ASSEMBLY, No. 402
STATE OF NEW JERSEY
Introduced Pending Technical Review by Legislative Counsel
PRE-FILED FOR INTRODUCTION IN THE 1996 SESSION
By Assemblywoman HECK
An Act concerning the "Pharmaceutical Assistance to the Aged and Disabled" program, amending and supplementing P.L.1975, c.194, amending P.L.1979, c.383, and repealing P.L.1983, c.293.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 2 of P.L.1975, c.194 (C.30:4D-21) is amended to read as follows:
2. a. Any resident of this State who is either a recipient of disability insurance benefits under Title II of the federal Social Security Act (42 U.S.C.§401 et seq.) or 65 years of age and over and whose annual income is less than[$15,700] $16,171 if single or, if married, whose annual income combined with that of his spouse is less than[$19,250] $19,828, shall be eligible for "Pharmaceutical Assistance to the Aged and Disabled" if he is not otherwise qualified for assistance under P.L.1968, c.413 (C.30:4D-1 et seq.). Annual income shall not include gain from the sale of a principal residence that is excluded from gross income pursuant to N.J.S.54A:6-9.
b. Beginning January 1, 1995 and annually thereafter, the income eligibility limits provided in subsection a. of this section shall increase by the amount of the maximum Social Security benefit cost-of-living increase for that year for single and married persons, respectively. The commissioner shall adopt the new income limits annually by regulation pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).
(cf. P.L.1991, c.84, s.1)
2. 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)
3. 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)
4. (New section) The label on each container of a prescription drug purchased by a person receiving benefits under the "Pharmaceutical Assistance to the Aged and Disabled" program, P.L.1975, c.194, (C.30:4D-20 et seq.) shall display prominently the usual over-the-counter price the participating pharmacy charges other persons in the community for that prescription drug.
5. (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.
6. P.L.1983, c.293 (C.30:4D-21.1) is repealed.
7. This act shall take effect immediately.
STATEMENT
This bill amends section 2 of P.L.1975, c.194 (C.30:4D-21) to establish, beginning on January 1, 1995, an automatic cost-of-living increase in the income eligibility limits for the "Pharmaceutical Assistance to the Aged and Disabled" (PAAD) program that is tied to the maximum Social Security benefit cost-of-living increase each year. Under the amendment, the Commissioner of Human Services is to establish the allowable increase in the program's income limits each year based upon the amount of the maximum Social Security benefit increase for single and married persons. The bill also makes permanent the income limits of $16,171 for single persons and $19,828 for married couples. In 1993, the income eligibility limits were temporary raised for the 1993 fiscal year from $15,700 to $16,171 for singles and from $19,250 to $19,828 for couples as part of a supplemental appropriations act. Those new, higher limits were readopted for the 1994 fiscal year as part of the annual Appropriations Act (P.L.1993, c.155).
In addition, the bill amends section 3 of P.L.1975, c.194 (C.30:4D-22) and section 1 of P.L.1979, c.27 (C.30:4D-34) to change the copayment for the PAAD program. Currently, beneficiaries are required to pay $5 per prescription. The bill maintains the $5 copayment for the first two prescriptions a beneficiary purchases during any month, but then reduces the copayment to $2 for each prescription thereafter.
Furthermore, the bill supplements P.L.1975, c.194 (C.30:4D-20 et seq.) to add two new sections to the law. The first requires participating pharmacies to place their usual over-the-counter price on the label of each container of a prescription drug purchased under the PAAD program. The second directs the Commissioner of Human Services to require the Division of Medical Assistance and Health Services to conduct periodic reviews in order to affirm the residency of persons receiving PAAD benefits.
Finally, the bill repeals P.L.1983, c.293 (C.30:4D-21.1). This statute addressed the disqualification of persons whose annual income increased above the PAAD program's eligibility limits due to a Social Security cost-of-living adjustment.
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.