SENATE, No. 1090

STATE OF NEW JERSEY

INTRODUCED MAY 9, 1996

By Senators SINGER and CIESLA

An Act establishing the Pharmaceutical Discount Program and revising parts of the statutory law.

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

    1. (New section) Sections 1 through 5 of this act shall be known and may be cited as the "Pharmaceutical Discount Act."

    2. (New section) As used in sections 1 through 5 of this act:

    "Commissioner" means the Commissioner of Human Services.

    "Prescription drug" means a prescription drug as defined in section 3 of P.L.1975, c.194 (C.30:4D-22 et seq.).

    "Program" means the Pharmaceutical Discount Program established pursuant to this act.

    "Resident" means a resident of this State as defined in section 3 of P.L.1975, c.194 (C.30:4D-22).

    3. (New section) The Pharmaceutical Discount Program is established in the Division of Medical Assistance and Health Services in the Department of Human Services.

     4. (New section) a. A resident of this State who is a recipient of disability insurance benefits under Title II of the federal Social Security Act (42 U.S.C. §401 et seq.), or a person who is certified by a licensed physician to have acquired immune deficiency syndrome or to have tested positive for the human immunodeficiency virus, or a person 65 years of age and over, and whose annual income is less than $35,000 if single or, if married, whose annual income combined with that of his spouse is less than $50,000, shall be eligible for the program if the resident is not otherwise qualified for assistance under P.L.1968, c.413 (C.30:4D-1 et seq.) or P.L.1975, c.194 (C.30:4D-20 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. The income eligibility limits provided in subsection a. of this section shall annually 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 increased income eligibility limits annually by regulation pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).

    5. (New section) a. The commissioner shall issue to each person who, upon application to participate in the program, is determined by the commissioner to be eligible therefor, an identification card to be presented by the person at the time of payment for a prescription drug in any pharmacy which participates in the "Pharmaceutical Assistance to the Aged and Disabled" program.

    b. Upon presentation of the identification card issued pursuant to subsection a. of this section, a person shall only be required to pay an amount for a prescription drug which is equal to the amount paid for that prescription drug by the "Pharmaceutical Assistance to the Aged and Disabled" program plus the amount of any copayment that would be paid by an eligible person under the "Pharmaceutical Assistance to the Aged and Disabled" program.

    6. Section 5 of P.L.1975, c.194 (C.30:4D-24) is amended to read as follows:

    5. The commissioner shall by regulation establish a system of payments or reimbursements [and] under the Pharmaceutical Assistance to the Aged and Disabled program. The commissioner shall also by regulation establish a system for determining eligibility for that program and for the Pharmaceutical Discount Program established pursuant to P.L. , c. (C. )(pending before the Legislature as this bill), including provisions for submission of proof of actual and anticipated annual income, and evidence of complete or partial coverage of prescription drug costs by any other assistance or insurance plans.

(cf: P.L.1977, c.268, s.3)

    7. Section 1 of P.L.1992, c.30 (C.30:4D-21.2) is amended to read as follows:

    1. Funds received from the federal government pursuant to sections 105 and 106 of the "Civil Liberties Act of 1988," Pub.L.100-383 (50 U.S.C. App. §1989b-4 and §1989b-5) shall not be counted as income for the purpose of determining eligibility for the Pharmaceutical Assistance to the Aged and Disabled program established pursuant to P.L.1975, c.194 (C.30:4D-20 et seq.) or the Pharmaceutical Discount Program established pursuant to P.L. , c. (C. )(pending before the Legislature as this bill).

(cf: P.L.1992, c.30, s.1)

    8. Section 2 of P.L.1995, c.5 (C.30:4D-22.1) is amended to read as follows:

    2. Payments to pharmacies made by the "Pharmaceutical Assistance to the Aged and Disabled" program in accordance with section 3 of P.L.1975, c.194 (C.30:4D-22) shall not be made unless, at the time of each prescription drug purchase for which a pharmacy submits a claim under the "Pharmaceutical Assistance to the Aged and Disabled" program, and at the time of each prescription drug purchase by a person eligible for the Pharmaceutical Discount Program, the pharmacy prominently displays on the receipt provided with the drug the usual price charged to other persons in the community by the pharmacy.

(cf: P.L.1995, c.5, s.2)

    9. Section 3 of P.L.1978, c.171 (C.30:4D-26) is amended to read as follows:

    3. A prescription may not be included under the [program] Pharmaceutical Assistance to the Aged and Disabled program or the Pharmaceutical Discount Program unless it contains the name and address or identification number of the eligible person.

(cf: P.L.1978, c.171, s.3)

    10. Section 4 of P.L.1978, c.171 (C.30:4D-27) is amended to read as follows:

    4. The commissioner shall include on the identification cards used in the [program] Pharmaceutical Assistance to the Aged and Disabled program established pursuant to P.L.1975, c.194 (C.30:4D-20 et seq.) and the Pharmaceutical Discount Program established pursuant to P.L.      , c. (C. )(pending before the Legislature as this bill) a conspicuous notice of the penalties for violating the provisions of [this act] those acts.

(cf: P.L.1978, c.171, s.4)

    11. Section 9 of P.L.1978, c.171(C.30:4D-32) is amended to read as follows:

    9. The commissioner shall issue an annual report to the Governor and the Legislature by October 1 of each year[. Such report shall include a summary of "Pharmaceutical Assistance to the Aged" program activities] which shall summarize the activities of the Pharmaceutical Assistance to the Aged and Disabled program and the Pharmaceutical Discount Program for the preceding fiscal year and any recommendations or suggestions for legislative consideration.

(cf: P. L.1978, c.171, s.9)

    12. Section 10 of P.L.1978, c.171 (C.30:4D-33) is amended to read as follows:

     10. Any person violating any provision of [this act] P.L.1975, c.194 (C.30:4D-20 et seq.) or sections 1 through 5 of P.L. , c. (C. )(pending before the Legislature as this bill) shall be subject to the applicable civil and criminal penalties contained in the "New Jersey Medical Assistance and Health Services Act" (P.L.1968, c. 413, C. 30:4D-1 et seq.). Any eligible person who violates any provision of [this act] P.L.1975, c.194 (C.30:4D-20 et seq.) or sections 1 through 5 of P.L. , c. (C. )(pending before the Legislature as this bill) shall be subject to a suspension of their eligibility for one year for a first offense and permanent revocation of their eligibility for a second offense.

(cf: P.L.1978, c.171, s.10)

    13. Section 2 of P.L.1979, c.27 (C.30:4D-35) is amended to read as follows:

    2. The department shall provide a notice of the availability of [such reimbursement] the Pharmaceutical Assistance to the Aged and Disabled program and the Pharmaceutical Discount Program and an application form therefor to every potentially eligible person.

(cf: P.L.1979, c.27, s.2)

    14. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations to carry out the provisions of P.L. , c. (C. )(pending before the Legislature as this bill).

    15. This act shall take effect immediately.

STATEMENT

    This bill, which is designated the "Pharmaceutical Discount Act," establishes the Pharmaceutical Discount Program (PDP) in the Department of Human Services.

    The essential features of this new program are as follows:

     -- A resident of this State who is a recipient of disability insurance benefits under Title II of the federal Social Security Act (42 U.S.C. §401 et seq.), or a person who is certified by a licensed physician to have acquired immune deficiency syndrome or to have tested positive for the human immunodeficiency virus, or a person 65 years of age and over, and whose annual income is less than $35,000 if single or, if married, whose annual income combined with that of his spouse is less than $50,000, shall be eligible for PDP if the resident is not otherwise qualified for Medicaid or the "Pharmaceutical Assistance to the Aged and Disabled" (PAAD).

    -- The PDP income eligibility limits shall annually 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 of Human Services shall issue to each person who, upon application to participate in PDP, is determined by the commissioner to be eligible therefor, an identification card to be presented by the person at the time of payment for a prescription drug in a PAAD-participating pharmacy.

    -- Upon presentation of the PDP identification card, a person shall only be required to pay an amount for a prescription drug which is equal to the amount paid by PAAD plus the required PAAD copayment. The PAAD reimbursement rate for prescription drugs is significantly less than the usual and customary rate charged by pharmacists to customers without insurance coverage for prescription drug costs.

Designated the "Pharmaceutical Discount Act."