PRINTER'S NO. 756
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
668
Session of
2021
INTRODUCED BY J. WARD, COLLETT, HUGHES, GORDNER, MENSCH,
STEFANO, COSTA, FONTANA, KANE, PITTMAN, YUDICHAK, COMITTA AND
BAKER, MAY 11, 2021
REFERRED TO AGING AND YOUTH, MAY 11, 2021
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 the Pharmaceutical Assistance Contract for the
Elderly Needs Enhancement Tier, for powers of the department
and for coordination of benefits.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Sections 519, 533 and 534 of the act of August
26, 1971 (P.L.351, No.91), known as the State Lottery Law, are
amended to read:
Section 519. The Pharmaceutical Assistance Contract for the
Elderly Needs Enhancement Tier.
(a) Establishment.--There is hereby established within the
department a program to be known as the Pharmaceutical
Assistance Contract for the Elderly Needs Enhancement Tier
(PACENET).
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(b) PACENET eligibility.--A person with an annual income of
not less than $14,500 and not more than [$27,500] $33,500 in the
case of a single person and of not less than $17,700 and not
more than [$35,500] $41,500 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 50ยข is eliminated.
[(c.1) Premium.--In those instances in which a PACENET
claimant is not enrolled in Part D pursuant to section 533, the
claimant shall be required to pay a monthly premium equivalent
to the regional benchmark premium.]
(d) Copayment.--
(1) For claimants under this section, the copayment
schedule shall be:
(i) eight dollars for noninnovator multiple source
drugs as defined in section 702; or
(ii) fifteen dollars for single-source drugs and
innovator multiple-source drugs as defined in section
702.
(2) The department shall annually calculate the
copayment schedules based on the Prescription Drugs and
Medical Supplies Consumer Price Index. When the aggregate
impact of the Prescription Drugs and Medical Supplies
Consumer Price Index equals or exceeds $1, the department
shall adjust the copayment schedules. Each copayment schedule
shall not be increased by more than $1 in a calendar year.
Section 533. Powers of the department.
The department shall:
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(1) Identify the Part D plan or plans with which the
department has entered into a contract under section 534 that
meet the prescription drug needs and pharmacy preferences of
a claimant.
(2) [Recommend] Have the discretion to require that the
claimant enroll in the Part D plan or program that meets the
prescription drug needs and pharmacy preferences of the
claimant in the most cost-effective manner for the
Commonwealth.
(3) Initiate enrollment on behalf of the claimant in the
Part D plan recommended by the department unless the claimant
notifies the department that the claimant wishes to enroll in
another Part D plan.
(4) File and pursue appeals in accordance with CMS
regulations with a claimant's Part D plan on the claimant's
behalf to request exceptions to the plan's tiered cost-
sharing structure or to request a nonformulary Part D drug.
(5) Assist claimants the department believes to be
eligible for the LIS in making an application to the Social
Security Administration.
(6) Provide at least ten days for the claimant to
decline enrollment in the recommended plan.
(7) Develop and distribute language, when recommending
enrollment, notifying claimants of:
(i) The ability to decline enrollment in the
recommended Part D plan.
(ii) The ability to file and pursue appeals to the
recommended Part D plan on their own behalf.
(iii) The possibility that their choice of plan may
affect their medical coverage if they are enrolled in a
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Medicare advantage plan, if applicable.
Section 534. Coordination of benefits.
(a) General coordination.--In addition to the specific
provisions of subsection (b), the department shall establish
standards and minimum requirements it deems necessary to allow
for the coordination of benefits between the program and Part D.
(b) Specific coordination provisions.--The following
provisions shall apply to claimants who are also Part D
enrollees:
(1) The primary payor shall be the PDP or the Medicare
Advantage Prescription Drug Plan, as appropriate.
(2) Part D enrollees shall be required to utilize
providers authorized by their PDPs or Medicare Advantage
Prescription Drug Plans.
(3) The program shall pay the premium assessed by a PACE
or PACENET enrollee's PDP or, with respect to the
prescription drug plan, Medicare Advantage Prescription Drug
Plan in an amount not to exceed the regional benchmark
premium and any copayments in excess of those set forth in
section 509.
[(4) Part D enrollees enrolled in PACENET shall pay the
Part D premiums charged by their PDP or, with respect to the
prescription drug plan, Medicare Advantage Prescription Drug
Plan and the program shall pay any copayments in excess of
those set forth in section 519.]
(5) For Part D enrollees enrolled in PACE who are not
eligible for LIS, PACE shall reimburse Part D providers for
prescription drugs in any noncoverage phase of Part D. For
Part D enrollees enrolled in PACENET, PACENET shall reimburse
Part D providers for prescription drugs in any noncoverage
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phase of Part D.
(6) The provisions of Chapter 7 shall apply to all
payments made by the program in the noncoverage phase.
(7) The department shall advise a claimant on the
various benefits and drugs provided by each PDP approved by
the department as follows:
(i) Analyze the claimant's eligibility for and
assist the claimant in applying for LIS.
(ii) Identify the claimant's prescription drug needs
and preferred pharmacy.
(iii) Assist the claimant in enrolling in the PDP
that best fits the claimant's prescription drug needs.
(iv) File and pursue appeals in accordance with CMS
regulations with a claimant's Part D plan on the
claimant's behalf to request exceptions to the plan's
tiered cost-sharing structure or to request a
nonformulary Part D drug.
(8) Notwithstanding the provisions of sections 511 and
513(a), for purposes of coordination of benefits with
Medicare Part D plans and to minimize disruption to
enrollees, the program shall be authorized to reimburse Part
D providers, including mail-order pharmacies, for more than a
30-day supply of prescription drugs.
(c) Contracts.--The department is authorized to enter into
contracts with Part D plans to provide for prescription drugs to
Part D enrollees through Part D pursuant to this subchapter. A
Part D plan selected by the department shall meet all of the
following requirements:
(1) The Part D plan has a retail pharmacy network that
includes at least 90% of the pharmacies in the PACE network.
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(2) The Part D plan has a premium at or below the
regional benchmark premium.
(c.1) Authorization.--The department may pay the LEP of Part
D enrollees in excess of the regional benchmark premium.
(d) Rebates.--The department may only receive rebates as
provided in Chapter 7 where the program is the only payor for a
Part D enrollee's covered prescription drugs.
Section 2. This act shall take effect in 60 days.
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