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CORRECTIVE REPRINT
PRIOR PRINTER'S NOS. 949, 4210
PRINTER'S NO. 4245
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
270
Session of
2017
INTRODUCED BY FARRY, SAMUELSON, BAKER, STAATS, WATSON, MILLARD,
DRISCOLL, FREEMAN, MATZIE, PICKETT, LONGIETTI, SOLOMON,
DAVIS, BULLOCK, SCHLOSSBERG, KAVULICH, KINSEY, A. HARRIS,
IRVIN, NEILSON, GALLOWAY, D. COSTA, MULLERY, KAUFER, SIMS,
WARD, DONATUCCI, THOMAS, NELSON, PASHINSKI, MADDEN, McCARTER,
W. KELLER, TOOHIL, GODSHALL, RAVENSTAHL, MASSER, ROZZI,
McNEILL, SANTORA, DALEY, COMITTA, KORTZ, BARBIN, DUSH,
McCLINTON, CEPHAS AND C. QUINN, MARCH 16, 2017
AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES,
OCTOBER 10, 2018
AN ACT
Amending the act of August 26, 1971 (P.L.351, No.91), entitled
"An act providing for a State Lottery and administration
thereof; authorizing the creation of a State Lottery
Commission; prescribing its powers and duties; disposition of
funds; violations and penalties therefor; exemption of prizes
from State and local taxation and making an appropriation,"
in pharmaceutical assistance for the elderly, further
providing for definitions, providing for medication
synchronization, further providing for the Pharmaceutical
Assistance Contract for the Elderly Needs Enhancement Tier
and for board and, providing for medication therapy
management AND FURTHER PROVIDING FOR COORDINATION OF
BENEFITS.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The definition of "board" in section 502 of the
act of August 26, 1971 (P.L.351, No.91), known as the State
Lottery Law, is amended and the section is amended by adding a
definition DEFINITIONS to read:
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Section 502. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
* * *
"Board." The Pharmaceutical Assistance [Review] Advisory
Board.
* * *
"LEP" OR "LATE ENROLLMENT PENALTY." THE AMOUNT ADDED TO THE
PART D PLAN PREMIUM OF EITHER:
(1) AN INDIVIDUAL WHO DID NOT OBTAIN CREDITABLE
PRESCRIPTION DRUG COVERAGE AS DEFINED UNDER 42 CFR § 423.56
(RELATING TO PROCEDURES TO DETERMINE AND DOCUMENT CREDITABLE
STATUS OF PRESCRIPTION DRUG COVERAGE) WHEN THE INDIVIDUAL WAS
FIRST ELIGIBLE FOR PART D; OR
(2) AN INDIVIDUAL WHO HAD A BREAK IN CREDITABLE
PRESCRIPTION DRUG COVERAGE OF AT LEAST 63 CONSECUTIVE DAYS.
THE LEP IS CONSIDERED A PART OF THE PLAN PREMIUM.
* * *
"MAINTENANCE MEDICATION." A MEDICATION PRESCRIBED FOR A
CHRONIC, LONG-TERM CONDITION AND TAKEN ON A REGULAR, RECURRING
BASIS.
"Medication synchronization." The coordination of
prescription drug filling or refilling by a pharmacy or
dispensing physician for a program participant taking two or
more medications for the purpose of improving medication
adherence.
* * *
Section 2. The act is amended by adding a section to read:
Section 515.1. Medication synchronization.
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(a) Prorated daily cost-sharing rate FEES .--The program
shall permit and apply a prorated daily cost-sharing rate FEE to
prescription drugs that are dispensed by a pharmacy for less
than a 30 days' supply if the pharmacist or prescriber
determines the fill or refill to be in the best interest of the
program participant and the program participant requests or
agrees to less than a 30 days' supply for the purpose of
medication synchronization. THE PROGRAM MAY NOT USE PAYMENT
STRUCTURES INCORPORATING PRORATED DISPENSING FEES.
(B) FULL PAYMENT.--DISPENSING FEES FOR A PARTIAL SUPPLY OR
REFILLED PRESCRIPTION SHALL BE PAID IN FULL FOR EACH MAINTENANCE
MEDICATION DISPENSED, REGARDLESS OF ANY PRORATED COPAY FOR THE
BENEFICIARY OR FEE PAID FOR ALIGNMENT SERVICES.
(C) PARTIAL SUPPLY.--THE PROGRAM MAY NOT DENY COVERAGE FOR
THE DISPENSING OF A MAINTENANCE MEDICATION THAT IS DISPENSED BY
A NETWORK PHARMACY ON THE BASIS THAT THE DISPENSING IS FOR A
PARTIAL SUPPLY IF THE PRESCRIBER OR PHARMACIST DETERMINES THE
FILL OR REFILL IS IN THE BEST INTEREST OF THE PATIENT AND THE
PATIENT REQUESTS OR AGREES TO A PARTIAL SUPPLY FOR THE PURPOSE
OF MEDICATION SYNCHRONIZATION.
(D) ANNUAL LIMITATION.--THE FILL OR REFILL UNDER THIS
SECTION SHALL BE LIMITED TO THREE TIMES A YEAR FOR EACH
MAINTENANCE MEDICATION FOR A COVERED INDIVIDUAL. FOR EACH
CLINICALLY NECESSARY SYNCHRONIZATION THEREAFTER, APPROVAL MAY BE
REQUIRED AT THE DISCRETION OF THE PROGRAM.
(b) (E) Override of denial codes.-- The SUBJECT TO SECTION
520(C.1), THE program shall allow a pharmacy to override any
denial codes indicating that a prescription drug is being
refilled too soon for the purposes of medication
synchronization . UTILIZING THE SUBMISSION CLARIFICATION AND
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MESSAGE CODES AS ADOPTED BY THE NATIONAL COUNCIL FOR
PRESCRIPTION DRUG PROGRAMS OR ALTERNATIVE CODES PROVIDED BY THE
PROGRAM.
(F) EXEMPTION.--THIS SECTION DOES NOT APPLY TO PRESCRIPTION
DRUGS THAT ARE EITHER:
(1) UNIT-OF-USE PACKAGING FOR WHICH MEDICATION
SYNCHRONIZATION IS NOT POSSIBLE; OR
(2) CONTROLLED SUBSTANCES CLASSIFIED IN SCHEDULE II
UNDER SECTION 4(2) OF THE ACT OF APRIL 14, 1972 (P.L.233,
NO.64), KNOWN AS THE CONTROLLED SUBSTANCE, DRUG, DEVICE AND
COSMETIC ACT.
Section 3. Sections 519(b) and 520 of the act are amended to
read:
Section 519. The Pharmaceutical Assistance Contract for the
Elderly Needs Enhancement Tier.
* * *
(b) PACENET eligibility.--A person with an annual income of
not less than $14,500 and not more than [$23,500] $31,000
$27,500 in the case of a single person and of not less than
$17,700 and not more than [$31,500] $41,000 $35,500 in the case
of the combined income of persons married to each other shall be
eligible for enhanced pharmaceutical assistance under this
section. A person may, in reporting income to the department,
round the amount of each source of income and the income total
to the nearest whole dollar, whereby any amount which is less
than 50¢ is eliminated.
* * *
Section 520. Board.
(a) Establishment.--The Pharmaceutical Assistance [Review]
Advisory Board is continued to ensure that the program is
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providing and continues to provide the assistance intended in a
fiscally responsible manner without excessively hampering the
pharmaceutical industry.
(b) Composition.--The board shall be comprised of the
following [eight] persons:
(1) The Secretary of Aging, who shall serve as its
chairman.
(2) The Secretary of Revenue.
(3) The Secretary of Health.
(4) [Five] Nine public members[, one appointed by the
President pro tempore of the Senate, one appointed by the
Minority Leader of the Senate, one appointed by the Speaker
of the House of Representatives, one appointed by the
Minority Leader of the House of Representatives and one
appointed by the Governor. Those appointed by the legislative
officers shall include two senior citizens who have not been
a part of the pharmaceutical industry to serve as consumer
advocates, one representative of the pharmaceutical industry
and one practicing Pennsylvania pharmacist. The individual
appointed by the Governor must be a physician. A public
member who misses two consecutive meetings without good cause
acceptable to the chairman shall be replaced by the
appointing authority.] appointed as follows:
(i) Four practicing Pennsylvania pharmacists whose
names are jointly submitted by the Pennsylvania
Pharmacists Association and the Pennsylvania Association
of Chain Drug Stores and then appointed by the following:
(A) One member appointed by the President pro
tempore of the Senate.
(B) One member appointed by the Minority Leader
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of the Senate.
(C) One member appointed by the Speaker of the
House of Representatives.
(D) One member appointed by the Minority Leader
of the House of Representatives.
(ii) Five individuals appointed by the Governor that
include the following:
(A) One representative from the pharmaceutical
industry.
(B) Four senior citizens who have not been a
part of the pharmaceutical industry, two of whom may
be senior advocates.
(5) Should a board vacancy not be filled by the
appointing authority within 60 days, the power to appoint an
individual to the vacancy shall be given to the Secretary of
Aging.
(c) Review.--Using the annual report submitted by the
department pursuant to section 2102 and other appropriate data
sources, the board shall conduct an annual review. The board
shall develop recommendations concerning any changes in the
level of copayment[,] OR deductible [or in the level of fees
paid to participating pharmacists]. The board shall review the
department's therapeutic drug utilization review program on an
ongoing basis. The board may also recommend other changes in the
structure of the program and direct the department to enter into
discussions with the private contractor concerning amendments to
the contract, or the department may enter into such discussion
if it deems necessary. The copayment or deductible schedule
shall only be adjusted on an annual basis.
(c.1) Powers and duties.--The board shall advise on the
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following:
(1) The development and implementation of the department
proposals for medication synchronization and medication
therapy management programs and reimbursement methodologies.
(2) Adjustment of the dispensing fee, as needed.
(3) Cost-of-living adjustment increases for medication
synchronization, medication therapy management and the
dispensing fee.
(d) Meetings.--The board shall meet at least two times per
year and not more than four times per year.
Section 4. The act is amended by adding a section to read:
Section 522.1. Medication therapy management.
PACE shall, in consultation with the board, develop a
proposal for a medication therapy management program by using
retail community pharmacies enrolled in the program. PACE, in
consultation with the board, shall submit the proposal to the
General Assembly no later than one year SIX MONTHS after the
effective date of this section.
SECTION 5. SECTION 534 OF THE ACT IS AMENDED BY ADDING A
SUBSECTION TO READ:
SECTION 534. COORDINATION OF BENEFITS.
* * *
(C.1) AUTHORIZATION.--THE DEPARTMENT MAY PAY THE LEP OF PART
D ENROLLEES IN EXCESS OF THE REGIONAL BENCHMARK PREMIUM.
* * *
Section 5 6. This act shall take effect immediately.
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