23 attesting that the assignor is of sound mind, is not acting
24 under duress, has been advised regarding the assignment by his
25 or her own independent legal counsel and understands and agrees
26 that with regard to the assigned payments, the Commonwealth and
27 the secretary will have no further liability or responsibility
28 to make said payments to the assignor; and
29 (iii) the proposed assignment does not include or cover
30 payments or portions of payments alleged to be subject to offset
19950H0544B4238 - 4 -
1 under judicial order, unless appropriate provision is made in
2 the order to satisfy the obligations giving rise to the claim
3 for offset, or to offset under any other statute.
4 (b) The secretary shall be discharged of all further
5 liability upon payment of a prize pursuant to this section.
6 (c) Soliciting or offering rights to lottery prize winnings,
7 either by assignment or through pledge as collateral for a loan,
8 shall not be deemed selling or offering for sale lottery tickets
9 or shares under this act. Selling or offering for sale assigned
10 or pledged lottery prizewinnings shall not be deemed selling or
11 offering for sale an interest under section 9(c).
12 (d) The secretary is authorized to establish a reasonable
13 fee to defray any administrative expenses associated with
14 assignments made pursuant to this section, including the cost to
15 the Commonwealth of any processing fee that may be imposed by a
16 private annuity provider. The fee amount shall reflect the
17 direct and indirect costs associated with processing the
18 assignments.
19 (e) Upon a voluntary assignment pursuant to appropriate
20 judicial order under subsection (a)(3) of payments due to a
21 prizewinner under a private annuity policy that has been
22 purchased by the lottery for the benefit of a prize winner, the
23 Commonwealth and the secretary shall be discharged of and from
24 any and all liability for the payments or portions thereof
25 assigned and, as to the payments or portions thereof assigned,
26 the assignee shall have recourse only against the private
27 annuity provider and its guarantors and shall have no further
28 recourse against the Commonwealth.
29 Section 2. The act is amended by adding a section to read:
30 Section 15.1. Temporary PACE Moratorium.--(a)
19950H0544B4238 - 5 -
1 Notwithstanding any other provision of law to the contrary,
2 persons who, as of December 31, 1995, were enrolled in the PACE
3 program established pursuant to the act of August 14, 1991
4 (P.L.342, No.36), known as the "Lottery Fund Preservation Act,"
5 shall be eligible for reenrollment in the PACE program,
6 commencing on the effective date of this section. Enrollment in
7 the PACE program pursuant to this section shall expire on
8 December 31, 1996.
9 (b) This section shall expire December 31, 1996.
10 Section 3. (a) Section 303(h)(9)(v) of the act of August
11 14, 1991 (P.L.342, No.36), known as the Lottery Fund
12 Preservation Act, is repealed.
13 (b) All other acts and parts of acts are repealed insofar as
14 they are inconsistent with this act.
15 Section 4. This act shall take effect as follows:
16 (1) The addition of section 15.1 of the act and this
17 section shall take effect immediately.
18 (2) The remainder of this act shall take effect in 60
19 days.
20 SECTION 1. SECTIONS 1, 2, 3, 6, 6.1, 7, 8, 9, 9.1, 10, 11, <--
21 12, 12.1, 13, 14, 15, 16 AND 17 OF THE ACT OF AUGUST 26, 1971
22 (P.L.351, NO.91), KNOWN AS THE STATE LOTTERY LAW, AMENDED OR
23 ADDED OCTOBER 17, 1980 (P.L.1088, NO.184), DECEMBER 15, 1982
24 (P.L.1288, NO.291), DECEMBER 14, 1992 (P.L.868, NO.138) AND MAY
25 20, 1993 (P.L.27, NO.8), ARE AMENDED AND CHAPTER HEADINGS AND A
26 SECTION ARE ADDED TO READ:
27 CHAPTER 1
28 GENERAL PROVISIONS
29 [SECTION 1. SHORT TITLE.--THIS ACT SHALL BE KNOWN AND MAY BE
30 CITED AS THE "STATE LOTTERY LAW."]
19950H0544B4238 - 6 -
1 SECTION 101. SHORT TITLE.
2 THIS ACT SHALL BE KNOWN AND MAY BE CITED AS THE STATE LOTTERY
3 LAW.
4 CHAPTER 3
5 STATE LOTTERY
6 [SECTION 2. STATEMENT OF PURPOSE.--THIS ACT IS ENACTED TO]
7 SECTION 301. STATEMENT OF PURPOSE.
8 THIS CHAPTER IS ENACTED TO ESTABLISH A LOTTERY TO BE OPERATED
9 BY THE STATE, THE NET PROCEEDS OF WHICH ARE TO BE USED AFTER
10 JUNE 30, 1972, FOR THE PURPOSES OF PROVIDING PROPERTY TAX RELIEF
11 FOR THE ELDERLY FOR TAXES PAID IN 1971 AND THEREAFTER TO PERSONS
12 [SIXTY-FIVE] 65 YEARS OF AGE OR OLDER AND FOR PROVIDING CERTAIN
13 FREE FIXED ROUTE LOCAL TRANSIT SERVICES TO PERSONS [SIXTY-FIVE]
14 65 YEARS OF AGE OR OLDER AND REDUCED FARE ON GROUP RIDE TRANSIT
15 SERVICE TO PERSONS [SIXTY-FIVE] 65 YEARS OF AGE OR OLDER. IT IS
16 FURTHER INTENDED TO PROVIDE A MEANS THROUGH WHICH TO CURB
17 ILLEGAL GAMBLING OPERATIONS IN PENNSYLVANIA.
18 [SECTION 3. DEFINITIONS.--AS USED IN THIS ACT:
19 (2) "DIVISION" SHALL MEAN THE DIVISION OF THE STATE LOTTERY
20 CREATED BY THIS ACT.
21 (3) "LOTTERY" OR "STATE LOTTERY" SHALL MEAN THE LOTTERY
22 ESTABLISHED AND OPERATED PURSUANT TO THIS ACT.
23 (4) "DIRECTOR" SHALL MEAN THE DIRECTOR OF THE DIVISION OF
24 THE STATE LOTTERY.
25 (5) "SECRETARY" SHALL MEAN THE SECRETARY OF REVENUE.]
26 SECTION 302. DEFINITIONS.
27 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
28 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
29 CONTEXT CLEARLY INDICATES OTHERWISE:
30 "DIRECTOR." THE DIRECTOR OF THE DIVISION OF THE STATE
19950H0544B4238 - 7 -
1 LOTTERY.
2 "DIVISION." THE DIVISION OF THE STATE LOTTERY CREATED BY
3 THIS CHAPTER.
4 "LOTTERY" OR "STATE LOTTERY." THE LOTTERY ESTABLISHED AND
5 OPERATED UNDER THIS CHAPTER.
6 "SECRETARY." THE SECRETARY OF REVENUE OF THE COMMONWEALTH.
7 [SECTION 6. POWERS AND DUTIES OF THE SECRETARY OF REVENUE.--
8 (A) IN]
9 SECTION 303. POWERS AND DUTIES OF SECRETARY.
10 (A) POWERS AND DUTIES ENUMERATED.--IN ADDITION TO THE POWERS
11 AND DUTIES PROVIDED BY LAW AND ["THE ADMINISTRATIVE CODE OF
12 1929,"] THE ACT OF APRIL 9, 1929 (P.L.177, NO.175), KNOWN AS THE
13 ADMINISTRATIVE CODE OF 1929, THE [SECRETARY OF REVENUE]
14 SECRETARY SHALL HAVE THE POWER AND IT SHALL BE HIS DUTY TO
15 OPERATE AND ADMINISTER THE LOTTERY, AND TO PROMULGATE RULES AND
16 REGULATIONS GOVERNING THE ESTABLISHMENT AND OPERATION THEREOF,
17 INCLUDING, BUT NOT LIMITED TO:
18 (1) THE TYPE OF LOTTERY TO BE CONDUCTED.
19 (2) THE PRICE, OR PRICES, OF TICKETS OR SHARES IN THE
20 LOTTERY.
21 (3) THE NUMBERS AND SIZES OF THE PRIZES ON THE WINNING
22 TICKETS OR SHARES.
23 (4) THE MANNER OF SELECTING THE WINNING TICKETS OR
24 SHARES.
25 (5) [THE] (I) EXCEPT AS PROVIDED IN SUBPARAGRAPH (II),
26 THE MANNER OF PAYMENT OF PRIZES TO THE HOLDERS OF WINNING
27 TICKETS OR SHARES.
28 (II) FOR NEW NONMULTISTATE ON-LINE, PARIMUTUEL GAMES
29 WITH PRIZES OF $1,000,000 OR MORE AND PAYABLE IN MORE
30 THAN ONE INSTALLMENT, THE PLAYER SHALL HAVE THE OPTION AT
19950H0544B4238 - 8 -
1 THE TIME OF PURCHASE TO ACCEPT, AS FULL PAYMENT OF THE
2 PLAYER'S SHARE OF THE PRIZE WON, A LUMP SUM OF THE PRIZE
3 MONEY ALLOCATED TO THE FIRST PLACE PRIZE CATEGORY,
4 DIVIDED EQUALLY BY THE NUMBER OF TICKETS DETERMINED BY
5 THE LOTTERY TO BE ENTITLED TO CLAIM A FIRST PLACE PRIZE,
6 PROVIDED THAT THE PLAYER SPECIFIED THE LUMP-SUM OPTION AT
7 THE TIME OF PURCHASE AND RECEIVED A MARK ON THE TICKET
8 CONFIRMING SUCH REQUEST. IN CASES WHERE THE PRIZE POOL
9 FOR THE FIRST PLACE PRIZE IS NOT SUFFICIENT TO FUND THE
10 GUARANTEED LUMP-SUM PRIZE AS ANNOUNCED BY THE LOTTERY,
11 THE PRIZE POOL SHALL BE INCREASED AS NECESSARY BY THE
12 LOTTERY. PLAYERS SHALL BE BOUND BY THEIR PREWINNING
13 CHOICE.
14 (6) THE FREQUENCY OF THE DRAWINGS OR SELECTIONS OF
15 WINNING TICKETS OR SHARES, WITHOUT LIMITATION.
16 (7) WITHOUT LIMIT AS TO NUMBER, THE TYPE OR TYPES OF
17 LOCATIONS AT WHICH TICKETS OR SHARES MAY BE SOLD.
18 (8) THE METHOD TO BE USED IN SELLING TICKETS OR SHARES.
19 (9) THE LICENSING OF AGENTS TO SELL TICKETS OR SHARES
20 PROVIDED THAT NO PERSON UNDER THE AGE OF [TWENTY-ONE] 21
21 SHALL BE LICENSED AS AN AGENT.
22 (10) THE MANNER AND AMOUNT OF COMPENSATION, IF ANY, TO
23 BE PAID LICENSED SALES AGENTS NECESSARY TO PROVIDE FOR THE
24 ADEQUATE AVAILABILITY OF TICKETS OR SHARES TO PROSPECTIVE
25 BUYERS AND FOR THE CONVENIENCE OF THE PUBLIC.
26 (11) THE APPORTIONMENT OF THE TOTAL REVENUES ACCRUING
27 FROM THE SALE OF LOTTERY TICKETS OR SHARES AND FROM ALL OTHER
28 SOURCES AMONG:
29 (I) THE PAYMENT OF PRIZES TO THE HOLDERS OF WINNING
30 TICKETS OR SHARES;
19950H0544B4238 - 9 -
1 (II) THE PAYMENT OF COSTS INCURRED IN THE OPERATION
2 AND ADMINISTRATION OF THE LOTTERY, INCLUDING THE EXPENSES
3 OF THE DIVISION AND THE COSTS RESULTING FROM ANY CONTRACT
4 OR CONTRACTS ENTERED INTO FOR PROMOTIONAL, ADVERTISING OR
5 OPERATIONAL SERVICES OR FOR THE PURCHASE OR LEASE OF
6 LOTTERY EQUIPMENT AND MATERIALS; AND
7 [(III) FOR THE REPAYMENT OF THE MONEYS APPROPRIATED
8 TO THE STATE LOTTERY FUND PURSUANT TO SECTION 16 OF THIS
9 ACT; AND]
10 (IV) FOR PROPERTY TAX RELIEF AND FREE OR REDUCED
11 FARE TRANSIT SERVICE FOR THE ELDERLY AS PROVIDED IN
12 SECTION [12 OF THIS ACT: PROVIDED, HOWEVER, THAT NO] 311.
13 NO LESS THAN [THIRTY PER CENT] 30% OF THE TOTAL REVENUES
14 ACCRUING FROM THE SALE OF LOTTERY TICKETS OR SHARES SHALL
15 BE DEDICATED TO [SUBCLAUSE (IV) ABOVE] THIS SUBPARAGRAPH.
16 (11.1) THE PRODUCTION AND MERCHANDISING OF PROMOTIONAL
17 ITEMS FOR THE LOTTERY.
18 (12) SUCH OTHER MATTERS NECESSARY OR DESIRABLE FOR THE
19 EFFICIENT AND ECONOMICAL OPERATION AND ADMINISTRATION OF THE
20 LOTTERY AND FOR THE CONVENIENCE OF THE PURCHASERS OF TICKETS
21 OR SHARES AND THE HOLDERS OF WINNING TICKETS OR SHARES.
22 (13) THE PERFORMANCE OF THE POWERS AND DUTIES HERETOFORE
23 VESTED IN THE STATE LOTTERY COMMISSION.
24 (B) [TO] REPORTS.--THE SECRETARY SHALL REPORT MONTHLY TO THE
25 GOVERNOR AND THE LEGISLATURE THE TOTAL LOTTERY REVENUES, PRIZE
26 DISBURSEMENTS AND OTHER EXPENSES FOR THE PRECEDING MONTH, AND
27 [TO] SHALL MAKE AN ANNUAL REPORT, WHICH SHALL INCLUDE A FULL AND
28 COMPLETE STATEMENT OF LOTTERY REVENUES, PRIZE DISBURSEMENTS AND
29 OTHER EXPENSES, TO THE GOVERNOR AND THE LEGISLATURE, AND
30 INCLUDING SUCH RECOMMENDATIONS FOR CHANGES IN THIS [ACT] CHAPTER
19950H0544B4238 - 10 -
1 AS THE SECRETARY DEEMS NECESSARY OR DESIRABLE.
2 [SECTION 6.1. COMMERCIAL ADVERTISING.--(A) THE SECRETARY
3 MAY]
4 SECTION 304. COMMERCIAL ADVERTISING.
5 (A) GENERAL RULE.--THE SECRETARY MAY ENTER INTO CONTRACTS
6 WITH PERSONS, ASSOCIATIONS OR CORPORATIONS THAT PROVIDE FOR THE
7 PLACEMENT OF COMMERCIAL ADVERTISEMENTS ON TICKETS OR SHARES.
8 (B) CONTRACTS.--THE SECRETARY MAY ENTER INTO THE CONTRACTS
9 ONLY AFTER COMPLETION OF THE BIDDING PROCEDURE CONTAINED IN
10 SUBSECTION (C).
11 (C) BIDDING PROCEDURES.--
12 (1) THE SECRETARY SHALL, NOT LESS THAN SIX WEEKS PRIOR
13 TO THE DATE SET FOR OPENING BIDS OR PROPOSALS TO PLACE
14 ADVERTISEMENTS ON THE TICKETS OR SHARES, ADVERTISE THE
15 OPENING OF PROPOSALS FOR AT LEAST THREE DAYS, THE FIRST AND
16 LAST PUBLICATION TO BE AT LEAST TEN DAYS APART, IN NOT FEWER
17 THAN SIX NOR MORE THAN [TWELVE] 12 NEWSPAPERS OF EXTENSIVE
18 GENERAL CIRCULATION IN DIFFERENT PARTS OF THIS COMMONWEALTH.
19 THE ADVERTISEMENTS SHALL INVITE PROPOSALS FOR THE PLACEMENT
20 OF COMMERCIAL ADVERTISEMENTS ON THE TICKETS OR SHARES, SHALL
21 DIRECT POTENTIAL BIDDERS TO INCLUDE WITH THEIR PROPOSALS A
22 SPECIMEN ADVERTISEMENT AND SHALL GIVE NOTICE OF THE TIME AND
23 PLACE WHERE THE PROPOSALS WILL BE RECEIVED AND WHEN THEY WILL
24 BE OPENED.
25 (2) ALL PROPOSALS SHALL BE DELIVERED TO THE SECRETARY ON
26 OR BEFORE THE HOUR DESIGNATED IN THE INVITATION TO BID, ON
27 THE DAY SET BY THE SECRETARY, FOLLOWING THE DATE OF THE LAST
28 ADVERTISEMENT, AND EACH BID SHALL BE IN DUPLICATES, ONE OF
29 WHICH SHALL BE MARKED "DUPLICATE BID." EACH BID SHALL BE
30 ENCLOSED IN AN ENVELOPE, SECURELY SEALED, AND SHALL BE MAILED
19950H0544B4238 - 11 -
1 OR DELIVERED TO THE SECRETARY WHO SHALL RETAIN ALL ENVELOPES
2 UNOPENED UNTIL THE TIME FIXED FOR THE OPENING THEREOF.
3 (3) THE SECRETARY SHALL, ON THE DATE FIXED FOR OPENING
4 OF BIDS, AT THE HOUR DESIGNATED IN THE INVITATION TO BID,
5 OPEN AND PUBLISH THE PROPOSALS AND, AS SOON THEREAFTER AS
6 PRACTICABLE, AWARD THE CONTRACT TO THE HIGHEST RESPONSIBLE
7 BIDDER. THE SECRETARY SHALL HAVE THE RIGHT TO REJECT ANY OR
8 ALL BIDS. THE BIDS, WHEN OPENED, SHALL BE TABULATED AND SHALL
9 BE SUBJECT TO EXAMINATION BY BIDDERS. A RECORD OF ALL BIDS
10 SHALL BE MADE BY THE SECRETARY IN A BOOK KEPT FOR THAT
11 PURPOSE.
12 (4) WHEN NO PROPOSAL HAS BEEN RECEIVED OR IF FOR ANY
13 REASON THE SECRETARY REJECTS ALL PROPOSALS, THE SECRETARY MAY
14 ADVERTISE AGAIN FOR PROPOSALS, GIVING AT LEAST [FIFTEEN] 15
15 DAYS' NOTICE OF THE TIME OF RECEIVING THE SAME, WHICH
16 PROPOSALS SHALL BE OPENED, AWARDED AND APPROVED IN LIKE
17 MANNER AS THE INITIAL BIDS.
18 (5) THE SECRETARY SHALL HAVE THE DISCRETION TO REFUSE TO
19 ACCEPT ANY ADVERTISEMENT THAT IS INAPPROPRIATE OR OFFENSIVE
20 OR DISPLAYS POOR TASTE. ADVERTISEMENTS FOR TOBACCO PRODUCTS
21 OR FOR ALCOHOLIC BEVERAGES SHALL NOT BE ACCEPTED.
22 (D) DISPOSITION OF REVENUES.--ALL REVENUES DERIVED FROM
23 CONTRACTS ENTERED INTO UNDER THIS SECTION SHALL BE DEPOSITED IN
24 THE STATE LOTTERY FUND.
25 (E) REGULATIONS.--THE SECRETARY MAY PROMULGATE RULES AND
26 REGULATIONS TO IMPLEMENT THE PROVISIONS OF THIS SECTION.
27 (F) DEFINITION.--AS USED IN THIS SECTION, THE TERM "TICKETS
28 OR SHARES" SHALL NOT INCLUDE INSTANT GAME TICKETS.
29 [SECTION 7. LOTTERY SALES AGENTS; QUALIFICATIONS;
30 PROHIBITIONS.--(A) NO LICENSE AS AN AGENT TO SELL LOTTERY]
19950H0544B4238 - 12 -
1 SECTION 305. LOTTERY SALES AGENTS.
2 (A) LICENSING.--NO LICENSE AS AN AGENT TO SELL LOTTERY
3 TICKETS OR SHARES SHALL BE ISSUED TO ANY PERSON TO ENGAGE IN
4 BUSINESS EXCLUSIVELY AS A LOTTERY SALES AGENT. BEFORE ISSUING
5 SUCH LICENSE THE SECRETARY SHALL CONSIDER SUCH FACTORS AS:
6 (1) THE FINANCIAL RESPONSIBILITY AND SECURITY OF THE
7 PERSON AND HIS BUSINESS OR ACTIVITY[;].
8 (2) THE ACCESSIBILITY OF HIS PLACE OF BUSINESS OR
9 ACTIVITY TO THE PUBLIC[;].
10 (3) THE SUFFICIENCY OF EXISTING LICENSES TO SERVE THE
11 PUBLIC CONVENIENCE[; AND].
12 (4) THE VOLUME OF EXPECTED SALES.
13 [FOR THE PURPOSES OF THIS SECTION, THE TERM "PERSON" SHALL BE
14 CONSTRUED TO MEAN AND INCLUDE AN INDIVIDUAL, ASSOCIATION,
15 CORPORATION, CLUB, TRUST, ESTATE, SOCIETY, COMPANY, JOINT-STOCK
16 COMPANY, RECEIVER, TRUSTEE, ASSIGNEE, REFEREE, OR ANY OTHER
17 PERSON ACTING IN A FIDUCIARY OR REPRESENTATIVE CAPACITY, WHETHER
18 APPOINTED BY A COURT OR OTHERWISE, AND ANY COMBINATION OF
19 INDIVIDUALS. "PERSON" SHALL ALSO BE CONSTRUED TO MEAN AND
20 INCLUDE ALL DEPARTMENTS, COMMISSIONS, AGENCIES AND
21 INSTRUMENTALITIES OF THE STATE, INCLUDING COUNTIES AND
22 MUNICIPALITIES AND AGENCIES AND INSTRUMENTALITIES THEREOF.]
23 (B) APPROVAL OF APPLICANT.--IF THE SECRETARY SHALL FIND THAT
24 THE EXPERIENCE, CHARACTER AND GENERAL FITNESS OF THE APPLICANT
25 ARE SUCH THAT THE PARTICIPATION OF SUCH PERSON AS A LOTTERY
26 SALES AGENT WILL BE CONSISTENT WITH THE PUBLIC INTEREST,
27 CONVENIENCE AND NECESSITY, IT MAY THEREUPON GRANT A LICENSE.
28 WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, THE
29 SECRETARY MAY REFUSE TO ISSUE A LICENSE PURSUANT TO THIS
30 SECTION, OR MAY SUSPEND OR REVOKE A LICENSE SO ISSUED IF IT
19950H0544B4238 - 13 -
1 SHALL FIND THAT THE APPLICANT OR LICENSEE:
2 (1) HAS BEEN CONVICTED OF A CRIME INVOLVING MORAL
3 TURPITUDE.
4 (2) HAS ENGAGED IN BOOKMAKING OR OTHER FORM OF ILLEGAL
5 GAMBLING.
6 (3) HAS BEEN FOUND GUILTY OF ANY FRAUD OR
7 MISREPRESENTATION IN ANY CONNECTION.
8 (4) HAS VIOLATED ANY RULE, REGULATION OR ORDER OF THE
9 SECRETARY.
10 (C) DENIAL OF LICENSE.--THE SECRETARY MAY REFUSE TO GRANT A
11 LICENSE OR MAY SUSPEND OR REVOKE A LICENSE ISSUED PURSUANT TO
12 THIS SECTION TO A CORPORATION, IF IT SHALL DETERMINE THAT:
13 (1) ANY OFFICER, DIRECTOR, MEMBER OR STOCKHOLDER OF SUCH
14 CORPORATION APPLYING FOR A LICENSE OR OF ANY CORPORATION
15 WHICH OWNS STOCK IN OR SHARES IN THE PROFITS, OR PARTICIPATES
16 IN THE MANAGEMENT OF THE AFFAIRS OF SUCH APPLICANT:
17 (I) HAS BEEN CONVICTED OF A CRIME INVOLVING MORAL
18 TURPITUDE[,];
19 (II) HAS ENGAGED IN BOOKMAKING OR OTHER FORMS OF
20 ILLEGAL GAMBLING[,];
21 (III) HAS BEEN FOUND GUILTY OF ANY FRAUD OR
22 MISREPRESENTATION IN ANY CONNECTION[,]; OR
23 (IV) HAS VIOLATED ANY RULE, REGULATION OR ORDER OF
24 THE SECRETARY.
25 (2) THE EXPERIENCE, CHARACTER, OR GENERAL FITNESS OF ANY
26 OFFICER, DIRECTOR, OR STOCKHOLDER OF ANY OF THE AFORESAID
27 CORPORATIONS IS SUCH THAT THE PARTICIPATION OF SUCH PERSON AS
28 A LOTTERY SALES AGENT WOULD BE INCONSISTENT WITH THE PUBLIC
29 INTEREST, CONVENIENCE OR NECESSITY, BUT IF THE SECRETARY
30 DETERMINES THAT THE INTEREST OF ANY STOCKHOLDER REFERRED TO
19950H0544B4238 - 14 -
1 IN THIS [CLAUSE OR IN CLAUSE (1) OF THIS SUBSECTION]
2 PARAGRAPH OR IN PARAGRAPH (1) IS SUFFICIENT, IN THE OPINION
3 OF THE SECRETARY, TO AFFECT ADVERSELY THE CONDUCT OF A
4 LOTTERY SALES AGENCY BY SUCH CORPORATION IN ACCORDANCE WITH
5 THE PROVISIONS OF THIS [ACT] CHAPTER, THE SECRETARY MAY
6 DISREGARD SUCH INTEREST IN DETERMINING WHETHER OR NOT TO
7 GRANT A LICENSE TO SUCH CORPORATION.
8 (3) THE APPLICANT IS NOT THE OWNER OR THE LESSEE OF THE
9 BUSINESS AT WHICH IT WILL CONDUCT A LOTTERY SALES AGENCY
10 PURSUANT TO THE LICENSE APPLIED FOR, OR THAT ANY PERSON,
11 FIRM, ASSOCIATION, OR CORPORATION OTHER THAN THE APPLICANT
12 SHARES, OR WILL SHARE, IN THE PROFITS OF THE APPLICANT, OTHER
13 THAN BY DIVIDENDS AS A STOCKHOLDER, OR PARTICIPATES, OR WILL
14 PARTICIPATE, IN THE MANAGEMENT OF THE AFFAIRS OF THE
15 APPLICANT.
16 (D) TEMPORARY LICENSE.--PENDING FINAL DETERMINATION OF ANY
17 QUESTION UNDER THIS SECTION, THE SECRETARY MAY ISSUE A TEMPORARY
18 LICENSE UPON SUCH TERMS AND CONDITIONS AS IT MAY DEEM NECESSARY,
19 DESIRABLE OR PROPER TO EFFECTUATE THE PROVISIONS OF THIS [ACT]
20 CHAPTER.
21 (E) RESURVEY.--ANY PERSON WHO HAS A PENDING APPLICATION FOR
22 A LOTTERY MACHINE AND IS CURRENTLY ENGAGED IN THE SALE OF OUT-
23 OF-STATE LOTTERY TICKETS MAY SUBMIT A WRITTEN REQUEST TO THE
24 DEPARTMENT OF REVENUE FOR A RESURVEY. THIS RESURVEY SHALL BE
25 COMPLETED BY THE DEPARTMENT WITHIN [NINETY] 90 DAYS OF RECEIPT
26 OF THE REQUEST.
27 (F) DEFINITION.--AS USED IN THIS SECTION, THE TERM "PERSON"
28 MEANS AND INCLUDES AN INDIVIDUAL, ASSOCIATION, CORPORATION,
29 CLUB, TRUST, ESTATE, SOCIETY, COMPANY, JOINT-STOCK COMPANY,
30 RECEIVER, TRUSTEE, ASSIGNEE, REFEREE, OR ANY OTHER PERSON ACTING
19950H0544B4238 - 15 -
1 IN A FIDUCIARY OR REPRESENTATIVE CAPACITY, WHETHER APPOINTED BY
2 A COURT OR OTHERWISE, AND ANY COMBINATION OF INDIVIDUALS. THE
3 TERM SHALL ALSO MEAN AND INCLUDE ALL DEPARTMENTS, COMMISSIONS,
4 AGENCIES AND INSTRUMENTALITIES OF THE STATE, INCLUDING COUNTIES
5 AND MUNICIPALITIES AND AGENCIES AND INSTRUMENTALITIES THEREOF.
6 [SECTION 8. ASSIGNABILITY OF PRIZES DRAWN.--NO RIGHT OF ANY
7 PERSON TO A PRIZE DRAWN SHALL BE ASSIGNABLE, EXCEPT THAT PAYMENT
8 OF ANY PRIZE DRAWN MAY BE PAID TO THE ESTATE OF A DECEASED PRIZE
9 WINNER, AND, EXCEPT THAT ANY PERSON PURSUANT TO AN APPROPRIATE
10 JUDICIAL ORDER MAY BE PAID THE PRIZE TO WHICH THE WINNER IS
11 ENTITLED. THE SECRETARY SHALL BE DISCHARGED OF ALL FURTHER
12 LIABILITY UPON PAYMENT OF A PRIZE PURSUANT TO THIS SECTION.]
13 SECTION 306. ASSIGNABILITY OF PRIZES DRAWN.
14 (A) ASSIGNABILITY.--THE RIGHT OF ANY PERSON TO A PRIZE DRAWN
15 SHALL BE ASSIGNABLE UNDER THE FOLLOWING LIMITED CIRCUMSTANCES:
16 (1) PAYMENT OF ANY PRIZE DRAWN MAY BE PAID TO THE ESTATE
17 OF A DECEASED PRIZE WINNER.
18 (2) PAYMENT OF ANY PRIZE DRAWN MAY BE MADE TO ANY PERSON
19 PURSUANT TO AN APPROPRIATE JUDICIAL ORDER.
20 (3) PAYMENT OF ANY PRIZE DRAWN MAY BE MADE TO ANY PERSON
21 PURSUANT TO A VOLUNTARY ASSIGNMENT OF THE RIGHT TO RECEIVE
22 FUTURE PRIZE PAYMENTS, IN WHOLE OR IN PART, IF THE ASSIGNMENT
23 IS MADE TO A PERSON OR ENTITY DESIGNATED PURSUANT TO AN
24 APPROPRIATE JUDICIAL ORDER OF THE COURT OF COMMON PLEAS
25 LOCATED IN EITHER THE JUDICIAL DISTRICT WHERE THE ASSIGNOR
26 RESIDES OR WHERE THE DIVISION'S HEADQUARTERS ARE LOCATED.
27 UNDER THIS PARAGRAPH, THE COURT SHALL ISSUE AN ORDER
28 APPROVING THE ASSIGNMENT AND DIRECTING THE SECRETARY TO PAY
29 THE ASSIGNEE ALL FUTURE PRIZE PAYMENTS, IN WHOLE OR IN PART,
30 IF:
19950H0544B4238 - 16 -
1 (I) THE ASSIGNMENT IS IN WRITING, EXECUTED BY THE
2 ASSIGNOR AND SUBJECT TO THE LAWS OF THIS COMMONWEALTH;
3 (II) THE ASSIGNOR PROVIDES A SWORN AFFIDAVIT TO THE
4 COURT ATTESTING THAT THE ASSIGNOR IS OF SOUND MIND, IS
5 NOT ACTING UNDER DURESS, HAS BEEN ADVISED REGARDING THE
6 ASSIGNMENT BY HIS OR HER OWN INDEPENDENT LEGAL COUNSEL
7 AND UNDERSTANDS AND AGREES THAT, WITH REGARD TO THE
8 ASSIGNED PAYMENTS, THE COMMONWEALTH AND THE SECRETARY
9 SHALL HAVE NO FURTHER LIABILITY OR RESPONSIBILITY TO MAKE
10 SAID PAYMENTS TO THE ASSIGNOR; AND
11 (III) THE PROPOSED ASSIGNMENT DOES NOT INCLUDE OR
12 COVER PAYMENTS OR PORTIONS OF PAYMENTS ALLEGED TO BE
13 SUBJECT TO OFFSET UNDER JUDICIAL ORDER, UNLESS
14 APPROPRIATE PROVISION IS MADE IN THE ORDER TO SATISFY THE
15 OBLIGATIONS GIVING RISE TO THE CLAIM FOR OFFSET, OR TO
16 OFFSET UNDER ANY OTHER STATUTE.
17 (B) DISCHARGE OF SECRETARY.--THE SECRETARY SHALL BE
18 DISCHARGED OF ALL FURTHER LIABILITY UPON PAYMENT OF A PRIZE
19 PURSUANT TO THIS SECTION.
20 (C) ENFORCEMENT.--SOLICITING OR OFFERING RIGHTS TO LOTTERY
21 PRIZEWINNINGS, EITHER BY ASSIGNMENT OR THROUGH PLEDGE AS
22 COLLATERAL FOR A LOAN, SHALL NOT BE DEEMED SELLING OR OFFERING
23 FOR SALE LOTTERY TICKETS OR SHARES UNDER THIS ACT. SELLING OR
24 OFFERING FOR SALE ASSIGNED OR PLEDGED LOTTERY PRIZEWINNINGS
25 SHALL NOT BE DEEMED SELLING OR OFFERING FOR SALE AN INTEREST
26 UNDER SECTION 307.
27 (D) FEES.--THE SECRETARY IS AUTHORIZED TO ESTABLISH A
28 REASONABLE FEE TO DEFRAY ANY ADMINISTRATIVE EXPENSES ASSOCIATED
29 WITH ASSIGNMENTS MADE PURSUANT TO THIS SECTION, INCLUDING THE
30 COST TO THE COMMONWEALTH OF ANY PROCESSING FEE THAT MAY BE
19950H0544B4238 - 17 -
1 IMPOSED BY A PRIVATE ANNUITY PROVIDER. THE FEE AMOUNT SHALL
2 REFLECT THE DIRECT AND INDIRECT COSTS ASSOCIATED WITH PROCESSING
3 THE ASSIGNMENTS.
4 (E) DISCHARGE OF COMMONWEALTH.--UPON A VOLUNTARY ASSIGNMENT
5 PURSUANT TO APPROPRIATE JUDICIAL ORDER UNDER SUBSECTION (A)(3)
6 OF PAYMENTS DUE TO A PRIZEWINNER UNDER A PRIVATE ANNUITY POLICY
7 THAT HAS BEEN PURCHASED BY THE LOTTERY FOR THE BENEFIT OF A
8 PRIZEWINNER, THE COMMONWEALTH AND THE SECRETARY SHALL BE
9 DISCHARGED FROM ANY AND ALL LIABILITY FOR THE PAYMENTS OR
10 PORTIONS THEREOF ASSIGNED AND, AS TO THE PAYMENTS OR PORTIONS
11 THEREOF ASSIGNED, THE ASSIGNEE SHALL HAVE RECOURSE ONLY AGAINST
12 THE PRIVATE ANNUITY PROVIDER AND ITS GUARANTORS AND SHALL HAVE
13 NO FURTHER RECOURSE AGAINST THE COMMONWEALTH.
14 (F) ASSIGNMENT LIMITATION.--NOTWITHSTANDING ANY OTHER
15 PROVISION OF THIS SECTION, NO PRIZEWINNER SHALL HAVE THE RIGHT
16 TO ASSIGN PRIZE PAYMENTS UPON:
17 (1) THE ISSUANCE BY THE UNITED STATES INTERNAL REVENUE
18 SERVICE (IRS) OF A TECHNICAL RULE LETTER, REVENUE RULING OR
19 OTHER PUBLIC RULING OF THE IRS IN WHICH THE IRS DETERMINES
20 THAT, BASED UPON THE RIGHT OF ASSIGNMENT PROVIDED IN THIS
21 ACT, A PENNSYLVANIA LOTTERY PRIZEWINNER WHO DOES NOT ASSIGN
22 ANY PRIZE PAYMENTS PURSUANT TO SUBSECTION (A)(3) WOULD BE
23 SUBJECT TO AN IMMEDIATE INCOME TAX LIABILITY FOR THE VALUE OF
24 THE ENTIRE PRIZE RATHER THAN ANNUAL INCOME TAX LIABILITY FOR
25 EACH INSTALLMENT WHEN PAID.
26 (2) THE ISSUANCE BY A COURT OF COMPETENT JURISDICTION OF
27 A PUBLISHED DECISION HOLDING THAT, BASED UPON THE RIGHT OF
28 ASSIGNMENT PROVIDED IN THIS ACT, A PENNSYLVANIA LOTTERY
29 PRIZEWINNER WHO DOES NOT ASSIGN ANY PRIZE PAYMENTS PURSUANT
30 TO SUBSECTION (A)(3) WOULD BE SUBJECT TO AN IMMEDIATE INCOME
19950H0544B4238 - 18 -
1 TAX LIABILITY FOR THE VALUE OF THE ENTIRE PRIZE RATHER THAN
2 ANNUAL INCOME TAX LIABILITY FOR EACH INSTALLMENT WHEN PAID.
3 (G) FILING OF LETTER DECISION.--UPON RECEIPT OF A LETTER OR
4 RULING FROM THE IRS OR A PUBLISHED DECISION OF A COURT OF
5 COMPETENT JURISDICTION, AS SPECIFIED IN SUBSECTION (F), THE
6 EXECUTIVE DIRECTOR SHALL IMMEDIATELY FILE A COPY OF THAT LETTER,
7 RULING OR PUBLISHED DECISION WITH THE SECRETARY OF STATE.
8 IMMEDIATELY UPON THE FILING BY THE DIRECTOR OF A LETTER, RULING
9 OR PUBLISHED DECISION WITH THE SECRETARY OF STATE, A PRIZEWINNER
10 SHALL BE INELIGIBLE TO ASSIGN A PRIZE PURSUANT TO SUBSECTION
11 (A)(3).
12 [SECTION 9. SALES OF TICKETS IN EXCESS OF REGULATED PRICE;
13 SALES BY NON-LICENSED PERSONS; PENALTIES.--(A) NO PERSON SHALL]
14 SECTION 307. TICKET SALES.
15 (A) PRICES.--NO PERSON SHALL SELL, RESELL OR ENGAGE IN THE
16 BUSINESS OF RESELLING LOTTERY TICKETS OR SHARES AT A PRICE
17 GREATER THAN THAT FIXED BY RULE OR REGULATION OF THE DEPARTMENT.
18 PRICE SHALL INCLUDE ANY FEE ASSOCIATED WITH THE ACQUISITION OR
19 TRANSPORTATION OF LOTTERY TICKETS OR SHARES.
20 (B) CONSTRUCTION.--NO PERSON OTHER THAN A LICENSED LOTTERY
21 SALES AGENT SHALL SELL LOTTERY TICKETS OR SHARES, EXCEPT THAT
22 NOTHING IN THIS SECTION SHALL BE CONSTRUED TO PREVENT ANY PERSON
23 FROM GIVING LOTTERY TICKETS OR SHARES TO ANOTHER AS A GIFT.
24 (C) LOTTERIES OF OTHER STATES.--EXCEPT AS PROVIDED IN THIS
25 [ACT] CHAPTER, NO PERSON SHALL ENGAGE IN THE SALE OR OFFERING
26 FOR SALE WITHIN THIS COMMONWEALTH OF ANY INTEREST IN A LOTTERY
27 OF ANOTHER STATE OR GOVERNMENT WHETHER OR NOT SUCH INTEREST IS
28 AN ACTUAL LOTTERY TICKET, RECEIPT, CONTINGENT PROMISE TO PAY,
29 ORDER TO PURCHASE OR OTHER RECORD OF SUCH INTEREST.
30 (D) PENALTY.--ANY PERSON CONVICTED OF VIOLATING THIS SECTION
19950H0544B4238 - 19 -
1 SHALL BE GUILTY OF A MISDEMEANOR AND UPON CONVICTION THEREOF,
2 SHALL BE SENTENCED TO PAY A FINE [NOT EXCEEDING TWO THOUSAND
3 DOLLARS ($2,000)] OF NOT MORE THAN $2,000.
4 [SECTION 9.1. COMPACT TO SELL TICKETS.--THE SECRETARY SHALL]
5 SECTION 308. COMPACT TO SELL TICKETS.
6 THE SECRETARY SHALL ENTER INTO A COMPACT WITH ANY OTHER
7 STATES THAT PERMIT SALE OF PENNSYLVANIA LOTTERY TICKETS WITHIN
8 THEIR BORDERS TO SELL THOSE STATES' LOTTERY TICKETS WITHIN THIS
9 COMMONWEALTH.
10 [SECTION 10. SALES TO CERTAIN PERSONS PROHIBITED; PENALTY.--
11 NO]
12 SECTION 309. CERTAIN SALES PROHIBITED.
13 (A) MINORS.--
14 (1) NO TICKET OR SHARE SHALL BE SOLD TO ANY PERSON UNDER
15 [THE AGE OF EIGHTEEN YEARS] 18 YEARS OF AGE. FOR THE PURPOSE
16 OF MAKING A GIFT, A PERSON [EIGHTEEN] 18 YEARS OF AGE OR
17 OLDER MAY PURCHASE A TICKET OR SHARE FOR THE BENEFIT OF A
18 PERSON LESS THAN THAT AGE.
19 (2) ANY AGENT OR [EMPLOYE] EMPLOYEE OF ANY AGENT WHO
20 KNOWINGLY SELLS A LOTTERY TICKET OR SHARE TO ANY PERSON UNDER
21 [THE AGE OF EIGHTEEN YEARS] 18 YEARS OF AGE SHALL BE GUILTY
22 OF A MISDEMEANOR, AND UPON CONVICTION THEREOF, SHALL BE
23 SENTENCED TO PAY A FINE [NOT EXCEEDING FIVE HUNDRED DOLLARS
24 ($500)] OF NOT MORE THAN $500.
25 (B) CERTAIN EMPLOYEES.--NO TICKET OR SHARE SHALL BE SOLD TO
26 AND NO PRIZE SHALL BE AWARDED TO ANY OFFICER OR [EMPLOYE]
27 EMPLOYEE OF THE [DIVISION OF THE STATE LOTTERY] DIVISION IN THE
28 DEPARTMENT OF REVENUE OR ANY SPOUSE, CHILD, BROTHER, SISTER OR
29 PARENT RESIDING AS A MEMBER OF THE SAME HOUSEHOLD IN THE
30 PRINCIPAL PLACE OF ABODE OF ANY OF THE FOREGOING PERSONS.
19950H0544B4238 - 20 -
1 [SECTION 11. OTHER LAWS INAPPLICABLE.--NO OTHER LAW
2 PROVIDING]
3 SECTION 310. OTHER LAWS INAPPLICABLE.
4 NO OTHER LAW PROVIDING ANY PENALTY OR DISABILITY FOR THE SALE
5 OF LOTTERY TICKETS OR SHARES OR ANY ACTS DONE IN CONNECTION WITH
6 A LOTTERY SHALL APPLY TO THE SALE OF TICKETS OR SHARES OR ACTS
7 PERFORMED PURSUANT TO THIS [ACT] CHAPTER.
8 [SECTION 12. DISPOSITION OF FUNDS FROM SALE OF TICKETS OR
9 SHARES.--(A) ALL MONEYS RECEIVED FROM THE OPERATION OF THE]
10 SECTION 311. DISPOSITION OF FUNDS.
11 (A) STATE LOTTERY FUND.--ALL MONEYS RECEIVED FROM THE
12 OPERATION OF THE STATE LOTTERY SHALL BE DEPOSITED IN A STATE
13 LOTTERY FUND WHICH IS HEREBY CREATED. SUCH MONEYS SHALL BE USED
14 TO THE EXTENT NECESSARY FOR THE PAYMENT OF LOTTERY PRIZES BUT
15 THE AMOUNT SO USED SHALL NOT BE LESS THAN [FORTY PER CENT] 40%
16 OF THE AMOUNT OF WHICH TICKETS OR SHARES HAVE BEEN SOLD. ALL
17 PAYMENTS OF LOTTERY PRIZES AND FOR EXPENSES OF OPERATION OF THE
18 LOTTERY SHALL BE MADE AS PROVIDED BY LAW. ALL MONEYS REMAINING
19 AFTER PAYMENT OF PRIZES AND OPERATING EXPENSES SHALL REMAIN IN
20 THE STATE LOTTERY FUND AND SHALL BE ALLOCATED FOR THE PURPOSE OF
21 PROVIDING PROPERTY TAX RELIEF FOR THE ELDERLY FOR TAXES PAID IN
22 1971 AND THEREAFTER PURSUANT TO THE PROVISIONS OF THE ACT OF
23 MARCH 11, 1971 (P.L.104, NO.3), KNOWN AS THE ["SENIOR CITIZENS
24 PROPERTY TAX OR RENT REBATE AND OLDER PERSONS INFLATION NEEDS
25 ACT,"] SENIOR CITIZENS REBATE AND ASSISTANCE ACT, AND FOR THE
26 PURPOSE OF PROVIDING FREE OR REDUCED FARE TRANSIT SERVICE FOR
27 THE ELDERLY PURSUANT TO [THE ACT OF JANUARY 22, 1968 (P.L.42,
28 NO.8), KNOWN AS THE "PENNSYLVANIA URBAN MASS TRANSPORTATION
29 ASSISTANCE LAW OF 1967,"] CHAPTER 9 AND THE ACT OF FEBRUARY 11,
30 1976 (P.L.14, NO.10), KNOWN AS THE ["]PENNSYLVANIA RURAL AND
19950H0544B4238 - 21 -
1 INTERCITY COMMON CARRIER SURFACE TRANSPORTATION ASSISTANCE
2 ACT.["] IN THE EVENT SUFFICIENT FUNDS ARE NOT AVAILABLE FROM THE
3 LOTTERY RECEIPTS TO MEET THE REQUIREMENTS OF THE [ACT OF MARCH
4 11, 1971 (P.L.104, NO.3), KNOWN AS THE "SENIOR CITIZENS PROPERTY
5 TAX OR RENT REBATE AND OLDER PERSONS INFLATION NEEDS ACT,"]
6 SENIOR CITIZENS REBATE AND ASSISTANCE ACT OR FOR PROVIDING FREE
7 OR REDUCED FARE TRANSIT SERVICE FOR THE ELDERLY UNDER [THE ACT
8 OF JANUARY 22, 1968 (P.L.42, NO.8), KNOWN AS THE "PENNSYLVANIA
9 URBAN MASS TRANSPORTATION ASSISTANCE LAW OF 1967,"] CHAPTER 9
10 AND THE [ACT OF FEBRUARY 11, 1976 (P.L.14, NO.10), KNOWN AS THE
11 "]PENNSYLVANIA RURAL AND INTERCITY COMMON CARRIER SURFACE
12 TRANSPORTATION ASSISTANCE ACT,["] ADDITIONAL FUNDS TO FULFILL
13 THESE OBLIGATIONS[,] SHALL BE APPROPRIATED FROM THE GENERAL FUND
14 FOR THIS PURPOSE.
15 (B) APPROPRIATIONS.--THE MONEYS IN SAID STATE LOTTERY FUND
16 SHALL BE APPROPRIATED ONLY:
17 (1) FOR THE PAYMENT OF PRIZES TO THE HOLDERS OF WINNING
18 LOTTERY TICKETS OR SHARES[;].
19 (2) FOR THE EXPENSES OF THE DIVISION IN ITS OPERATION OF
20 THE LOTTERY[;].
21 (3) FOR PROPERTY TAX RELIEF AND FREE OR REDUCED FARE
22 TRANSIT SERVICE FOR THE ELDERLY AS PROVIDED UNDER [SECTION 12
23 OF THIS ACT; AND
24 (4) FOR TRANSFER TO THE GENERAL FUND THROUGH JUNE 30,
25 1972, AND FOR THE REPAYMENT TO THE GENERAL FUND OF THE AMOUNT
26 APPROPRIATED TO THE FUND PURSUANT TO SECTION 16 OF THIS ACT]
27 SUBSECTION (A).
28 [SECTION 12.1. TRANSPORTATION ASSISTANCE GRANT.--FOR THE
29 FISCAL YEAR 1982-1983 FOUR MILLION ONE HUNDRED THOUSAND DOLLARS
30 ($4,100,000) IS HEREBY APPROPRIATED FROM THE LOTTERY FUND TO THE
19950H0544B4238 - 22 -
1 DEPARTMENT OF AGING FOR TRANSPORTATION GRANTS TO AREA AGENCIES
2 ON AGING TO PURCHASE, REPLACE, LEASE, MAINTAIN, OPERATE OR
3 CONTRACT FOR THE OPERATION OF VEHICLES OR EQUIPMENT FOR USE IN
4 SENIOR CITIZENS TRANSPORTATION. THE TOTAL AMOUNT TO BE GRANTED
5 TO EACH AREA AGENCY ON AGING SHALL BE DETERMINED BY THE
6 FOLLOWING FORMULA:
7 (TWO MILLION FIFTY THOUSAND DOLLARS X A/B) +
8 (TWO MILLION FIFTY THOUSAND DOLLARS X C/D)
9 "A" EQUALS THE NUMBER OF ELDERLY POOR PERSONS RESIDING IN
10 THE AREA SERVED BY THE AREA AGENCY ON AGING.
11 "B" EQUALS THE NUMBER OF ELDERLY POOR PERSONS IN
12 PENNSYLVANIA.
13 "C" EQUALS THE NUMBER OF SQUARE MILES OF THE AREA SERVED
14 BY THE AREA AGENCY ON AGING.
15 "D" EQUALS THE NUMBER OF SQUARE MILES IN PENNSYLVANIA.
16 THE GRANT SHALL BE IN ADDITION TO THOSE AUTHORIZED UNDER AND
17 MAY BE USED IN CONJUNCTION WITH SECTION 406 OF THE ACT OF
18 JANUARY 22, 1968 (P.L.42, NO.8), KNOWN AS THE "PENNSYLVANIA
19 URBAN MASS TRANSPORTATION LAW."
20 SECTION 13. EXEMPTION OF LOTTERY PRIZES FROM STATE AND LOCAL
21 TAXATION.--NO STATE OR LOCAL TAXES OF ANY KIND WHATSOEVER SHALL]
22 SECTION 312. TAX EXEMPTION.
23 NO STATE OR LOCAL TAXES OF ANY KIND WHATSOEVER SHALL BE
24 IMPOSED UPON THE PROCEEDS FROM A PRIZE AWARDED BY THE STATE
25 LOTTERY.
26 [SECTION 14. UNCLAIMED PRIZE MONEY.--UNCLAIMED PRIZE MONEY
27 ON]
28 SECTION 313. UNCLAIMED PRIZE MONEY.
29 UNCLAIMED PRIZE MONEY ON A WINNING LOTTERY TICKET OR SHARE
30 SHALL BE RETAINED BY THE SECRETARY FOR PAYMENT TO THE PERSON
19950H0544B4238 - 23 -
1 ENTITLED THERETO FOR ONE YEAR AFTER THE DRAWING IN WHICH THE
2 PRIZE WAS WON. IF NO CLAIM IS MADE WITHIN SUCH PERIOD, THE PRIZE
3 MONEY SHALL BE PAID INTO THE STATE LOTTERY FUND AND USED FOR
4 PURPOSES AS OTHERWISE HEREIN PROVIDED.
5 [SECTION 15. BANK DEPOSITS AND CONTROL OF LOTTERY
6 TRANSACTIONS.--THE SECRETARY MAY, IN HIS DISCRETION, REQUIRE
7 ANY]
8 SECTION 314. DEPOSITS AND TRANSACTIONS.
9 THE SECRETARY MAY, IN HIS DISCRETION, REQUIRE ANY OR ALL
10 LOTTERY SALES AGENTS TO DEPOSIT TO THE CREDIT OF THE STATE
11 LOTTERY FUND IN BANKS, DESIGNATED BY THE STATE TREASURER, ALL
12 MONEYS RECEIVED BY SUCH AGENTS FROM THE SALE OF LOTTERY TICKETS
13 OR SHARES, LESS THE AMOUNT, IF ANY, RETAINED AS COMPENSATION FOR
14 THE SALE OF THE TICKETS OR SHARES, AND TO FILE WITH THE
15 SECRETARY OR HIS DESIGNATED AGENTS REPORTS OF THEIR RECEIPTS AND
16 TRANSACTIONS IN THE SALE OF LOTTERY TICKETS IN SUCH FORM AND
17 CONTAINING SUCH INFORMATION AS HE MAY REQUIRE. THE SECRETARY MAY
18 MAKE SUCH ARRANGEMENTS FOR ANY PERSON, INCLUDING A BANK, TO
19 PERFORM SUCH FUNCTIONS, ACTIVITIES OR SERVICES IN CONNECTION
20 WITH THE OPERATION OF THE LOTTERY AS HE MAY DEEM ADVISABLE
21 PURSUANT TO THIS [ACT] CHAPTER AND THE RULES AND REGULATIONS OF
22 THE DEPARTMENT, AND SUCH FUNCTIONS, ACTIVITIES OR SERVICES SHALL
23 CONSTITUTE LAWFUL FUNCTIONS, ACTIVITIES AND SERVICES OF SUCH
24 PERSON.
25 [SECTION 16. APPROPRIATION.--THERE IS HEREBY APPROPRIATED
26 THE SUM OF ONE MILLION DOLLARS ($1,000,000), OR SO MUCH THEREOF
27 AS IS NECESSARY FOR THE ESTABLISHMENT OF THE STATE LOTTERY AND
28 THE DIVISION OF THE STATE LOTTERY IN THE DEPARTMENT OF REVENUE.
29 THE DEPARTMENT OF REVENUE SHALL REIMBURSE THE GENERAL FUND FROM
30 RECEIPTS FROM SALE OF LOTTERY TICKETS OR SHARES THE ACTUAL
19950H0544B4238 - 24 -
1 AMOUNT OF MONEY EXPENDED FROM SAID APPROPRIATION WITHIN ONE YEAR
2 OF THE DATE OF THE FIRST LOTTERY DRAWING.
3 SECTION 17. EFFECTIVE DATE.--THIS ACT SHALL TAKE EFFECT
4 IMMEDIATELY.]
5 SECTION 2. THE ACT IS AMENDED BY ADDING CHAPTERS TO READ:
6 CHAPTER 5
7 PHARMACEUTICAL ASSISTANCE FOR THE ELDERLY
8 SECTION 501. LEGISLATIVE FINDINGS.
9 FINDING THAT AN INCREASING NUMBER OF THE COMMONWEALTH'S
10 ELDERLY CITIZENS WHO ARE LIVING ON FIXED INCOMES ARE
11 EXPERIENCING DIFFICULTIES IN MEETING THE COSTS OF LIFE-
12 SUSTAINING PRESCRIPTION DRUGS, THE GENERAL ASSEMBLY, IN ITS
13 RESPONSIBILITIES TO PROVIDE FOR THE HEALTH, WELFARE AND SAFETY
14 OF THE RESIDENTS OF THIS COMMONWEALTH, HEREBY CONTINUES A
15 LIMITED STATE PHARMACEUTICAL ASSISTANCE PROGRAM FOR THE ELDERLY.
16 SECTION 502. DEFINITIONS.
17 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
18 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
19 CONTEXT CLEARLY INDICATES OTHERWISE:
20 "A-RATED GENERIC THERAPEUTICALLY EQUIVALENT DRUG." A DRUG
21 PRODUCT THAT THE COMMISSIONER OF FOOD AND DRUGS OF THE UNITED
22 STATES FOOD AND DRUG ADMINISTRATION HAS APPROVED AS SAFE AND
23 EFFECTIVE AND HAS DETERMINED TO BE THERAPEUTICALLY EQUIVALENT,
24 AS LISTED IN "THE APPROVED DRUG PRODUCTS WITH THERAPEUTIC
25 EQUIVALENCE EVALUATIONS" (FOOD AND DRUG ADMINISTRATION "ORANGE
26 BOOK"), WITH A SPECIFIC "A" CODE DESIGNATION ONLY.
27 "AVERAGE WHOLESALE COST." THE COST OF A DISPENSED DRUG BASED
28 UPON THE PRICE PUBLISHED IN A NATIONAL DRUG PRICING SYSTEM IN
29 CURRENT USE BY THE DEPARTMENT OF AGING AS THE AVERAGE WHOLESALE
30 PRICE OF A PRESCRIPTION DRUG IN THE MOST COMMON PACKAGE SIZE.
19950H0544B4238 - 25 -
1 "AVERAGE WHOLESALE PRICE." AVERAGE WHOLESALE COST.
2 "BOARD." THE PHARMACEUTICAL ASSISTANCE REVIEW BOARD.
3 "DEPARTMENT." THE DEPARTMENT OF AGING OF THE COMMONWEALTH.
4 "ELIGIBLE CLAIMANT." A RESIDENT OF THE COMMONWEALTH FOR NO
5 LESS THAN 90 DAYS, WHO IS 65 YEARS OF AGE AND OVER, WHOSE ANNUAL
6 INCOME IS LESS THAN THE MAXIMUM ANNUAL INCOME AND WHO IS NOT
7 OTHERWISE QUALIFIED FOR PUBLIC ASSISTANCE UNDER THE ACT OF JUNE
8 13, 1967 (P.L.31, NO.21), KNOWN AS THE PUBLIC WELFARE CODE.
9 "FDA." THE UNITED STATES FOOD AND DRUG ADMINISTRATION OF THE
10 PUBLIC HEALTH SERVICE OF THE DEPARTMENT OF HEALTH AND HUMAN
11 SERVICES.
12 "HCFA." THE HEALTH CARE FINANCING ADMINISTRATION OF THE
13 UNITED STATES.
14 "INCOME." ALL INCOME FROM WHATEVER SOURCE DERIVED,
15 INCLUDING, BUT NOT LIMITED TO, SALARIES, WAGES, BONUSES,
16 COMMISSIONS, INCOME FROM SELF-EMPLOYMENT, ALIMONY, SUPPORT
17 MONEY, CASH PUBLIC ASSISTANCE AND RELIEF, THE GROSS AMOUNT OF
18 ANY PENSIONS OR ANNUITIES, INCLUDING RAILROAD RETIREMENT
19 BENEFITS, ALL BENEFITS RECEIVED UNDER THE FEDERAL SOCIAL
20 SECURITY ACT (49 STAT. 620, 42 U.S.C. § 301 ET. SEQ.) (EXCEPT
21 MEDICARE BENEFITS), ALL BENEFITS RECEIVED UNDER STATE
22 UNEMPLOYMENT INSURANCE LAWS AND VETERANS' DISABILITY PAYMENTS,
23 ALL INTEREST RECEIVED FROM THE FEDERAL GOVERNMENT OR ANY STATE
24 GOVERNMENT, OR ANY INSTRUMENTALITY OR POLITICAL SUBDIVISION
25 THEREOF, REALIZED CAPITAL GAINS, RENTALS, WORKMEN'S COMPENSATION
26 AND THE GROSS AMOUNT OF LOSS OF TIME INSURANCE BENEFITS, LIFE
27 INSURANCE BENEFITS AND PROCEEDS, EXCEPT THE FIRST $5,000 OF THE
28 TOTAL OF DEATH BENEFITS PAYMENTS, AND GIFTS OF CASH OR PROPERTY,
29 OTHER THAN TRANSFERS BY GIFT BETWEEN MEMBERS OF A HOUSEHOLD, IN
30 EXCESS OF A TOTAL VALUE OF $300, BUT SHALL NOT INCLUDE SURPLUS
19950H0544B4238 - 26 -
1 FOOD OR OTHER RELIEF IN KIND SUPPLIED BY A GOVERNMENT AGENCY OR
2 PROPERTY TAX REBATE.
3 "MAXIMUM ANNUAL INCOME." FOR PACE ELIGIBILITY, THE TERM
4 SHALL MEAN ANNUAL INCOME WHICH SHALL NOT EXCEED $14,000 IN THE
5 CASE OF SINGLE PERSONS NOR $17,200 IN THE CASE OF THE COMBINED
6 ANNUAL INCOME OF PERSONS MARRIED TO EACH OTHER. PERSONS MAY, IN
7 REPORTING INCOME TO THE DEPARTMENT OF AGING, ROUND THE AMOUNT OF
8 EACH SOURCE OF INCOME AND THE INCOME TOTAL TO THE NEAREST WHOLE
9 DOLLAR, WHEREBY ANY AMOUNT WHICH IS LESS THAN 50¢ IS ELIMINATED.
10 "PACE." THE PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE
11 ELDERLY PROGRAM PROVIDED FOR IN THIS CHAPTER.
12 "PACENET." THE PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE
13 ELDERLY NEEDS ENHANCEMENT TIER PROVIDED FOR IN THIS CHAPTER.
14 "PHARMACY." A PHARMACY LICENSED BY THE COMMONWEALTH.
15 "PRESCRIPTION DRUG." ALL DRUGS REQUIRING A PRESCRIPTION IN
16 THIS COMMONWEALTH, INSULIN, INSULIN SYRINGES AND INSULIN
17 NEEDLES. EXPERIMENTAL DRUGS OR DRUGS PRESCRIBED FOR WRINKLE
18 REMOVAL OR HAIR GROWTH ARE PROHIBITED.
19 "PRIVATE CONTRACTOR." A PERSON, PARTNERSHIP OR CORPORATE
20 ENTITY WHO ENTERS INTO A CONTRACT WITH THE COMMONWEALTH TO
21 PROVIDE SERVICES UNDER THE PROVISIONS OF THIS CHAPTER.
22 "PROGRAM." THE PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE
23 ELDERLY (PACE) AND THE PHARMACEUTICAL ASSISTANCE CONTRACT FOR
24 THE ELDERLY NEEDS ENHANCEMENT TIER (PACENET) AS ESTABLISHED BY
25 THIS CHAPTER, UNLESS OTHERWISE SPECIFIED.
26 "PROVIDER." A PHARMACY OR DISPENSING PHYSICIAN ENROLLED AS A
27 PROVIDER IN THE PROGRAM.
28 SECTION 503. DETERMINATION OF ELIGIBILITY.
29 THE DEPARTMENT SHALL ADOPT REGULATIONS RELATING TO THE
30 DETERMINATION OF ELIGIBILITY OF PROSPECTIVE CLAIMANTS AND
19950H0544B4238 - 27 -
1 PROVIDERS, INCLUDING DISPENSING PHYSICIANS, AND THE
2 DETERMINATION AND ELIMINATION OF PROGRAM ABUSE. TO THIS END, THE
3 DEPARTMENT SHALL ESTABLISH A COMPLIANCE UNIT STAFFED
4 SUFFICIENTLY TO FULFILL THIS RESPONSIBILITY. THE DEPARTMENT
5 SHALL HAVE THE POWER TO DECLARE INELIGIBLE ANY CLAIMANT OR
6 PROVIDER WHO ABUSES OR MISUSES THE ESTABLISHED PRESCRIPTION
7 PLAN. THE DEPARTMENT SHALL HAVE THE POWER TO INVESTIGATE CASES
8 OF SUSPECTED PROVIDER OR RECIPIENT FRAUD.
9 SECTION 504. PHYSICIAN AND PHARMACY PARTICIPATION.
10 ANY PHYSICIAN, PHARMACIST, PHARMACY OR CORPORATION OWNED IN
11 WHOLE OR IN PART BY A PHYSICIAN OR PHARMACIST ENROLLED AS A
12 PROVIDER IN THE PROGRAM, OR WHO HAS PRESCRIBED MEDICATION FOR A
13 CLAIMANT IN THE PROGRAM, WHO IS PRECLUDED OR EXCLUDED FOR CAUSE
14 FROM THE DEPARTMENT OF PUBLIC WELFARE'S MEDICAL ASSISTANCE
15 PROGRAM SHALL BE PRECLUDED OR EXCLUDED FROM PARTICIPATION IN THE
16 PROGRAM. NO PHYSICIAN PRECLUDED OR EXCLUDED FROM THE DEPARTMENT
17 OF PUBLIC WELFARE'S MEDICAL ASSISTANCE PROGRAM SHALL HAVE CLAIMS
18 RESULTING FROM PRESCRIPTIONS PAID FOR BY THE PROGRAM.
19 SECTION 505. DRUG UTILIZATION REVIEW SYSTEM.
20 THE DEPARTMENT SHALL ENSURE THAT A STATE-OF-THE-ART
21 THERAPEUTIC DRUG UTILIZATION REVIEW SYSTEM IS ESTABLISHED TO
22 MONITOR AND CORRECT MISUTILIZATION OF DRUG THERAPIES.
23 SECTION 506. REDUCED ASSISTANCE.
24 ANY ELIGIBLE CLAIMANT WHOSE PRESCRIPTION DRUG COSTS ARE
25 COVERED IN PART BY ANY OTHER PLAN OF ASSISTANCE OR INSURANCE MAY
26 BE REQUIRED TO RECEIVE REDUCED ASSISTANCE UNDER THE PROVISIONS
27 OF THIS CHAPTER.
28 SECTION 507. REBATES FOR EXPENSES PROHIBITED.
29 A SYSTEM OF REBATES OR REIMBURSEMENTS TO THE CLAIMANT FOR
30 PRESCRIPTION DRUGS SHALL BE PROHIBITED.
19950H0544B4238 - 28 -
1 SECTION 508. REQUEST FOR PROPOSAL.
2 (A) GENERAL RULE.--THE DEPARTMENT SHALL PREPARE A REQUEST
3 FOR PROPOSAL FOR THE PURPOSE OF PROVIDING PHARMACEUTICAL
4 ASSISTANCE FOR THE ELDERLY WITHIN THIS COMMONWEALTH. UPON THE
5 ADOPTION OF THE GENERAL FUND BUDGET, THE DEPARTMENT OF REVENUE
6 SHALL BE AUTHORIZED TO TRANSMIT THE APPROPRIATED FUNDS IN THE
7 STATE LOTTERY FUND TO THE STATE TREASURER TO BE DEPOSITED IN THE
8 PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY FUND. THIS
9 FUND SHALL CONSIST OF APPROPRIATIONS AND INTEREST AND SHALL BE
10 CREATED BY THE STATE TREASURER TO FUND THE OPERATIONS OF THE
11 PROGRAM BY THE DEPARTMENT AND THE PRIVATE CONTRACTOR. FUNDS NOT
12 EXPENDED IN THE FISCAL YEAR IN WHICH THEY WERE APPROPRIATED
13 SHALL NOT LAPSE AND BE AVAILABLE FOR USE IN THE NEXT FISCAL
14 YEAR.
15 (B) ADDITIONAL REQUESTS FOR PROPOSALS.--TO PROVIDE FOR THE
16 CONTINUED OPERATION OF THE PROGRAM, THE DEPARTMENT SHALL
17 PREPARE, AS NEEDED, REQUESTS FOR PROPOSALS, IN ADDITION TO THAT
18 SET FORTH IN SUBSECTION (A), FOR THE PURPOSE OF PROVIDING
19 PHARMACEUTICAL ASSISTANCE FOR THE ELDERLY WITHIN THIS
20 COMMONWEALTH. A REQUEST FOR PROPOSAL SHALL REQUIRE POTENTIAL
21 PRIVATE CONTRACTORS TO SUBMIT A PROPOSAL FOR A PERIOD OF TIME
22 AND WITH MONETARY LIMITATIONS AS DETERMINED BY THE DEPARTMENT.
23 UPON THE ENACTMENT OF AN APPROPRIATION FROM THE STATE LOTTERY
24 FUND, THE DEPARTMENT OF REVENUE SHALL BE AUTHORIZED TO TRANSMIT
25 THE APPROPRIATED AMOUNT TO THE STATE TREASURER TO BE DEPOSITED
26 IN THE PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY FUND.
27 FUNDS NOT EXPENDED IN THE FISCAL YEAR IN WHICH THEY WERE
28 APPROPRIATED SHALL NOT LAPSE AND SHALL BE AVAILABLE FOR USE IN
29 THE NEXT FISCAL YEAR.
30 SECTION 509. PROGRAM GENERALLY.
19950H0544B4238 - 29 -
1 THE PROGRAM SHALL INCLUDE THE FOLLOWING:
2 (1) PARTICIPATING PHARMACIES SHALL BE PAID WITHIN 21
3 DAYS OF THE CONTRACTING FIRM RECEIVING THE APPROPRIATE
4 SUBSTANTIATION OF THE TRANSACTION. PHARMACIES SHALL BE
5 ENTITLED TO INTEREST FOR PAYMENT NOT MADE WITHIN THE 21-DAY
6 PERIOD AT A RATE APPROVED BY THE BOARD.
7 (2) COLLECTION OF THE COPAYMENT BY PHARMACIES SHALL BE
8 MANDATORY.
9 (3) SENIOR CITIZENS PARTICIPATING IN THE PROGRAM ARE NOT
10 REQUIRED TO MAINTAIN RECORDS OF EACH TRANSACTION.
11 (4) A SYSTEM OF REBATES OR REIMBURSEMENTS TO ELIGIBLE
12 CLAIMANTS FOR PHARMACEUTICAL EXPENSES SHALL BE PROHIBITED.
13 (5) PACE SHALL INCLUDE A PARTICIPANT COPAYMENT SCHEDULE
14 FOR EACH PRESCRIPTION. THE COPAYMENT MAY INCREASE OR DECREASE
15 ON AN 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 PACE AND AFTER
21 CONSULTATION WITH THE BOARD. THE DEPARTMENT IS PROHIBITED
22 FROM APPROVING ADJUSTMENTS TO THE COPAYMENT ON MORE THAN AN
23 ANNUAL BASIS.
24 (6) THE PROGRAM SHALL CONSIST OF PAYMENTS TO PHARMACIES
25 ON BEHALF OF ELIGIBLE CLAIMANTS FOR 90% OF THE AVERAGE
26 WHOLESALE COSTS OF PRESCRIPTION DRUGS WHICH EXCEED THE
27 COPAYMENT, PLUS A DISPENSING FEE OF AT LEAST $3.50 OR THE
28 DISPENSING FEE ESTABLISHED BY THE DEPARTMENT BY REGULATION,
29 WHICHEVER IS GREATER.
30 (7) IN NO CASE SHALL THE COMMONWEALTH OR ANY PERSON
19950H0544B4238 - 30 -
1 ENROLLED IN THE PROGRAM BE CHARGED MORE THAN THE PRICE OF THE
2 DRUG AT THE PARTICULAR PHARMACY ON THE DATE OF THE SALE.
3 SECTION 510. GENERIC DRUGS.
4 (A) IN GENERAL.--NOTWITHSTANDING ANY OTHER STATUTE OR
5 REGULATION, IF AN A-RATED GENERIC THERAPEUTICALLY EQUIVALENT
6 DRUG IS AVAILABLE FOR DISPENSING TO A CLAIMANT, THE PROVIDER
7 SHALL DISPENSE THE A-RATED GENERIC THERAPEUTICALLY EQUIVALENT
8 DRUG TO THE CLAIMANT. THE DEPARTMENT SHALL NOT REIMBURSE
9 PROVIDERS FOR BRAND NAME PRODUCTS EXCEPT IN THE FOLLOWING
10 CIRCUMSTANCES:
11 (1) THERE IS NO A-RATED GENERIC THERAPEUTICALLY
12 EQUIVALENT DRUG AVAILABLE ON THE MARKET. THIS SUBPARAGRAPH
13 DOES NOT APPLY TO THE LACK OF AVAILABILITY OF AN A-RATED
14 GENERIC THERAPEUTICALLY EQUIVALENT DRUG IN THE PROVIDING
15 PHARMACY, UNLESS IT CAN BE SHOWN TO THE DEPARTMENT THAT THE
16 PROVIDER MADE REASONABLE ATTEMPTS TO OBTAIN THE A-RATED
17 GENERIC THERAPEUTICALLY EQUIVALENT DRUG OR THAT THERE WAS AN
18 UNFORESEEABLE DEMAND AND DEPLETION OF THE SUPPLY OF THE A-
19 RATED GENERIC THERAPEUTICALLY EQUIVALENT DRUG. IN EITHER
20 CASE, THE DEPARTMENT SHALL REIMBURSE THE PROVIDER FOR 90% OF
21 THE AVERAGE WHOLESALE COST PLUS A DISPENSING FEE BASED ON THE
22 LEAST EXPENSIVE A-RATED GENERIC THERAPEUTICALLY EQUIVALENT
23 DRUG FOR THE BRAND DRUG DISPENSED.
24 (2) AN A-RATED GENERIC THERAPEUTICALLY EQUIVALENT DRUG
25 IS DEEMED BY THE DEPARTMENT, IN CONSULTATION WITH A
26 UTILIZATION REVIEW COMMITTEE, TO HAVE TOO NARROW A
27 THERAPEUTIC INDEX FOR SAFE AND EFFECTIVE DISPENSING IN THE
28 COMMUNITY SETTING. THE DEPARTMENT SHALL NOTIFY PROVIDING
29 PHARMACIES OF A-RATED GENERIC THERAPEUTICALLY EQUIVALENT
30 DRUGS THAT ARE IDENTIFIED PURSUANT TO THIS SUBPARAGRAPH ON A
19950H0544B4238 - 31 -
1 REGULAR BASIS.
2 (3) THE DEPARTMENT OF HEALTH HAS DETERMINED THAT A DRUG
3 SHALL NOT BE RECOGNIZED AS AN A-RATED GENERIC THERAPEUTICALLY
4 EQUIVALENT DRUG FOR PURPOSE OF SUBSTITUTION UNDER SECTION
5 5(B) OF THE ACT OF NOVEMBER 24, 1976 (P.L.1163, NO.259),
6 REFERRED TO AS THE GENERIC EQUIVALENT DRUG LAW.
7 (4) AT THE TIME OF DISPENSING, THE PROVIDER HAS A
8 PRESCRIPTION ON WHICH THE BRAND NAME DRUG DISPENSED IS BILLED
9 TO THE PROGRAM BY THE PROVIDER AT A USUAL AND CUSTOMARY
10 CHARGE WHICH IS EQUAL TO OR LESS THAN THE LEAST EXPENSIVE
11 USUAL AND CUSTOMARY CHARGE OF ANY A-RATED GENERIC
12 THERAPEUTICALLY EQUIVALENT DRUG REASONABLY AVAILABLE ON THE
13 MARKET TO THE PROVIDER.
14 (B) GENERIC NOT ACCEPTED.--IF A CLAIMANT CHOOSES NOT TO
15 ACCEPT THE A-RATED GENERIC THERAPEUTICALLY EQUIVALENT DRUG
16 REQUIRED BY SUBSECTION (A), THE CLAIMANT SHALL BE LIABLE FOR THE
17 COPAYMENT AND 70% OF THE AVERAGE WHOLESALE COST OF THE BRAND
18 NAME DRUG.
19 (C) GENERIC DRUGS NOT DEEMED INCORRECT SUBSTITUTION.--THE
20 DISPENSING OF AN A-RATED GENERIC THERAPEUTICALLY EQUIVALENT DRUG
21 IN ACCORDANCE WITH THIS CHAPTER SHALL NOT BE DEEMED INCORRECT
22 SUBSTITUTION UNDER SECTION 6(A) OF THE ACT OF NOVEMBER 24, 1976
23 (P.L.1163, NO.259), REFERRED TO AS THE GENERIC EQUIVALENT DRUG
24 LAW.
25 (D) MEDICAL EXCEPTION.--A MEDICAL EXCEPTION PROCESS SHALL BE
26 ESTABLISHED BY THE DEPARTMENT, WHICH SHALL BE PUBLISHED AS A
27 NOTICE IN THE PENNSYLVANIA BULLETIN AND DISTRIBUTED TO PROVIDERS
28 AND RECIPIENTS IN THE PROGRAM.
29 SECTION 511. SUPPLY.
30 PRESCRIPTION BENEFITS FOR ANY SINGLE PRESCRIPTION SHALL BE
19950H0544B4238 - 32 -
1 LIMITED TO A 30-DAY SUPPLY OF THE PRESCRIPTION DRUG OR 100
2 UNITS, WHICHEVER IS LESS, EXCEPT THAT, IN THE CASE OF DIAGNOSIS
3 FOR ACUTE CONDITIONS, THE LIMITATION SHALL BE A 15-DAY SUPPLY.
4 THIS LIMITATION SHALL NOT APPLY TO TOPICAL OINTMENTS OR GELS
5 THAT ARE NOT AVAILABLE IN CONTAINERS WHICH MEET THE SIZE AND
6 SUPPLY RESTRICTIONS SET FORTH IN THIS SECTION.
7 SECTION 512. RESTRICTED FORMULARY.
8 THE DEPARTMENT MAY ESTABLISH A RESTRICTED FORMULARY OF THE
9 DRUGS WHICH WILL NOT BE REIMBURSED BY THE PROGRAM. THIS
10 FORMULARY SHALL INCLUDE ONLY EXPERIMENTAL DRUGS AND DRUGS ON THE
11 DRUG EFFICACY STUDY IMPLEMENTATION LIST PREPARED BY THE HEALTH
12 CARE FINANCE ADMINISTRATION. A MEDICAL EXCEPTION MAY BE
13 PERMITTED BY THE DEPARTMENT FOR REIMBURSEMENT OF A DRUG ON THE
14 DRUG EFFICACY STUDY IMPLEMENTATION LIST UPON DECLARATION OF ITS
15 NECESSITY ON THE PRESCRIPTION BY THE TREATING PHYSICIAN; EXCEPT
16 THAT, FOR DESI DRUGS FOR WHICH THE FDA HAS ISSUED A NOTICE FOR
17 OPPORTUNITY HEARING (NOOH) FOR THE PURPOSE OF WITHDRAWING THE
18 NEW DRUG APPLICATION APPROVED FOR THAT DRUG, REIMBURSEMENT
19 COVERAGE SHALL BE DISCONTINUED UNDER THE PROVISIONS OF THIS
20 CHAPTER.
21 SECTION 513. MAIL ORDER SYSTEM.
22 THE DEPARTMENT MAY NOT ENTER INTO A CONTRACT WITH A PRIVATE
23 CONTRACTOR FOR AN EXCLUSIVE MAIL-ORDER SYSTEM FOR THE DELIVERY
24 OF PRESCRIPTION DRUGS UNDER THIS PROGRAM. ONLY MAIL-ORDER
25 PHARMACY SERVICES PROVIDED BY PHARMACIES WHICH ARE LICENSED BY
26 THE COMMONWEALTH AND WHICH HAVE THEIR PRINCIPAL PLACE OF
27 BUSINESS WITHIN THIS COMMONWEALTH MAY PARTICIPATE AS PROVIDERS
28 UNDER THE PROGRAM. THE DEPARTMENT SHALL DEVELOP AND PROMULGATE
29 SPECIFIC REGULATIONS GOVERNING THE PRACTICE OF MAIL-ORDER
30 PHARMACY AND OTHER ENROLLED PROVIDERS TO INCLUDE THE FOLLOWING
19950H0544B4238 - 33 -
1 MINIMUM STANDARDS OF PRACTICE TO ENSURE THE HEALTH, SAFETY AND
2 WELFARE OF PROGRAM PARTICIPANTS:
3 (1) THE APPROPRIATE METHOD OR METHODS BY WHICH SUCH
4 PHARMACIES SHALL VERIFY THE IDENTITY OF THE PROGRAM RECIPIENT
5 AND THE AUTHENTICITY OF PRESCRIPTIONS RECEIVED.
6 (2) THE APPROPRIATE METHOD OR METHODS BY WHICH SUCH
7 PHARMACIES SHALL MAIL OR DELIVER PRESCRIPTION DRUGS TO
8 PROGRAM RECIPIENTS ENSURING, TO THE MAXIMUM EXTENT POSSIBLE,
9 THAT THE INTENDED PROGRAM RECIPIENT IS THE ACTUAL ULTIMATE
10 RECIPIENT OF ANY PRESCRIPTION DISPENSED BY SUCH PHARMACIES.
11 (3) THE APPROPRIATE METHOD OR METHODS BY WHICH SUCH
12 PHARMACIES SHALL COMMUNICATE WITH PROGRAM PARTICIPANTS IN
13 EMERGENCY SITUATIONS.
14 SECTION 514. INDICATION OF PRICE.
15 THE RETAIL PRICE OF THE PRESCRIPTION SHALL BE INDICATED ON
16 THE LABEL OF THE PRESCRIPTION CONTAINER OR FURNISHED BY SEPARATE
17 RECEIPT.
18 SECTION 515. REIMBURSEMENT.
19 FOR-PROFIT THIRD PARTY INSURERS AND NOT-FOR-PROFIT
20 PRESCRIPTION PLANS SHALL BE RESPONSIBLE FOR ANY PAYMENTS MADE TO
21 A PROVIDING PHARMACY ON BEHALF OF A CLAIMANT COVERED BY SUCH A
22 THIRD PARTY.
23 SECTION 516. NONLIABILITY.
24 (A) PERSONS RENDERING SERVICE.--ANY PERSON RENDERING SERVICE
25 AS A MEMBER OF A UTILIZATION REVIEW COMMITTEE FOR THIS PROGRAM
26 SHALL NOT BE LIABLE FOR ANY CIVIL DAMAGES AS A RESULT OF ANY
27 ACTS OR OMISSIONS IN RENDERING THE SERVICE AS A MEMBER OF ANY
28 SUCH COMMITTEE EXCEPT ANY ACTS OR OMISSIONS INTENTIONALLY
29 DESIGNED TO HARM OR ANY GROSSLY NEGLIGENT ACTS OR OMISSIONS
30 WHICH RESULT IN HARM TO THE PERSON RECEIVING SUCH SERVICE.
19950H0544B4238 - 34 -
1 (B) OFFICER AND EMPLOYEES OF DEPARTMENT.--ANY OFFICER OR
2 EMPLOYEE OF THE DEPARTMENT RENDERING SERVICE AS A MEMBER OF A
3 UTILIZATION REVIEW COMMITTEE FOR THIS PROGRAM SHALL NOT BE
4 LIABLE FOR ANY CIVIL DAMAGES AS A RESULT OF ANY ACTS OR
5 OMISSIONS IN RENDERING THE SERVICE AS A MEMBER OF ANY SUCH
6 COMMITTEE OR AS A RESULT OF ANY DECISION OR ACTION IN CONNECTION
7 WITH THE PROGRAM EXCEPT ANY ACTS OR OMISSIONS INTENTIONALLY
8 DESIGNED TO HARM OR ANY GROSSLY NEGLIGENT ACTS OR OMISSIONS
9 WHICH RESULT IN HARM TO THE PERSON RECEIVING SUCH SERVICE.
10 SECTION 517. INCOME VERIFICATION.
11 (A) PROCEDURE.--THE DEPARTMENT SHALL ANNUALLY VERIFY THE
12 INCOME OF ELIGIBLE CLAIMANTS. THE DEPARTMENT SHALL VERIFY THE
13 INCOME OF ELIGIBLE CLAIMANTS BY REQUIRING INCOME DOCUMENTATION
14 FROM THE CLAIMANTS. AN APPLICATION FOR BENEFITS UNDER THIS
15 CHAPTER SHALL CONSTITUTE A WAIVER TO THE DEPARTMENT OF ALL
16 RELEVANT CONFIDENTIALITY REQUIREMENTS RELATING TO THE CLAIMANT'S
17 PENNSYLVANIA STATE INCOME TAX INFORMATION IN THE POSSESSION OF
18 THE DEPARTMENT OF REVENUE. THE DEPARTMENT OF REVENUE SHALL
19 PROVIDE THE DEPARTMENT WITH THE NECESSARY INCOME INFORMATION
20 SHOWN ON THE CLAIMANT'S PENNSYLVANIA STATE INCOME TAX RETURN
21 SOLELY FOR INCOME VERIFICATION PURPOSES.
22 (B) INFORMATION CONFIDENTIAL.--IT SHALL BE UNLAWFUL FOR ANY
23 OFFICER, AGENT OR EMPLOYEE OF THE DEPARTMENT TO DIVULGE OR MAKE
24 KNOWN IN ANY MANNER WHATSOEVER ANY INFORMATION GAINED THROUGH
25 ACCESS TO THE DEPARTMENT OF REVENUE INFORMATION EXCEPT FOR
26 OFFICIAL INCOME VERIFICATION PURPOSES UNDER THIS CHAPTER.
27 (C) PENALTY.--A PERSON WHO VIOLATES THIS ACT COMMITS A
28 MISDEMEANOR AND SHALL, UPON CONVICTION, BE SENTENCED TO PAY A
29 FINE OF NOT MORE THAN $1,000 OR TO IMPRISONMENT FOR NOT MORE
30 THAN ONE YEAR, OR BOTH, TOGETHER WITH THE COST OF PROSECUTION,
19950H0544B4238 - 35 -
1 AND IF THE OFFENDER IS AN OFFICER OR EMPLOYEE OF THE
2 COMMONWEALTH, HE SHALL BE DISMISSED FROM OFFICE OR DISCHARGED
3 FROM EMPLOYMENT.
4 (D) COORDINATION WITH DEPARTMENT OF PUBLIC WELFARE.--TO THE
5 EXTENT POSSIBLE, THE DEPARTMENT AND THE DEPARTMENT OF PUBLIC
6 WELFARE SHALL COORDINATE EFFORTS TO FACILITATE THE APPLICATION
7 AND ENROLLMENT OF ELIGIBLE OLDER PEOPLE IN THE MEDICAID HEALTHY
8 HORIZONS PROGRAM BY PROCESSING THESE APPLICATIONS AT SENIOR
9 CITIZENS CENTERS AND OTHER APPROPRIATE FACILITIES PROVIDING
10 SERVICES TO THE ELDERLY.
11 SECTION 518. CONTRACT.
12 THE DEPARTMENT IS AUTHORIZED TO ENTER INTO A CONTRACT
13 PROVIDING FOR PRESCRIPTION DRUGS TO ELIGIBLE PERSONS PURSUANT TO
14 THIS CHAPTER. THE DEPARTMENT SHALL SELECT A PROPOSAL THAT
15 INCLUDES, BUT IS NOT LIMITED TO, THE CRITERIA SET FORTH IN THIS
16 CHAPTER.
17 SECTION 519. THE PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE
18 ELDERLY NEEDS ENHANCEMENT TIER.
19 (A) ESTABLISHMENT.--THERE IS HEREBY ESTABLISHED WITHIN THE
20 DEPARTMENT A PROGRAM TO BE KNOWN AS THE PHARMACEUTICAL
21 ASSISTANCE CONTRACT FOR THE ELDERLY NEEDS ENHANCEMENT TIER
22 (PACENET).
23 (B) PACENET ELIGIBILITY.--A CLAIMANT WITH AN ANNUAL INCOME
24 OF NOT LESS THAN $14,000 AND NOT MORE THAN $16,000 IN THE CASE
25 OF A SINGLE PERSON AND OF NOT LESS THAN $17,200 AND NOT MORE
26 THAN $19,200 IN THE CASE OF THE COMBINED INCOME OF PERSONS
27 MARRIED TO EACH OTHER SHALL BE ELIGIBLE FOR ENHANCED
28 PHARMACEUTICAL ASSISTANCE UNDER THIS SECTION. A PERSON MAY, IN
29 REPORTING INCOME TO THE DEPARTMENT, ROUND THE AMOUNT OF EACH
30 SOURCE OF INCOME AND THE INCOME TOTAL TO THE NEAREST WHOLE
19950H0544B4238 - 36 -
1 DOLLAR, WHEREBY ANY AMOUNT WHICH IS LESS THAN 50¢ IS ELIMINATED.
2 (C) DEDUCTIBLE.--UPON ENROLLMENT IN PACENET, ELIGIBLE
3 CLAIMANTS IN THE INCOME RANGES SET FORTH IN SUBSECTION (B) SHALL
4 BE REQUIRED TO MEET AN ANNUAL DEDUCTIBLE IN UNREIMBURSED
5 PRESCRIPTION DRUG EXPENSES OF $500 PER PERSON. TO QUALIFY FOR
6 THE DEDUCTIBLE SET FORTH IN THIS SUBSECTION THE PRESCRIPTION
7 DRUG MUST BE PURCHASED FOR THE USE OF THE ELIGIBLE CLAIMANT FROM
8 A PROVIDER AS DEFINED IN THIS CHAPTER. THE DEPARTMENT, AFTER
9 CONSULTATION WITH THE BOARD, MAY APPROVE AN ADJUSTMENT IN THE
10 DEDUCTIBLE ON AN ANNUAL BASIS.
11 (D) COPAYMENT.--FOR ELIGIBLE CLAIMANTS UNDER THIS SECTION,
12 THE COPAYMENT SCHEDULE, WHICH MAY BE ADJUSTED BY THE DEPARTMENT
13 ON AN ANNUAL BASIS AFTER CONSULTATION WITH THE BOARD, SHALL BE:
14 (I) EIGHT DOLLARS FOR NONINNOVATOR MULTIPLE SOURCE
15 DRUGS AS DEFINED IN SECTION 702; OR
16 (II) FIFTEEN DOLLARS FOR SINGLE-SOURCE DRUGS AND
17 INNOVATOR MULTIPLE-SOURCE DRUGS AS DEFINED IN SECTION
18 702.
19 SECTION 520. BOARD.
20 (A) ESTABLISHMENT.--THE PHARMACEUTICAL ASSISTANCE REVIEW
21 BOARD IS CONTINUED TO ENSURE THAT THE PROGRAM IS PROVIDING AND
22 CONTINUES TO PROVIDE THE ASSISTANCE INTENDED IN A FISCALLY
23 RESPONSIBLE MANNER WITHOUT EXCESSIVELY HAMPERING THE
24 PHARMACEUTICAL INDUSTRY.
25 (B) COMPOSITION.--THE BOARD SHALL BE COMPRISED OF THE
26 FOLLOWING EIGHT PERSONS:
27 (1) THE SECRETARY OF AGING, WHO SHALL SERVE AS ITS
28 CHAIRMAN.
29 (2) THE SECRETARY OF REVENUE.
30 (3) THE SECRETARY OF HEALTH.
19950H0544B4238 - 37 -
1 (4) FIVE PUBLIC MEMBERS, ONE APPOINTED BY THE PRESIDENT
2 PRO TEMPORE OF THE SENATE, ONE APPOINTED BY THE MINORITY
3 LEADER OF THE SENATE, ONE APPOINTED BY THE SPEAKER OF THE
4 HOUSE OF REPRESENTATIVES, ONE APPOINTED BY THE MINORITY
5 LEADER OF THE HOUSE OF REPRESENTATIVES AND ONE APPOINTED BY
6 THE GOVERNOR. THOSE APPOINTED BY THE LEGISLATIVE OFFICERS
7 SHALL INCLUDE TWO SENIOR CITIZENS, WHO HAVE NOT BEEN A PART
8 OF THE PHARMACEUTICAL INDUSTRY, TO SERVE AS CONSUMER
9 ADVOCATES AND TWO REPRESENTATIVES OF THE PHARMACEUTICAL
10 INDUSTRY, AT LEAST ONE OF WHOM IS A PRACTICING PENNSYLVANIA
11 PHARMACIST. THE INDIVIDUAL APPOINTED BY THE GOVERNOR MUST BE
12 A PHYSICIAN. A PUBLIC MEMBER WHO MISSES TWO CONSECUTIVE
13 MEETINGS WITHOUT GOOD CAUSE ACCEPTABLE TO THE CHAIRMAN SHALL
14 BE REPLACED BY THE APPOINTING AUTHORITY.
15 (C) REVIEW.--USING THE ANNUAL REPORT SUBMITTED BY THE
16 DEPARTMENT PURSUANT TO SECTION 2102 AND OTHER APPROPRIATE DATA
17 SOURCES, THE BOARD SHALL CONDUCT AN ANNUAL REVIEW. THE BOARD
18 SHALL DEVELOP RECOMMENDATIONS CONCERNING ANY CHANGES IN THE
19 LEVEL OF COPAYMENT, DEDUCTIBLE OR IN THE LEVEL OF FEES PAID TO
20 PARTICIPATING PHARMACISTS. THE BOARD SHALL REVIEW THE
21 DEPARTMENT'S THERAPEUTIC DRUG UTILIZATION REVIEW PROGRAM ON AN
22 ONGOING BASIS. THE BOARD MAY ALSO RECOMMEND OTHER CHANGES IN THE
23 STRUCTURE OF THE PROGRAM AND DIRECT THE DEPARTMENT TO ENTER INTO
24 DISCUSSIONS WITH THE PRIVATE CONTRACTOR CONCERNING AMENDMENTS TO
25 THE CONTRACT, OR THE DEPARTMENT MAY ENTER INTO SUCH DISCUSSION
26 IF IT DEEMS NECESSARY. THE COPAYMENT OR DEDUCTIBLE SCHEDULE
27 SHALL ONLY BE ADJUSTED ON AN ANNUAL BASIS.
28 (D) MEETINGS.--THE BOARD SHALL MEET AT LEAST TWO TIMES PER
29 YEAR.
30 SECTION 521. PENALTIES.
19950H0544B4238 - 38 -
1 (A) PROHIBITED ACTS.--IT SHALL BE UNLAWFUL FOR ANY PERSON TO
2 SUBMIT A FALSE OR FRAUDULENT CLAIM OR APPLICATION UNDER THIS
3 CHAPTER, INCLUDING, BUT NOT LIMITED TO:
4 (1) AIDING OR ABETTING ANOTHER IN THE SUBMISSION OF A
5 FALSE OR FRAUDULENT CLAIM OR APPLICATION;
6 (2) RECEIVING BENEFITS OR REIMBURSEMENT UNDER A PRIVATE,
7 FEDERAL OR STATE PROGRAM FOR PRESCRIPTION ASSISTANCE AND
8 CLAIMING OR RECEIVING DUPLICATIVE BENEFITS HEREUNDER;
9 (3) SOLICITING, RECEIVING, OFFERING OR PAYING ANY
10 KICKBACK, BRIBE OR REBATE, IN CASH OR IN KIND, FROM OR TO ANY
11 PERSON IN CONNECTION WITH THE FURNISHING OF SERVICES UNDER
12 THIS CHAPTER;
13 (4) ENGAGING IN A PATTERN OF SUBMITTING CLAIMS THAT
14 REPEATEDLY USES INCORRECT NATIONAL DRUG CODE NUMBERS FOR THE
15 PURPOSE OF OBTAINING WRONGFUL ENHANCED REIMBURSEMENT; OR
16 (5) OTHERWISE VIOLATING ANY PROVISION OF THIS CHAPTER.
17 (B) CIVIL PENALTY.--IN ADDITION TO ANY APPROPRIATE CRIMINAL
18 PENALTY FOR PROHIBITED ACTS UNDER THIS CHAPTER WHETHER OR NOT
19 THAT ACT CONSTITUTES A CRIME UNDER 18 PA.C.S. (RELATING TO
20 CRIMES AND OFFENSES), A PROVIDER WHO VIOLATES THIS SECTION MAY
21 BE LIABLE FOR A CIVIL PENALTY IN AN AMOUNT NOT LESS THAN $500
22 AND NOT MORE THAN $10,000 FOR EACH VIOLATION OF THIS ACT WHICH
23 SHALL BE COLLECTED BY THE DEPARTMENT. EACH VIOLATION CONSTITUTES
24 A SEPARATE OFFENSE. IF THE DEPARTMENT COLLECTS THREE OR MORE
25 CIVIL PENALTIES AGAINST THE SAME PROVIDER, THE PROVIDER SHALL BE
26 INELIGIBLE TO PARTICIPATE IN EITHER PACE OR PACENET FOR A PERIOD
27 OF ONE YEAR. IF MORE THAN THREE CIVIL PENALTIES ARE COLLECTED
28 FROM ANY PROVIDER, THE DEPARTMENT MAY DETERMINE THAT THE
29 PROVIDER IS PERMANENTLY INELIGIBLE TO PARTICIPATE IN PACE OR
30 PACENET.
19950H0544B4238 - 39 -
1 (C) SUSPENSION OF LICENSE.--THE LICENSE OF ANY PROVIDER WHO
2 HAS BEEN FOUND GUILTY UNDER THIS CHAPTER SHALL BE SUSPENDED FOR
3 A PERIOD OF ONE YEAR. THE LICENSE OF ANY PROVIDER WHO HAS
4 COMMITTED THREE OR MORE VIOLATIONS OF THIS CHAPTER MAY BE
5 SUSPENDED FOR A PERIOD OF ONE YEAR.
6 (D) REPAYMENT OF GAIN.--ANY PROVIDER, RECIPIENT OR OTHER
7 PERSON WHO IS FOUND GUILTY OF A CRIME FOR VIOLATING THIS CHAPTER
8 SHALL REPAY THREE TIMES THE VALUE OF THE MATERIAL GAIN RECEIVED.
9 IN ADDITION TO THE CIVIL PENALTY AUTHORIZED PURSUANT TO
10 SUBSECTION (B), THE DEPARTMENT MAY REQUIRE THE PROVIDER,
11 RECIPIENT OR OTHER PERSON TO REPAY UP TO THREE TIMES THE VALUE
12 OF ANY MATERIAL GAIN TO PACE OR PACENET.
13 SECTION 522. PRESCRIPTION DRUG EDUCATION PROGRAM.
14 THE DEPARTMENT, IN COOPERATION WITH THE DEPARTMENT OF HEALTH,
15 SHALL DEVELOP AND IMPLEMENT A STATEWIDE PRESCRIPTION DRUG
16 EDUCATION PROGRAM DESIGNED TO INFORM OLDER ADULTS OF THE DANGERS
17 OF PRESCRIPTION DRUG ABUSE AND MISUSE. THE PRESCRIPTION DRUG
18 EDUCATION PROGRAM SHALL INCLUDE, BUT NOT BE LIMITED TO,
19 INFORMATION CONCERNING THE FOLLOWING:
20 (1) THE HAZARDS OF PRESCRIPTION DRUG OVERDOSE.
21 (2) THE POTENTIAL DANGERS OF MIXING PRESCRIPTION DRUGS.
22 (3) THE DANGER OF RETAINING UNUSED PRESCRIPTION DRUGS
23 AFTER THE NEED TO TAKE THEM NO LONGER EXISTS.
24 (4) THE NECESSITY TO CAREFULLY QUESTION PHYSICIANS AND
25 PHARMACISTS CONCERNING THE EFFECTS OF TAKING PRESCRIPTION
26 DRUGS, INCLUDING THE DIFFERENCES BETWEEN BRAND NAME DRUGS AND
27 GENERICALLY EQUIVALENT DRUGS.
28 (5) THE ADVISABILITY OF MAINTAINING A PRESCRIPTION DRUG
29 PROFILE OR OTHER RECORD OF PRESCRIPTION DRUG DOSAGE AND
30 FREQUENCY OF DOSAGE.
19950H0544B4238 - 40 -
1 (6) THE DESIRABILITY OF ADVISING FAMILY MEMBERS OF THE
2 TYPES AND PROPER DOSAGE OF PRESCRIPTION DRUGS WHICH ARE BEING
3 TAKEN.
4 (7) THE DANGERS OF TAKING PRESCRIPTION DRUGS IN EXCESS
5 OF PRESCRIBED DOSAGES.
6 (8) THE NEED TO OBTAIN COMPLETE, DETAILED DIRECTIONS
7 FROM THE PHYSICIAN OR PHARMACIST CONCERNING THE TIME PERIOD A
8 PRESCRIPTION DRUG SHOULD BE TAKEN.
9 CHAPTER 7
10 PRUDENT PHARMACEUTICAL PURCHASING
11 SECTION 701. DECLARATION OF POLICY.
12 THE GENERAL ASSEMBLY FINDS AND DECLARES AS FOLLOWS:
13 (1) THE COMMONWEALTH, THROUGH ASSISTANCE PROGRAMS
14 ENACTED FOR THE BENEFIT OF ITS CITIZENS, IS THE LARGEST
15 SINGLE PAYOR OF PRESCRIPTION MEDICATIONS IN PENNSYLVANIA.
16 (2) IN ORDER TO ENSURE THAT THE COMMONWEALTH, IN
17 EXPENDING MONEY ON BEHALF OF ITS CITIZENS, IS NOT UNDULY
18 HARMED BY BEING REQUIRED TO PAY A PRICE FOR PHARMACEUTICAL
19 PRODUCTS PURCHASED FROM MANUFACTURERS IN EXCESS OF THAT
20 ESTABLISHED FOR OTHER PURCHASERS AND REIMBURSERS OF THESE
21 PRODUCTS AND TO ENSURE THAT THE COMMONWEALTH CAN EFFICIENTLY
22 AND PRUDENTLY EXPEND ITS MONEY AND MAXIMIZE ITS ABILITY TO
23 PROVIDE FOR THE HEALTH AND WELFARE OF AS MANY OF ITS NEEDY
24 CITIZENS AS POSSIBLE, IT IS REASONABLE, NECESSARY AND IN THE
25 PUBLIC INTEREST TO REQUIRE THAT PHARMACEUTICAL MANUFACTURERS
26 OFFER A DISCOUNT TO THE COMMONWEALTH FOR PHARMACEUTICAL
27 PRODUCTS PURCHASED OR REIMBURSED THROUGH STATE AGENCIES.
28 (3) IT IS IN THE PUBLIC INTEREST FOR PHARMACEUTICAL
29 MANUFACTURERS TO PROVIDE THE COMMONWEALTH WITH DATA RELATING
30 TO THE PRICE OF PHARMACEUTICAL PRODUCTS SOLD BY THE
19950H0544B4238 - 41 -
1 MANUFACTURER TO PUBLIC BODIES, HOSPITALS, FOR-PROFIT OR
2 NONPROFIT ORGANIZATIONS, OTHER MANUFACTURERS OR WHOLESALERS
3 DOING BUSINESS IN THIS COMMONWEALTH IN ORDER TO ENSURE THAT
4 THE COMMONWEALTH CAN DETERMINE THAT IT IS BEING PROVIDED WITH
5 THE BEST PRICES OFFERED BY THE MANUFACTURER.
6 (4) ON A NATIONAL LEVEL, THERE HAS BEEN A RECOGNITION
7 THAT THE NEED FOR DISCOUNTS TO STATE MEDICAID AGENCIES, WHICH
8 REIMBURSE FOR A HIGH VOLUME OF PHARMACEUTICAL PRODUCTS,
9 EXISTS.
10 (5) ON A STATE LEVEL, THE GENERAL ASSEMBLY RECOGNIZES
11 THAT IT IS IN THE BEST INTEREST OF ITS CITIZENS TO PROVIDE
12 PHARMACEUTICAL ASSISTANCE IN A REASONABLE AND COST-EFFICIENT
13 MANNER.
14 (6) DRUG PRICE INFLATION HAS CAUSED AN INCREASE IN THE
15 AMOUNT OF PUBLIC FUNDS EXPENDED BY PACE AND GENERAL
16 ASSISTANCE.
17 SECTION 702. 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
20 CONTEXT CLEARLY INDICATES OTHERWISE:
21 "AVERAGE MANUFACTURER PRICE (AMP)." WITH RESPECT TO A
22 COVERED PRESCRIPTION DRUG OF THE MANUFACTURER FOR A CALENDAR
23 QUARTER, THE AVERAGE UNIT PRICE PAID TO THE MANUFACTURER FOR THE
24 DRUG BY WHOLESALERS FOR DRUGS DISTRIBUTED TO THE RETAIL PHARMACY
25 CLASS OF TRADE, EXCEPT FOR DIRECT SALES TO HOSPITALS, HEALTH
26 MAINTENANCE ORGANIZATIONS AND WHOLESALERS WHERE THE DRUG IS
27 RELABELED UNDER THAT DISTRIBUTOR'S NATIONAL DRUG CODE NUMBER.
28 FEDERAL SUPPLY SCHEDULE PRICES SHALL NOT BE INCLUDED IN THE
29 CALCULATION OF AMP. THE TERM INCLUDES CASH DISCOUNTS AND ALL
30 OTHER PRICE REDUCTIONS, OTHER THAN REBATES UNDER THIS ACT AND
19950H0544B4238 - 42 -
1 SECTION 1927 OF TITLE XIX OF THE SOCIAL SECURITY ACT (PUBLIC LAW
2 74-271, 42 U.S.C. § 301 ET SEQ.), ADDED NOVEMBER 5, 1990 (PUBLIC
3 LAW 101-508, TITLE IV, SECTION 4401(A)(3), 104 STAT. 1388-143),
4 WHICH REDUCE THE ACTUAL PRICE PAID. FOR BUNDLED OR CAPITATED
5 SALES, THE ALLOCATION OF THE DISCOUNT SHALL BE MADE
6 PROPORTIONATELY TO THE DOLLAR VALUE OF THE UNITS OF EACH COVERED
7 PRESCRIPTION DRUG SOLD UNDER THE BUNDLED OR CAPITATED
8 ARRANGEMENT. THE AMP FOR A QUARTER SHALL BE ADJUSTED BY THE
9 MANUFACTURER IF CUMULATIVE DISCOUNTS OR OTHER ARRANGEMENTS
10 SUBSEQUENTLY ADJUST THE PRICES ACTUALLY REALIZED.
11 "BUNDLED OR CAPITATED SALES." THE PACKAGING OF DRUGS OF
12 DIFFERENT TYPES WHERE:
13 (1) THE CONDITION OF REBATE OR DISCOUNT IS THAT MORE
14 THAN ONE DRUG TYPE IS PURCHASED; OR
15 (2) THE RESULTING DISCOUNT OR REBATE IS GREATER THAN
16 THAT WHICH WOULD HAVE BEEN RECEIVED HAD THE DRUG PRODUCTS
17 BEEN PURCHASED SEPARATELY.
18 "CONSUMER PRICE INDEX-URBAN" OR "CPI-U." A PRICE INDEX
19 COMPILED BY THE BUREAU OF LABOR STATISTICS OF THE UNITED STATES
20 DEPARTMENT OF LABOR FOR MEASURING THE AVERAGE CHANGE IN THE
21 PRICES PAID BY URBAN CONSUMERS FOR A FIXED MARKET BASKET OF
22 SERVICES.
23 "COVERED PRESCRIPTION DRUG." A LEGEND DRUG, INSULIN, AN
24 INSULIN SYRINGE OR AN INSULIN NEEDLE ELIGIBLE FOR PAYMENT BY THE
25 COMMONWEALTH UNDER PACE, PACENET OR DESIGNATED PHARMACEUTICAL
26 PROGRAMS.
27 "DEPOT PRICE." THE PRICE AVAILABLE TO ANY DEPOT OF THE
28 FEDERAL GOVERNMENT FOR PURCHASE OF DRUGS FROM THE MANUFACTURER
29 THROUGH THE DEPOT SYSTEM OF PROCUREMENT.
30 "DESIGNATED PHARMACEUTICAL PROGRAMS." THE GENERAL ASSISTANCE
19950H0544B4238 - 43 -
1 PROGRAM AND THE SPECIAL PHARMACEUTICAL BENEFIT PROGRAM IN THE
2 DEPARTMENT OF PUBLIC WELFARE AND THE END STAGE RENAL DIALYSIS
3 PROGRAM IN THE DEPARTMENT OF HEALTH.
4 "DIRECT SELLER." ANY PERSON, PARTNERSHIP, CORPORATION,
5 INSTITUTION OR ENTITY ENGAGED IN THE SELLING OF PHARMACEUTICAL
6 PRODUCTS DIRECTLY TO CONSUMERS IN THIS COMMONWEALTH.
7 "DISTRIBUTOR." A PRIVATE ENTITY UNDER CONTRACT WITH THE
8 ORIGINAL LABELER OR HOLDER OF THE NATIONAL DRUG CODE NUMBER TO
9 MANUFACTURE, PACKAGE OR MARKET THE COVERED PRESCRIPTION DRUG.
10 "DOING BUSINESS IN THIS COMMONWEALTH." THE DIRECT OR
11 INDIRECT SELLING OR THE MAKING OF COVERED PRESCRIPTION DRUGS
12 AVAILABLE FOR SALE IN A CONTINUOUS AND SYSTEMATIC MANNER WITH
13 THE REASONABLE EXPECTATION THAT THESE PRODUCTS WILL BE SOLD TO
14 CONSUMERS IN THIS COMMONWEALTH.
15 "FDA." THE FOOD AND DRUG ADMINISTRATION OF THE PUBLIC HEALTH
16 SERVICE OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES.
17 "GENERAL ASSISTANCE." THE GENERAL ASSISTANCE PROGRAM OF THE
18 DEPARTMENT OF PUBLIC WELFARE OF THE COMMONWEALTH.
19 "INNOVATOR MULTIPLE-SOURCE DRUGS." A MULTIPLE-SOURCE DRUG
20 THAT WAS ORIGINALLY MARKETED UNDER A NEW DRUG APPLICATION
21 APPROVED BY THE FDA. THE TERM INCLUDES:
22 (1) COVERED PRESCRIPTION DRUGS APPROVED UNDER PRODUCT
23 LICENSE APPROVAL (PLA), ESTABLISHMENT LICENSE APPROVAL (ELA)
24 OR ANTIBIOTIC DRUG APPROVAL (ADA); AND
25 (2) A COVERED PRESCRIPTION DRUG MARKETED BY A CROSS-
26 LICENSED PRODUCER OR DISTRIBUTOR UNDER THE APPROVED
27 ABBREVIATED NEW DRUG APPLICATION (ANDA) WHEN THE DRUG PRODUCT
28 MEETS THIS DEFINITION.
29 "MANUFACTURER."
30 (1) AN ENTITY WHICH IS ENGAGED IN ANY OF THE FOLLOWING:
19950H0544B4238 - 44 -
1 (I) THE PRODUCTION, PREPARATION, PROPAGATION,
2 COMPOUNDING, CONVERSION OR PROCESSING OF PRESCRIPTION
3 DRUG PRODUCTS:
4 (A) DIRECTLY OR INDIRECTLY BY EXTRACTION FROM
5 SUBSTANCES OF NATURAL ORIGIN;
6 (B) INDEPENDENTLY BY MEANS OF CHEMICAL
7 SYNTHESIS; OR
8 (C) BY A COMBINATION OF EXTRACTION AND CHEMICAL
9 SYNTHESIS.
10 (II) THE PACKAGING, REPACKAGING, LABELING OR
11 RELABELING, OR DISTRIBUTION OF PRESCRIPTION DRUG
12 PRODUCTS.
13 (2) THE ENTITY HOLDING LEGAL TITLE TO OR POSSESSION OF
14 THE NATIONAL DRUG CODE NUMBER FOR THE COVERED PRESCRIPTION
15 DRUG.
16 (3) THE TERM DOES NOT INCLUDE A WHOLESALE DISTRIBUTOR OF
17 DRUGS, DRUGSTORE CHAIN ORGANIZATION OR RETAIL PHARMACY
18 LICENSED BY THE COMMONWEALTH.
19 "NATIONAL DRUG CODE NUMBER." THE IDENTIFYING DRUG NUMBER
20 MAINTAINED BY THE FDA. THE COMPLETE ELEVEN DIGIT NUMBER MUST
21 INCLUDE THE LABELER CODE, PRODUCT CODE AND PACKAGE SIZE CODE.
22 "NEW DRUG." A COVERED PRESCRIPTION DRUG APPROVED AS A NEW
23 DRUG UNDER SECTION 201(P) OF THE FEDERAL FOOD, DRUG, AND
24 COSMETIC ACT (52 STAT. 1040, 21 U.S.C. § 321(P)).
25 "NONINNOVATOR MULTIPLE-SOURCE DRUG." ANY OF THE FOLLOWING:
26 (1) A COVERED PRESCRIPTION DRUG WHICH IS NOT AN
27 INNOVATOR MULTIPLE-SOURCE DRUG APPROVED UNDER AN ABBREVIATED
28 NEW DRUG APPLICATION (ANDA) OR AN AMENDED ANTIBIOTIC DRUG
29 APPROVAL (AADA).
30 (2) A DRUG THAT HAS BEEN APPROVED FOR SUBSTITUTION UNDER
19950H0544B4238 - 45 -
1 THE ACT OF NOVEMBER 24, 1976 (P.L.1163, NO.259), REFERRED TO
2 AS THE GENERIC EQUIVALENT DRUG LAW.
3 "PACE." THE PROGRAM UNDER CHAPTER 5.
4 "PACENET." THE PROGRAM ESTABLISHED UNDER SECTION 519.
5 "PRIVATE ENTITY." INCLUDES A FOR-PROFIT ENTITY AND A
6 NONPROFIT ENTITY.
7 "PRODUCER PRICE INDEX FOR PHARMACEUTICALS." THE PRESCRIPTION
8 DRUG PRODUCER PRICE INDEX COMPILED BY THE BUREAU OF LABOR
9 STATISTICS OF THE UNITED STATES DEPARTMENT OF LABOR FOR
10 MEASURING AVERAGE CHANGES IN SELLING PRICES RECEIVED BY DOMESTIC
11 DRUG MANUFACTURERS.
12 "PROVIDER." A LICENSED PHARMACY OR DISPENSING PHYSICIAN
13 ENROLLED AS A PROVIDER IN PACE, PACENET OR DESIGNATED
14 PHARMACEUTICAL PROGRAMS.
15 "REBATE PERIOD." A CALENDAR QUARTER OR OTHER PERIOD
16 SPECIFIED BY THE SECRETARY OF AGING WITH RESPECT TO THE PAYMENT
17 OF REBATES UNDER AN AGREEMENT AS PROVIDED IN SECTION 703.
18 "SECRETARY." THE SECRETARY OF AGING OF THE COMMONWEALTH.
19 "SINGLE-SOURCE DRUGS." LEGEND DRUG PRODUCTS FOR WHICH THE
20 FDA HAS NOT APPROVED AN ABBREVIATED NEW DRUG APPLICATION (ANDA).
21 "UNIT." A DRUG UNIT IN THE LOWEST IDENTIFIABLE AMOUNT, SUCH
22 AS TABLET OR CAPSULE FOR SOLID DOSAGE FORMS, MILLILITER FOR
23 LIQUID FORMS AND GRAM FOR OINTMENTS OR CREAMS. THE MANUFACTURER
24 SHALL SPECIFY THE UNIT FOR EACH DOSAGE FORM AND STRENGTH OF EACH
25 COVERED PRESCRIPTION DRUG IN ACCORDANCE WITH THE INSTRUCTIONS
26 DEVELOPED BY THE HEALTH CARE FINANCING ADMINISTRATION FOR
27 PURPOSES OF THE FEDERAL MEDICAID REBATE PROGRAM UNDER SECTION
28 1927 OF TITLE XIX OF THE SOCIAL SECURITY ACT (PUBLIC LAW 74-271,
29 42 U.S.C. § 301 ET SEQ.).
30 "WHOLESALER." ANY PERSON, PARTNERSHIP, CORPORATION,
19950H0544B4238 - 46 -
1 INSTITUTION OR ENTITY TO WHICH THE MANUFACTURER SELLS THE
2 COVERED PRESCRIPTION DRUG, INCLUDING A PHARMACY OR CHAIN OF
3 PHARMACIES, BUT THAT DOES NOT RELABEL OR REPACKAGE THE COVERED
4 PRESCRIPTION DRUG.
5 SECTION 703. REBATE AGREEMENT.
6 (A) REQUIREMENT.--PACE, PACENET AND DESIGNATED
7 PHARMACEUTICAL PROGRAMS SHALL NOT REIMBURSE FOR ANY COVERED
8 PRESCRIPTION DRUG WITHOUT A REBATE AGREEMENT BETWEEN THE
9 DEPARTMENT AND THE MANUFACTURER OF THE COVERED PRESCRIPTION
10 DRUG.
11 (B) EXCEPTION.--SUBSECTION (A) SHALL NOT APPLY IF THE
12 AVAILABILITY OF THE DRUG IS ESSENTIAL TO THE HEALTH OF ELIGIBLE
13 CLAIMANTS AS DETERMINED BY THE DEPARTMENT.
14 (C) AGREEMENTS.--MANUFACTURERS OF PRESCRIPTION DRUGS
15 REIMBURSED UNDER PACE, PACENET AND DESIGNATED PHARMACEUTICAL
16 PROGRAMS MUST ENTER INTO A REBATE AGREEMENT WITH THE DEPARTMENT
17 UNDER THIS CHAPTER TO OBTAIN SUCH REIMBURSEMENT. NOTHING IN THIS
18 CHAPTER SHALL BE DEEMED TO AFFECT OR IMPAIR ANY AGREEMENT MADE
19 UNDER THE FORMER PROVISIONS OF CHAPTER 6 OF THE ACT OF AUGUST
20 14, 1991 (P.L.342, NO.36), KNOWN AS THE LOTTERY FUND
21 PRESERVATION ACT.
22 (D) NOTICE.--THE DEPARTMENT SHALL NOTIFY ENROLLED PROVIDERS
23 OF PACE, PACENET AND DESIGNATED PHARMACEUTICAL PROGRAMS ON AN
24 ANNUAL BASIS AND AS APPROPRIATE OF ALL MANUFACTURERS WHO HAVE
25 ENTERED INTO A REBATE AGREEMENT.
26 (E) DRUG FORMULARY.--EXCEPT AS PROVIDED IN SECTION 512,
27 THERE SHALL BE NO DRUG FORMULARY, PRIOR OR RETROACTIVE APPROVAL
28 SYSTEM OR ANY SIMILAR RESTRICTION IMPOSED ON THE COVERAGE OF
29 OUTPATIENT DRUGS MADE BY MANUFACTURERS WHO HAVE AGREEMENTS IN
30 EFFECT WITH THE COMMONWEALTH TO PAY REBATES FOR DRUGS UTILIZED
19950H0544B4238 - 47 -
1 IN PACE AND PACENET, PROVIDED THAT SUCH OUTPATIENT DRUGS WERE
2 APPROVED FOR MARKETING BY THE FOOD AND DRUG ADMINISTRATION. THIS
3 SUBSECTION SHALL NOT APPLY TO ANY ACT TAKEN BY THE DEPARTMENT
4 PURSUANT TO ITS THERAPEUTIC DRUG UTILIZATION REVIEW PROGRAM
5 UNDER SECTION 505.
6 SECTION 704. TERMS OF REBATE AGREEMENT.
7 (A) QUARTERLY BASIS.--A REBATE AGREEMENT SHALL REQUIRE ANY
8 MANUFACTURER OF COVERED PRESCRIPTION DRUGS TO PROVIDE TO THE
9 DEPARTMENT A REBATE EACH CALENDAR QUARTER IN AN AMOUNT SPECIFIED
10 IN SECTION 705 FOR COVERED PRESCRIPTION DRUGS OF THE
11 MANUFACTURER REIMBURSED DURING THE QUARTER. THE REBATE SHALL BE
12 PAID BY THE MANUFACTURER NOT LATER THAN 30 DAYS AFTER THE DATE
13 OF RECEIPT OF THE INFORMATION DESCRIBED IN SUBSECTION (B) FOR
14 THE PERIOD INVOLVED.
15 (B) INFORMATION.--
16 (1) THE DEPARTMENT SHALL REPORT TO EACH MANUFACTURER,
17 NOT LATER THAN 60 DAYS AFTER THE END OF EACH CALENDAR
18 QUARTER, INFORMATION BY ZIP CODE OF PROVIDER ON THE TOTAL
19 NUMBER OF DOSAGE UNITS OF EACH COVERED PRESCRIPTION DRUG
20 REIMBURSED UNDER PACE, PACENET AND DESIGNATED PHARMACEUTICAL
21 PROGRAMS DURING THE QUARTER.
22 (2) A MANUFACTURER MAY REVIEW THE INFORMATION PROVIDED
23 UNDER PARAGRAPH (1) AND VERIFY INFORMATION. ADJUSTMENTS TO
24 REBATES SHALL BE MADE TO THE EXTENT THAT INFORMATION
25 INDICATES THAT UTILIZATION WAS GREATER OR LESS THAN THE
26 AMOUNT PREVIOUSLY SPECIFIED.
27 (3) IN THE EVENT THAT, IN ANY QUARTER, A MATERIAL
28 DISCREPANCY IN THE DEPARTMENT'S INFORMATION IS CERTIFIED BY
29 THE MANUFACTURER PRIOR TO THE DUE DATE OF THE REBATE, THE
30 DEPARTMENT AND THE MANUFACTURER SHALL, IN GOOD FAITH, ATTEMPT
19950H0544B4238 - 48 -
1 TO RESOLVE THE DISCREPANCY. IF RESOLUTION IS NOT REACHED
2 WITHIN 30 DAYS OF RECEIPT OF THE MANUFACTURER'S CERTIFICATION
3 BY THE DEPARTMENT, THE MANUFACTURER MAY APPEAL THE
4 DEPARTMENT'S DECISION UNDER THE DEPARTMENT'S FORMAL FAIR
5 HEARINGS AND APPEALS PROCESS. THE MANUFACTURER SHALL PAY THE
6 DEPARTMENT THAT PORTION OF THE REBATE AMOUNT WHICH IS NOT
7 DISPUTED WITHIN THE REQUIRED TIME FRAME UNDER THIS CHAPTER.
8 ANY BALANCE DUE, PLUS STATUTORY INTEREST, SHALL BE PAID OR
9 CREDITED BY THE MANUFACTURER OR THE DEPARTMENT BY THE DUE
10 DATE OF THE NEXT QUARTERLY PAYMENT AFTER RESOLUTION OF THE
11 DISPUTE.
12 (C) MANUFACTURER PROVISION OF PRICE INFORMATION.--
13 (1) EACH MANUFACTURER WITH AN AGREEMENT IN EFFECT UNDER
14 THIS CHAPTER SHALL REPORT THE AVERAGE MANUFACTURER PRICE FOR
15 ALL COVERED PRESCRIPTION DRUGS PRODUCED BY THAT MANUFACTURER
16 TO THE DEPARTMENT NOT LATER THAN 30 DAYS AFTER THE LAST DAY
17 OF EACH QUARTER.
18 (2) THE DEPARTMENT SHALL RETAIN THE SERVICES OF AN
19 INDEPENDENT CONTRACTOR TO SURVEY WHOLESALERS, DIRECT SELLERS
20 AND MANUFACTURERS THAT DIRECTLY DISTRIBUTE THEIR COVERED
21 PRESCRIPTION DRUGS, WHEN NECESSARY, TO VERIFY MANUFACTURER
22 PRICES REPORTED UNDER PARAGRAPH (1). ANY SURVEY CONDUCTED
23 SHALL NOT REVEAL TO THE DEPARTMENT NOR TO ANY OTHER PERSON OR
24 ENTITY OTHER THAN THE INDEPENDENT CONTRACTOR THE NAME,
25 IDENTITY, LOCATION, ACTUAL ACQUISITION INVOICE, OTHER
26 PROPRIETARY INFORMATION OR ANY INFORMATION FROM WHICH THE
27 DEPARTMENT MIGHT BE ENABLED TO ASCERTAIN THE NAME, IDENTITY
28 OR LOCATION OF ANY WHOLESALER, DIRECT SELLER OR PROVIDER SO
29 SURVEYED UNLESS THE CONTRACTOR SHALL HAVE GATHERED SUFFICIENT
30 EVIDENCE TO ENABLE THE DEPARTMENT TO BRING CHARGES AGAINST
19950H0544B4238 - 49 -
1 ANY WHOLESALER, DIRECT SELLER OR PROVIDER IN VIOLATION OF
2 SUBSECTION (D)(3).
3 (D) PENALTIES.--THE DEPARTMENT SHALL ADMINISTER PENALTIES AS
4 FOLLOWS:
5 (1) A MANUFACTURER WHO FAILS TO SUPPLY INFORMATION
6 REQUIRED UNDER SUBSECTION (C)(1) SHALL BE LIABLE FOR A CIVIL
7 PENALTY IN THE AMOUNT OF 2% OF THE REBATE NEXT REQUIRED TO BE
8 PAID, PLUS $1,000 FOR EACH DAY THAT THE INFORMATION IS LATE.
9 IF THE INFORMATION IS NOT REPORTED WITHIN 30 DAYS OF THE DUE
10 DATE, THE AGREEMENT SHALL BE SUSPENDED FOR SERVICES FURNISHED
11 AFTER THE END OF THE 30-DAY PERIOD UNTIL THE DATE THE
12 INFORMATION IS REPORTED OR THE EXPIRATION OF 45 DAYS,
13 WHICHEVER IS LATER.
14 (2) A MANUFACTURER WHO KNOWINGLY SUPPLIES FALSE
15 INFORMATION THAT IS REQUIRED UNDER SUBSECTION (C)(1) SHALL BE
16 LIABLE FOR A CIVIL PENALTY IN THE AMOUNT OF $50,000 FOR EACH
17 ITEM OF FALSE INFORMATION.
18 (3) A DIRECT SELLER, MANUFACTURER OR WHOLESALER WHO
19 REFUSES A REQUEST FOR INFORMATION OR KNOWINGLY PROVIDES FALSE
20 INFORMATION THAT IS REQUIRED UNDER SUBSECTION (C)(2) SHALL BE
21 LIABLE FOR A CIVIL PENALTY IN THE AMOUNT OF $50,000.
22 (4) PENALTIES COLLECTED UNDER THIS SUBSECTION SHALL BE
23 DEPOSITED INTO THE FUND.
24 (5) ALL CIVIL MONETARY PENALTIES IMPOSED UNDER THIS
25 CHAPTER ARE IN ADDITION TO OTHER CIVIL OR CRIMINAL PENALTIES.
26 (E) CONFIDENTIALITY OF INFORMATION.--INFORMATION DISCLOSED
27 BY MANUFACTURERS, WHOLESALERS OR DIRECT SELLERS UNDER THIS
28 CHAPTER IS CONFIDENTIAL AND SHALL NOT BE DISCLOSED BY THE
29 DEPARTMENT IN A FORM WHICH DISCLOSES THE IDENTITY OF A SPECIFIC
30 MANUFACTURER, WHOLESALER OR DIRECT SELLER OR THE PRICES CHARGED
19950H0544B4238 - 50 -
1 FOR DRUGS BY THE MANUFACTURER OR WHOLESALER, EXCEPT AS THE
2 DEPARTMENT DETERMINES TO BE NECESSARY TO CARRY OUT THIS CHAPTER
3 AND TO PERMIT THE DEPARTMENT OF THE AUDITOR GENERAL AND THE
4 OFFICE OF STATE INSPECTOR GENERAL TO REVIEW THE INFORMATION
5 PROVIDED.
6 (F) LENGTH OF AGREEMENT.--A REBATE AGREEMENT SHALL REMAIN IN
7 EFFECT FOR AN INITIAL PERIOD OF NOT LESS THAN ONE YEAR AND SHALL
8 BE AUTOMATICALLY RENEWED FOR A PERIOD OF NOT LESS THAN ONE YEAR
9 UNLESS TERMINATED UNDER SUBSECTION (G).
10 (G) TERMINATION.--
11 (1) THE DEPARTMENT MAY PROVIDE FOR TERMINATION OF A
12 REBATE AGREEMENT FOR ANY REASON. TERMINATION SHALL NOT BE
13 EFFECTIVE EARLIER THAN 60 DAYS AFTER THE DATE OF RECEIPT OF
14 NOTICE OF TERMINATION BY THE MANUFACTURERS.
15 (2) A MANUFACTURER MAY TERMINATE A REBATE AGREEMENT FOR
16 ANY REASON. TERMINATION SHALL NOT BE EFFECTIVE EARLIER THAN
17 60 DAYS AFTER THE DATE OF RECEIPT OF NOTICE OF TERMINATION BY
18 THE DEPARTMENT.
19 (3) TERMINATION OF THE REBATE AGREEMENT SHALL NOT AFFECT
20 REBATES DUE UNDER THE AGREEMENT BEFORE THE EFFECTIVE DATE OF
21 TERMINATION.
22 (4) COMMONWEALTH COURT SHALL HAVE ORIGINAL JURISDICTION
23 OVER CASES OF TERMINATION OF AGREEMENTS UNDER THIS
24 SUBSECTION. COMMENCEMENT OF AN ACTION UNDER THIS PARAGRAPH
25 SHALL NOT DELAY THE EFFECTIVE DATE OF TERMINATION.
26 (5) IF A REBATE AGREEMENT IS TERMINATED FOR CAUSE,
27 ANOTHER AGREEMENT WITH THE SAME MANUFACTURER OR A SUCCESSOR
28 MANUFACTURER MAY NOT BE ENTERED INTO UNTIL A PERIOD OF ONE
29 YEAR HAS ELAPSED FROM THE DATE OF THE TERMINATION UNLESS THE
30 DEPARTMENT FINDS GOOD CAUSE FOR AN EARLIER AGREEMENT.
19950H0544B4238 - 51 -
1 SECTION 705. AMOUNT OF REBATE.
2 (A) SINGLE-SOURCE DRUGS AND INNOVATOR MULTIPLE-SOURCE
3 DRUGS.--WITH RESPECT TO SINGLE-SOURCE DRUGS AND INNOVATOR
4 MULTIPLE-SOURCE DRUGS, EACH MANUFACTURER SHALL REMIT A REBATE TO
5 THE COMMONWEALTH. EXCEPT AS OTHERWISE PROVIDED IN THIS SECTION,
6 THE AMOUNT OF THE REBATE TO THE COMMONWEALTH PER CALENDAR
7 QUARTER WITH RESPECT TO EACH DOSAGE FORM AND STRENGTH OF SINGLE-
8 SOURCE DRUGS AND INNOVATOR MULTIPLE-SOURCE DRUGS SHALL BE AS
9 FOLLOWS:
10 (1) FOR QUARTERS BEGINNING AFTER SEPTEMBER 30, 1992, AND
11 ENDING BEFORE JANUARY 1, 1997, THE PRODUCT OF THE TOTAL
12 NUMBER OF UNITS OF EACH DOSAGE FORM AND STRENGTH REIMBURSED
13 BY PACE AND GENERAL ASSISTANCE IN THE QUARTER AND THE
14 DIFFERENCE BETWEEN THE AVERAGE MANUFACTURER PRICE AND 85% OF
15 THAT PRICE, AFTER DEDUCTING CUSTOMARY PROMPT PAYMENT
16 DISCOUNTS, FOR THE QUARTER.
17 (2) FOR QUARTERS BEGINNING AFTER DECEMBER 31, 1996, THE
18 PRODUCT OF THE TOTAL NUMBER OF UNITS OF EACH DOSAGE FORM AND
19 STRENGTH REIMBURSED BY PACE, PACENET AND DESIGNATED
20 PHARMACEUTICAL PROGRAMS IN THE QUARTER AND THE DIFFERENCE
21 BETWEEN THE AVERAGE MANUFACTURER PRICE AND 83% OF THAT PRICE,
22 AFTER DEDUCTING CUSTOMARY PROMPT PAYMENT DISCOUNTS.
23 (B) REBATE FOR OTHER DRUGS.--
24 (1) THE AMOUNT OF THE REBATE TO THE COMMONWEALTH FOR A
25 CALENDAR QUARTER WITH RESPECT TO COVERED PRESCRIPTION DRUGS
26 WHICH ARE NONINNOVATOR MULTIPLE-SOURCE DRUGS SHALL BE EQUAL
27 TO THE PRODUCT OF:
28 (I) THE APPLICABLE PERCENTAGE OF THE AVERAGE
29 MANUFACTURER PRICE, AFTER DEDUCTING CUSTOMARY PROMPT
30 PAYMENT DISCOUNTS, FOR EACH DOSAGE FORM AND STRENGTH OF
19950H0544B4238 - 52 -
1 SUCH DRUGS FOR THE QUARTER; AND
2 (II) THE NUMBER OF UNITS OF SUCH FORM AND DOSAGE
3 REIMBURSED BY PACE AND GENERAL ASSISTANCE IN THE QUARTER.
4 (2) FOR THE PURPOSES OF PARAGRAPH (1), THE APPLICABLE
5 PERCENTAGE FOR CALENDAR QUARTERS BEGINNING AFTER SEPTEMBER
6 30, 1992, AND ENDING BEFORE JANUARY 1, 1997, IS 11%.
7 (C) REVISED REBATE FOR OTHER DRUGS.--BEGINNING AFTER
8 DECEMBER 31, 1996:
9 (1) THE AMOUNT OF THE REBATE TO THE COMMONWEALTH FOR A
10 CALENDAR QUARTER WITH RESPECT TO COVERED PRESCRIPTION DRUGS
11 WHICH ARE NONINNOVATOR MULTIPLE-SOURCE DRUGS SHALL BE THE
12 GREATER OF THE PRODUCT OF:
13 (I) THE APPLICABLE PERCENTAGE OF THE AVERAGE
14 MANUFACTURER PRICE, AFTER DEDUCTING CUSTOMARY PROMPT
15 PAYMENT DISCOUNTS, FOR EACH DOSAGE FORM AND STRENGTH OF
16 SUCH DRUGS FOR THE QUARTER; AND
17 (II) THE NUMBER OF UNITS OF SUCH FORM AND DOSAGE
18 REIMBURSED BY PACE, PACENET AND DESIGNATED PHARMACEUTICAL
19 PROGRAMS IN THE QUARTER.
20 (2) FOR PURPOSES OF PARAGRAPH (1), THE APPLICABLE
21 PERCENTAGE IS 17%.
22 (D) DRUGS APPROVED AFTER ACT TAKES EFFECT.--IN THE CASE OF A
23 COVERED OUTPATIENT DRUG APPROVED FOR MARKETING AFTER THE
24 EFFECTIVE DATE OF THE ACT OF AUGUST 14, 1991 (P.L.342, NO.36),
25 KNOWN AS THE LOTTERY FUND PRESERVATION ACT, ANY REFERENCE TO
26 JANUARY 1, 1991, SHALL BE A REFERENCE TO THE FIRST DAY OF THE
27 FIRST MONTH DURING WHICH THE DRUG WAS MARKETED.
28 SECTION 706. EXCESSIVE PHARMACEUTICAL PRICE INFLATION DISCOUNT.
29 (A) GENERAL RULE.--A DISCOUNT SHALL BE PROVIDED TO THE
30 DEPARTMENT FOR ALL COVERED PRESCRIPTION DRUGS. THE DISCOUNT
19950H0544B4238 - 53 -
1 SHALL BE CALCULATED AS FOLLOWS:
2 (1) FOR EACH QUARTER FOR WHICH A REBATE UNDER SECTION
3 705(A) AND (B) IS TO BE PAID AFTER DECEMBER 31, 1991, AND
4 BEFORE JANUARY 1, 1997, THE AVERAGE MANUFACTURER PRICE FOR
5 EACH DOSAGE FORM AND STRENGTH OF A COVERED PRESCRIPTION DRUG
6 SHALL BE COMPARED TO THE AVERAGE MANUFACTURER PRICE FOR THE
7 SAME FORM AND STRENGTH IN THE PREVIOUS CALENDAR YEAR, AND A
8 PERCENTAGE INCREASE SHALL BE CALCULATED.
9 (2) FOR EACH QUARTER UNDER PARAGRAPH (1), THE AVERAGE
10 PERCENTAGE INCREASE IN THE PRODUCER PRICE INDEX FOR
11 PHARMACEUTICALS OVER THE SAME QUARTER IN THE PREVIOUS
12 CALENDAR YEAR SHALL BE CALCULATED.
13 (3) IF THE CALCULATION UNDER PARAGRAPH (1) IS GREATER
14 THAN THE CALCULATION UNDER PARAGRAPH (2), THE DISCOUNT AMOUNT
15 FOR EACH QUARTER SHALL BE EQUAL TO THE PRODUCT OF:
16 (I) THE DIFFERENCE BETWEEN THE CALCULATIONS UNDER
17 PARAGRAPHS (1) AND (2); AND
18 (II) THE TOTAL NUMBER OF UNITS OF EACH DOSAGE FORM
19 AND STRENGTH REIMBURSED BY PACE AND GENERAL ASSISTANCE
20 AND THE AVERAGE MANUFACTURER PRICE REPORTED BY THE
21 MANUFACTURER UNDER SECTION 704(C)(1).
22 (B) REVISED GENERAL RULE.--A DISCOUNT SHALL BE PROVIDED TO
23 THE DEPARTMENT FOR ALL COVERED PRESCRIPTION DRUGS. THE DISCOUNT
24 SHALL BE CALCULATED AS FOLLOWS:
25 (1) FOR EACH QUARTER FOR WHICH A REBATE UNDER SECTION
26 705(A) AND (C) IS TO BE PAID AFTER DECEMBER 31, 1996, THE
27 AVERAGE MANUFACTURER PRICE FOR EACH DOSAGE FORM AND STRENGTH
28 OF A COVERED PRESCRIPTION DRUG SHALL BE COMPARED TO THE
29 AVERAGE MANUFACTURER PRICE FOR THE SAME FORM AND STRENGTH IN
30 THE PREVIOUS CALENDAR YEAR AND A PERCENTAGE INCREASE SHALL BE
19950H0544B4238 - 54 -
1 CALCULATED.
2 (2) FOR EACH QUARTER UNDER PARAGRAPH (1), THE AVERAGE
3 PERCENTAGE INCREASE IN THE CONSUMER PRICE INDEX-URBAN OVER
4 THE SAME QUARTER IN THE PREVIOUS CALENDAR YEAR SHALL BE
5 CALCULATED.
6 (3) IF THE CALCULATION UNDER PARAGRAPH (1) IS GREATER
7 THAN THE CALCULATION UNDER PARAGRAPH (2), THE DISCOUNT AMOUNT
8 FOR EACH QUARTER SHALL BE EQUAL TO THE PRODUCT OF:
9 (I) THE DIFFERENCE BETWEEN THE CALCULATIONS UNDER
10 PARAGRAPHS (1) AND (2); AND
11 (II) THE TOTAL NUMBER OF UNITS OF EACH DOSAGE FORM
12 AND STRENGTH REIMBURSED BY PACE, PACENET AND DESIGNATED
13 PHARMACEUTICAL PROGRAMS AND THE AVERAGE MANUFACTURER
14 PRICE REPORTED BY THE MANUFACTURER UNDER SECTION
15 704(C)(1).
16 (C) NEW BI-MARKETED DRUGS.--FOR COVERED PRESCRIPTION DRUGS
17 THAT HAVE NOT BEEN MARKETED FOR A FULL CALENDAR YEAR, SUBSECTION
18 (A) SHALL APPLY AFTER THE COVERED PRESCRIPTION DRUG HAS BEEN ON
19 THE MARKET FOR FOUR CONSECUTIVE QUARTERS. THE DRUG'S INITIAL
20 AVERAGE MANUFACTURER PRICE SHALL BE BASED ON THE FIRST DAY OF
21 THE FIRST QUARTER THAT THE DRUG WAS MARKETED.
22 SECTION 707. LOWERED BEST PRICE.
23 (A) GENERAL RULE.--IF THE REBATE UNDER SECTION 705 AND THE
24 DISCOUNT UNDER SECTION 706 WOULD ESTABLISH A LOWERED FEDERAL
25 BEST PRICE, AS DEFINED IN SECTION 1927(C)(1)(C) OF THE SOCIAL
26 SECURITY ACT (PUBLIC LAW 74-271, 42 U.S.C. § 1396R-8(C)(1)(C)),
27 THE MANUFACTURER SHALL BE LIABLE FOR A TOTAL REBATE AND DISCOUNT
28 IN AN AMOUNT THAT DOES NOT REDUCE THE FEDERAL BEST PRICE FOR
29 THAT COVERED PRESCRIPTION DRUG.
30 (B) PROCEDURE.--ANY CLAIM BY A MANUFACTURER THAT A REBATE
19950H0544B4238 - 55 -
1 WOULD ESTABLISH A LOWER FEDERAL BEST PRICE UNDER SUBSECTION (A)
2 SHALL BE VERIFIED IN WRITING BY A DEPARTMENT-APPROVED
3 INDEPENDENT PUBLIC ACCOUNTING FIRM WITHIN 45 DAYS OF THE END OF
4 THE QUARTER FOR WHICH THE CLAIM IS ASSERTED. THE INFORMATION
5 PROVIDED TO THE PUBLIC ACCOUNTING FIRM SHALL REMAIN
6 CONFIDENTIAL.
7 (C) CIVIL PENALTY.--A MANUFACTURER WHICH PROVIDES FALSE
8 INFORMATION UNDER THIS SECTION SHALL BE LIABLE FOR A CIVIL
9 PENALTY IN AN AMOUNT NOT TO EXCEED $50,000. EACH ITEM OF FALSE
10 INFORMATION CONSTITUTES A SEPARATE VIOLATION.
11 SECTION 708. EXEMPTION.
12 SECTION 521(A) SHALL NOT APPLY TO REBATES UNDER THIS CHAPTER.
13 SECTION 709. DISPOSITION OF FUNDS.
14 (A) PACE AND PACENET.--MONEY RECEIVED UNDER THIS CHAPTER IN
15 CONNECTION WITH PACE AND PACENET SHALL BE DEPOSITED IN THE
16 PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY FUND.
17 (B) DESIGNATED PHARMACEUTICAL PROGRAMS.--MONEY RECEIVED
18 UNDER THIS CHAPTER IN CONNECTION WITH DESIGNATED PHARMACEUTICAL
19 PROGRAMS SHALL BE TREATED AS A REFUND OF EXPENDITURES TO THE
20 APPROPRIATION WHICH ORIGINALLY PROVIDED THE FUNDING FOR THE
21 PHARMACEUTICAL PURCHASE.
22 CHAPTER 9
23 TRANSPORTATION SERVICES
24 SECTION 901. DEFINITIONS.
25 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
26 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
27 CONTEXT CLEARLY INDICATES OTHERWISE:
28 "SHARED-RIDE PUBLIC TRANSPORTATION SERVICES." DEMAND-
29 RESPONSIVE TRANSPORTATION THAT IS AVAILABLE TO THE GENERAL
30 PUBLIC, OPERATES ON A NONFIXED ROUTE BASIS AND CHARGES A FARE TO
19950H0544B4238 - 56 -
1 ALL RIDERS. FOR TRANSPORTATION TO BE INCLUDED IN THIS
2 DEFINITION, THE FIRST FARE PAYING PASSENGERS TO ENTER THE PUBLIC
3 TRANSPORTATION VEHICLE MUST NOT REFUSE TO SHARE THE VEHICLE WITH
4 OTHER PASSENGERS DURING A GIVEN TRIP. THE TERM EXCLUDES
5 EXCLUSIVE RIDE TAXI SERVICE, CHARTER AND SIGHTSEEING SERVICES,
6 NONPUBLIC TRANSPORTATION, SCHOOL BUS AND LIMOUSINE SERVICES.
7 SECTION 902. DEPARTMENT OF TRANSPORTATION.
8 THE DEPARTMENT OF TRANSPORTATION HAS THE POWER AND DUTY TO
9 MAKE GRANTS FROM THE FUND TO TRANSPORTATION COMPANIES, COUNTY
10 TRANSPORTATION SYSTEMS AND LOCAL TRANSPORTATION ORGANIZATIONS TO
11 PAY ESTIMATED TRANSIT LOSSES RESULTING FROM PROVIDING FREE
12 SERVICE OR LOCAL COMMON CARRIER MASS TRANSPORTATION SYSTEMS TO
13 PERSONS 65 YEARS OF AGE OR OLDER WHEN PASSAGE IS ON FIXED ROUTE
14 PUBLIC TRANSPORTATION SERVICES DURING NONPEAK RIDING HOURS AND
15 ON HOLIDAYS AND WEEKENDS. REIMBURSEMENT SHALL BE AS FOLLOWS:
16 (1) THE LOSSES RESULTING FROM GRANTING SERVICE ON MASS
17 TRANSPORTATION SYSTEMS SHALL BE REIMBURSABLE AT 100% OF THE
18 SYSTEM'S AVERAGE OR BASE FARE, WHICHEVER IS LESS, MULTIPLIED
19 BY THE NUMBER OF TRIPS MADE BY SENIOR CITIZENS PARTICIPATING
20 IN THE FREE TRANSIT PROGRAM.
21 (2) NOTWITHSTANDING PARAGRAPH (1), THE DEPARTMENT SHALL,
22 WITH THE APPROVAL OF THE GOVERNOR'S OFFICE OF THE BUDGET,
23 REIMBURSE TRANSPORTATION COMPANIES OR LOCAL TRANSPORTATION
24 ORGANIZATIONS FOR 100% OF THE LOSSES RESULTING FROM SENIOR
25 CITIZEN TRANSFER TRIPS INCURRED UNDER THE CONDITIONS OF THIS
26 SUBSECTION.
27 (3) MONEY APPROPRIATED FROM THE GENERAL FUND TO THE
28 DEPARTMENT OF TRANSPORTATION TO AUGMENT FIXED ROUTE PUBLIC
29 TRANSPORTATION SERVICES UNDER THIS SECTION SHALL BE GRANTED
30 TO TRANSPORTATION PROVIDERS AT THE DISCRETION OF THE
19950H0544B4238 - 57 -
1 DEPARTMENT OF TRANSPORTATION.
2 SECTION 903. COMMUTER RAIL FARE.
3 WITH REGARD TO PASSAGE ON FIXED-ROUTE COMMUTER RAIL LINES,
4 THE FARE FOR ADULTS 65 YEARS OF AGE OR OLDER WHO DO NOT QUALIFY
5 AS ELIGIBLE CLAIMANTS UNDER THE PHARMACEUTICAL ASSISTANCE
6 CONTRACT FOR THE ELDERLY PROGRAM SHALL BE LIMITED TO $1 PER TRIP
7 BUT ONLY WHEN UTILIZING SUCH TRANSPORTATION SERVICES DURING
8 NONPEAK RIDING HOURS AND ON HOLIDAYS AND WEEKENDS.
9 SECTION 904. SHARED-RIDE TRANSPORTATION.
10 (A) PROGRAM GRANTS.--THE DEPARTMENT OF TRANSPORTATION HAS
11 THE POWER AND DUTY TO ADMINISTER, UTILIZING A FIXED AMOUNT OF
12 MONEY FROM THE FUND AS PROVIDED THROUGH EXECUTIVE AUTHORIZATIONS
13 BY THE GOVERNOR, A PROGRAM PROVIDING SHARED-RIDE PUBLIC
14 TRANSPORTATION SERVICES FOR ADULTS 65 YEARS OF AGE OR OLDER.
15 INDIVIDUALS UTILIZING SHARED-RIDE PUBLIC TRANSPORTATION SERVICES
16 FOR OLDER ADULTS SHALL CONTRIBUTE 15% OF THE INDIVIDUAL FARE AND
17 85% OF THE INDIVIDUAL FARE SHALL BE REIMBURSED BY THE FUND.
18 (B) REGULATIONS.--THE DEPARTMENT OF TRANSPORTATION SHALL
19 PROMULGATE REGULATIONS NECESSARY TO CARRY OUT THE PURPOSES OF
20 THIS SECTION, INCLUDING REGULATIONS THAT PERMIT LIMITED
21 REIMBURSEMENT FOR SHARED-RIDE PUBLIC TRANSPORTATION SERVICES
22 PROVIDING ACCESS TO AND FROM PUBLIC AIRPORTS. THE DEPARTMENT OF
23 TRANSPORTATION, IN CONSULTATION WITH THE PENNSYLVANIA PUBLIC
24 UTILITY COMMISSION AND THE DEPARTMENT, SHALL ESTABLISH
25 REASONABLE PER MILE OR TRIP FARE LIMITS FOR PURPOSES OF
26 SUBSECTION (A). IN ACCORDANCE WITH SECTION 2203-A(A)(27) OF THE
27 ACT OF APRIL 9, 1929 (P.L.177, NO.175), KNOWN AS THE
28 ADMINISTRATIVE CODE OF 1929, NO REGULATION SHALL TAKE EFFECT
29 UNTIL SUBMITTED TO THE DEPARTMENT FOR COMMENT.
30 (C) COORDINATED TRANSPORTATION PLANS.--THE DEPARTMENT OF
19950H0544B4238 - 58 -
1 TRANSPORTATION SHALL REQUIRE THAT EACH TRANSPORTATION PROVIDER
2 OR DESIGNATED COORDINATOR, WHICHEVER IS APPROPRIATE, ANNUALLY
3 DEVELOP A COORDINATED TRANSPORTATION PLAN WHICH SHALL INCLUDE,
4 BUT NOT BE LIMITED TO, ANY CURRENT FIXED-ROUTE SYSTEM AND
5 SHARED-RIDE PROGRAMS. ALL PLANS MUST BE SUBMITTED TO AND
6 APPROVED BY THE DEPARTMENT NO LATER THAN JUNE 1 OF EACH FISCAL
7 YEAR.
8 (D) OTHER FORMS OF ASSISTANCE.--ANY ELIGIBLE CLAIMANT WHOSE
9 TRANSPORTATION SERVICES ARE COVERED IN PART BY ANY OTHER PLAN OF
10 ASSISTANCE MAY BE REQUIRED TO RECEIVE REDUCED TRANSPORTATION
11 ASSISTANCE UNDER THE PROVISIONS OF THIS CHAPTER.
12 (E) ENTITLEMENT NOT CREATED.--NOTHING IN THIS CHAPTER
13 CREATES OR PROVIDES ANY INDIVIDUAL WITH AN ENTITLEMENT TO
14 SERVICES.
15 SECTION 905. GRANTS.
16 GRANTS MAY BE MADE UNDER THIS CHAPTER WITH REFERENCE TO ANY
17 APPROPRIATE PROJECT, IRRESPECTIVE OF WHEN IT WAS FIRST COMMENCED
18 OR CONSIDERED AND REGARDLESS OF WHETHER COSTS WITH RESPECT TO
19 THE PROJECT HAVE BEEN INCURRED PRIOR TO THE TIME THE GRANT IS
20 APPLIED FOR OR MADE.
21 CHAPTER 21
22 MISCELLANEOUS PROVISIONS
23 SECTION 2101. SAVINGS.
24 THIS ACT DOES NOT AFFECT ANY ACT DONE, REGULATION
25 PROMULGATED, LIABILITY INCURRED OR RIGHT ACCRUED OR VESTED OR
26 AFFECT ANY CIVIL OR CRIMINAL PROCEEDING PENDING OR TO BE
27 COMMENCED TO ENFORCE ANY RIGHT OR PENALTY OR PUNISH ANY OFFENSE
28 UNDER ANY STATUTE OR PART OF A STATUTE REPEALED BY THIS ACT.
29 SECTION 2102. ANNUAL REPORT TO GENERAL ASSEMBLY.
30 (A) SUBMISSION OF REPORT.--THE DEPARTMENT SHALL SUBMIT A
19950H0544B4238 - 59 -
1 REPORT NO LATER THAN APRIL 1 OF EACH YEAR TO THE CHAIRMAN AND
2 MINORITY CHAIRMAN OF THE AGING AND YOUTH COMMITTEE OF THE
3 SENATE, THE CHAIRMAN AND MINORITY CHAIRMAN OF THE AGING AND
4 YOUTH COMMITTEE OF THE HOUSE OF REPRESENTATIVES AND THE
5 PHARMACEUTICAL ASSISTANCE REVIEW BOARD.
6 (B) COLLECTION OF DATA.--THE DEPARTMENT SHALL MAINTAIN
7 MONTHLY STATISTICAL RECORDS ON PACE AND PACENET, INCLUDING THE
8 LEVEL OF PARTICIPATION AND ANY PATTERNS OF UNUSUAL DRUG USAGE
9 FOR PURPOSES OF FORMULATING THE ANNUAL REPORT.
10 (C) INFORMATION FOR INCLUSION IN ANNUAL REPORT.--THE ANNUAL
11 REPORT SHALL CONTAIN, BUT NOT BE LIMITED TO, ALL INFORMATION
12 RELATING TO:
13 (1) THE NUMBER OF PERSONS SERVED BY PACE AND PACENET AND
14 THEIR COUNTIES OF RESIDENCE.
15 (2) A BREAKDOWN OF THE NUMBERS AND KINDS OF
16 PHARMACEUTICALS USED.
17 (3) THE COST OF PRESCRIPTIONS.
18 (4) AN ESTIMATE OF ACTUAL EXPENSES INCURRED BY
19 PHARMACISTS PARTICIPATING IN THE PROGRAM.
20 (5) THE RESULTS OBTAINED BY THE DRUG EDUCATION PROGRAM
21 UNDER SECTION 522.
22 (6) INFORMATION REGARDING THE OPERATION OF THE
23 THERAPEUTIC DRUG UTILIZATION REVIEW SYSTEM FOR THE PRIOR
24 CALENDAR YEAR, WHICH SHALL INCLUDE, AT A MINIMUM:
25 (I) THE SCOPE OF PHYSICIAN AND PHARMACIST
26 PARTICIPATION IN THE SYSTEM.
27 (II) A DESCRIPTION OF CLAIMANT RESPONSE TO THE
28 SYSTEM.
29 (III) DATA FOR EACH MONTH OF THE COVERED PERIOD
30 REGARDING THE NUMBER OF PRESCRIPTION REVISIONS BASED ON
19950H0544B4238 - 60 -
1 UTILIZATION REVIEW, INCLUDING DRUG INFORMATION, COST
2 SAVINGS AND THE POLICY USED BY THE DEPARTMENT TO MAKE
3 UTILIZATION REVIEW DECISIONS.
4 (7) INFORMATION ON THE EXISTENCE AND SCOPE OF FRAUDULENT
5 ACTIVITY AND VIOLATIONS OF THIS ACT BY PROVIDERS
6 PARTICIPATING IN PACE AND PACENET.
7 (8) INFORMATION REGARDING THE FINANCIAL STATUS OF PACE
8 AND PACENET, INCLUDING, BUT NOT LIMITED TO, THE ADEQUACY OF
9 ANY APPLICABLE DEDUCTIBLE AND COPAYMENT LEVELS, BASED UPON
10 THE FINANCIAL EXPERIENCE AND PROJECTIONS OF PACE AND PACENET.
11 SECTION 3. THE PROVISIONS OF THIS ACT ARE SEVERABLE. IF ANY
12 PROVISION OF THIS ACT OR ITS APPLICATION TO ANY PERSON OR
13 CIRCUMSTANCE IS HELD INVALID, THE INVALIDITY SHALL NOT AFFECT
14 OTHER PROVISIONS OR APPLICATIONS OF THIS ACT WHICH CAN BE GIVEN
15 EFFECT WITHOUT THE INVALID PROVISION OR APPLICATION.
16 SECTION 4. (A) THE ACT OF AUGUST 14, 1991 (P.L.342, NO.36),
17 KNOWN AS THE LOTTERY FUND PRESERVATION ACT, IS REPEALED.
18 (B) ALL OTHER ACTS AND PARTS OF ACTS ARE REPEALED INSOFAR AS
19 THEY ARE INCONSISTENT WITH THIS ACT.
20 SECTION 5. THIS ACT SHALL TAKE EFFECT AS FOLLOWS:
21 (1) THE AMENDMENT OR ADDITION OF SECTIONS 303 AND 306 OF
22 THE ACT SHALL TAKE EFFECT IN 60 DAYS.
23 (2) THE REMAINDER OF THIS ACT SHALL TAKE EFFECT
24 IMMEDIATELY.
L30L72JLW/19950H0544B4238 - 61 -