ASSEMBLY, No. 2529

 

STATE OF NEW JERSEY

 

210th LEGISLATURE

 

INTRODUCED JUNE 17, 2002

 

 

Sponsored by:

Assemblywoman ROSE MARIE HECK

District 38 (Bergen)

 

 

 

 

SYNOPSIS

    Changes the copayment for PAAD when more than two prescription drugs are purchased during any given month and increases the income eligibility limits for the PAAD program.

 

CURRENT VERSION OF TEXT

    As introduced.

 


An Act concerning the "Pharmaceutical Assistance to the Aged and Disabled" program, amending and supplementing P.L.1975, c.194 and amending P.L.1979, c.27.

 

    Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

    1. Section 3 of P.L.1975, c.194 (C.30:4D-22) is amended to read as follows:

    3. The program of "Pharmaceutical Assistance to the Aged and Disabled" shall consist of payments to pharmacies for the reasonable cost of prescription drugs of eligible persons which exceed a[$2.00] copayment as provided in this section. [Said] The copayment shall be paid in full by each eligible person to the pharmacist at the time of each purchase of prescription drugs, and shall not be waived, discounted or rebated in whole or in part.

    The commissioner may restrict the day supply of initial prescriptions to less than a 30 day supply in order to reduce waste and reduce inappropriate drug utilization. Subsequently, the commissioner may limit prescription drugs used in the treatment of acute care medical conditions to an amount not to exceed a 30 day supply. The commissioner may allow up to a 60 day supply or 100 unit doses, whichever is greater, of prescription drugs used in the treatment of chronic maintenance conditions.

    Whenever any interchangeable drug product contained in the latest list approved and published by the Drug Utilization Review Council is available for the prescription written, an eligible person shall either:

    (1) Purchase an interchangeable drug product which is equal to or less than the maximum allowable cost, at the[$2.00] designated copayment; or

    (2) Purchase the prescribed drug product which is higher in cost than the maximum allowable cost and pay the difference between the two, in addition to the[$2.00] copayment, unless the prescriber specifically indicates that substitution is not permissible, in which case an eligible person may purchase the prescribed drug product at the[$2.00] designated copayment.

    An eligible person shall pay a $5.00 copayment for each of the first two prescription drugs purchased in any given month, and then a $2.00 copayment for any additional prescriptions purchased during that month.

    For purposes of this act:

    a. "Prescription drugs" means all legend drugs, including any interchangeable drug products contained in the latest list approved and published by the Drug Utilization Review Council in conformance with the Provisions of the "Prescription Drug Price and Quality Stabilization Act," [(]P.L.1977, c.240[;](C.24:6E-1 et seq.), diabetic testing materials, and insulin, insulin syringes and insulin needles;

    b. "Reasonable cost" means the maximum allowable cost of prescription drugs and a dispensing fee, as determined by the commissioner. In the case of diabetic testing materials, the maximum allowable cost is the manufacturer's suggested retail selling price or the pharmacy's usual over-the-counter price charged to other persons in the community, whichever is less;

    c. "Resident" means one legally domiciled within the State for a period of 30 days immediately preceding the date of application for inclusion in the program. Mere seasonal or temporary residence within the State, of whatever duration, does not constitute domicile. Absence from this State for a period of 12 months is prima facie evidence of abandonment of domicile. The burden of establishing legal domicile within the State is upon the applicant;

    d. "Diabetic testing materials" means blood glucose reagent strips which can be visually read, urine monitoring strips, tapes and tablets and bloodletting devices and lancets, but shall not include electronically monitored devices.

(cf: P.L.1985, c.291, s.2)

 

    2. Section 1 of P.L.1979, c.27 (C.30:4D-34) is amended to read as follows:

    1. Any eligible person under the program of Pharmaceutical Assistance to the Aged and Disabled shall, upon the submission of such application and proof of expenditure as the department may prescribe, be reimbursed for the cost of all prescription drugs purchased by such person, minus [a $2.00] the copayment per prescription, during the period commencing 30 days after [such] the person's properly completed application was received by the department and ending on the date on which [such] the person received his proof of eligibility from the department; provided, however, that no reimbursement under this act shall be made for any prescription drug purchased prior to the effective date of this act.

(cf: P.L.1979, c.383, s.1)

 

    3. (New section) The Commissioner of Human Services shall direct the Division of Medical Assistance and Health Services in the Department of Human Services to conduct periodic reviews in order to affirm the residency of persons receiving benefits under the "Pharmaceutical Assistance to the Aged and Disabled" program (P.L.1975, c.194; C.30:4D-20 et seq.). To the greatest extent possible, these reviews shall be undertaken whenever a person is required to apply for a new identification card.

    4. This act shall take effect immediately.

 

 

STATEMENT

 

    This bill amends section N.J.S.A.30:4D-22 and N.J.S.A.30:4D-34 to change the copayment for the PAAD program. The bill requires a $5 copayment for the first two prescriptions a beneficiary purchases during any month, but then reduces the copayment to $2 for each prescription thereafter.

    In addition, the bill supplements N.J.S.A.30:4D-20 et seq. to add a new section of law that requires the Division of Medical Assistance and Health Services in the Department of Human Services to conduct periodic reviews in order to affirm the residency of persons receiving PAAD benefits.