General Assembly Raised Bill No. 392
February Session, 2012 LCO No. 1362
*01362_______HS_*
Referred to Committee on Human Services
Introduced by:
(HS)
General Assembly
Raised Bill No. 392
February Session, 2012
LCO No. 1362
*01362_______HS_*
Referred to Committee on Human Services
Introduced by:
(HS)
AN ACT CONCERNING PHARMACY MEDICAID REIMBURSEMENT.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Section 17b-280 of the 2012 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2012):
(a) The state shall reimburse for all legend drugs provided under medical assistance programs administered by the Department of Social Services at the lower of (1) the rate established by the Centers for Medicare and Medicaid Services as the federal acquisition cost, (2) the average wholesale price minus sixteen per cent for chain pharmacies and fourteen per cent for independent pharmacies, or (3) an equivalent percentage as established under the Medicaid state plan. The state shall pay a professional fee of two dollars to licensed chain pharmacies and four dollars to independent pharmacies for each prescription dispensed to a recipient of benefits under a medical assistance program administered by the Department of Social Services in accordance with federal regulations. On and after September 4, 1991, payment for legend and nonlegend drugs provided to Medicaid recipients shall be based upon the actual package size dispensed. Effective October 1, 1991, reimbursement for over-the-counter drugs for such recipients shall be limited to those over-the-counter drugs and products published in the Connecticut Formulary, or the cross reference list, issued by the commissioner. The cost of all over-the-counter drugs and products provided to residents of nursing facilities, chronic disease hospitals, and intermediate care facilities for the mentally retarded shall be included in the facilities' per diem rate. Notwithstanding the provisions of this subsection, no dispensing fee shall be issued for a prescription drug dispensed to a ConnPACE or Medicaid recipient who is a Medicare Part D beneficiary when the prescription drug is a Medicare Part D drug, as defined in Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
(b) The Department of Social Services may provide an enhanced dispensing fee to a pharmacy enrolled in the federal Office of Pharmacy Affairs Section 340B drug discount program established pursuant to 42 USC 256b or a pharmacy under contract to provide services under said program.
(c) For purposes of this section, "chain pharmacy" means a community pharmacy that is publicly traded. "Independent pharmacy" is a community pharmacy that is privately owned and has twenty or fewer stores in the state. "Community pharmacy" is defined in section 20-631a. "Legend drug" is defined in section 20-571.
This act shall take effect as follows and shall amend the following sections:
Section 1 July 1, 2012 17b-280
This act shall take effect as follows and shall amend the following sections:
Section 1
July 1, 2012
17b-280
Statement of Purpose:
To expand consumer options by establishing more equitable reimbursement rates for pharmacies.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]