CHAPTER 319ff
CONNECTICUT PHARMACEUTICAL ASSISTANCE CONTRACT
TO THE ELDERLY AND THE DISABLED PROGRAM

Sec.17b-490.(Formerly Sec. 17a-340). Definitions. As used in sections 17b-490 to 17b-498, inclusive:
(a)"Pharmacy" means a pharmacy licensed under section 20-594 or a pharmacy located in a health care institution, as defined in subsection (a) of section 19a-490, which elects to participate in the program;
(b)"Prescription drugs" means (1) legend drugs, as defined in section 20-571, (2) any other drugs which by state law or regulation require the prescription of a licensed practitioner for dispensing, except products prescribed for cosmetic purposes as specified in regulations adopted pursuant to section 17b-494, and on and after September 15, 1991, diet pills, smoking cessation gum, contraceptives, multivitamin combinations, cough preparations and antihistamines, and (3) insulin, insulin syringes and insulin needles;
(c)"Reasonable cost" means the cost of the prescription drug determined in accordance with the formula adopted by the Commissioner of Social Services in regulations for medical assistance purposes plus a dispensing fee equal to the fee determined by said commissioner for medical assistance purposes;
(d)"Resident" means a person legally domiciled within the state for a period of not less than one hundred eighty-three days immediately preceding the date of application for inclusion in the program. Mere seasonal or temporary residences within the state, of whatever duration, shall not constitute domicile;
(e)"Disabled" means a person over eighteen years of age who is receiving disability payments pursuant to either Title 2 or Title 16 of the Social Security Act of 1935, as amended;
(f)"Commissioner" means the Commissioner of Social Services;
(g)"Income" means adjusted gross income as determined for purposes of the federal income tax plus any other income of such person not included in such adjusted gross income minus Medicare Part B premium payments. The amount of any Medicaid payments made on behalf of such person or the spouse of such person shall not constitute income;
(h)"Program" means the Connecticut Pharmaceutical Assistance Contract to the Elderly and the Disabled Program otherwise known as ConnPACE;
(i)"Pharmaceutical manufacturer" means any entity holding legal title to or possession of a national drug code number issued by the federal Food and Drug Administration;
(j)"Average manufacturer price" means the average price paid by a wholesaler to a pharmaceutical manufacturer, after the deduction of any customary prompt payment discounts, for a product distributed for retail sale.
(P.A. 85-573, S. 3, 18; P.A. 87-3, S. 1, 9; 87-12, S. 1, 2; 87-267, S. 3; 87-589, S. 11, 87; P.A. 90-89, S. 1; June Sp. Sess. P.A. 91-8, S. 45, 63; P.A. 92-196, S. 1, 4; P.A. 93-262, S. 1, 87; May Sp. Sess. P.A. 94-5, S. 1, 30.)
History: P.A. 85-573, S. 3 effective July 10, 1985, and applicable in any municipality to the assessment year commencing October 1, 1985, and each assessment year thereafter; P.A. 87-3 redefined "pharmacy" to include pharmacies located in health care institutions, redefined "reasonable cost" to be the cost as determined by a formula adopted in regulations for medical assistance plus a dispensing fee, added Subdiv. (e) which defined "disabled", and redefined "program" to include the disabled; P.A. 87-12 redefined "prescription drugs" to include any drugs which require a prescription of a licensed practitioner for dispensing; P.A. 87-267 amended Subsec. (g) by adding the provision on Medicaid payments; P.A. 87- 589 revised definition of "disabled"; P.A. 90-89 redefined "prescription drugs" to exclude products prescribed for cosmetic purposes as specified in regulations; Sec. 17-510 transferred to Sec. 17a-340 in 1991; June Sp. Sess. P.A. 91-8 redefined "prescription drugs" to exclude diet pills, smoking cessation gum, contraceptives, multivitamins, cough preparations and antihistamines, redefined "reasonable cost" by deleting the reference to generic drugs and added Subsecs. (i) and (j) defining "pharmaceutical manufacturer" and "wholesale price"; P.A. 92-196 amended Subsec. (j) by substituting "average manufacturer price" for "wholesale price"; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance and commissioner and department on aging, effective July 1, 1993; May Sp. Sess. P.A. 94-5 amended Subsec. (g) to specifically subtract Medicare Part B premiums payments from consideration as adjusted gross income, effective July 1, 1994; Sec. 17a-340 transferred to Sec. 17b-490 in 1995.

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Sec.17b-491a.Plan for prior authorization of prescriptions. Plan for designation of specific providers. Schedule for dispensing of maximum quantities of oral dosage units. Submission of plans to General Assembly. (a) The Commissioner of Social Services may establish a plan for the prior authorization of (1) any initial prescription for a drug covered under the Medicaid, state-administered general assistance, general assistance or ConnPACE program that costs five hundred dollars or more for a thirty-day supply, or (2) any early refill of a prescription drug covered under any of said programs. The Commissioner of Social Services shall establish a procedure by which prior authorization under this subsection shall be obtained from an independent pharmacy consultant acting on behalf of the Department of Social Services, under an administrative services only contract. If prior authorization is not granted or denied within two hours of receipt by the commissioner of the request for prior authorization, it shall be deemed granted.
(b)The Commissioner of Social Services shall, to increase cost-efficiency or enhance access to a particular prescription drug, establish a plan under which the commissioner may designate specific suppliers of a prescription drug from which a dispensing pharmacy shall order the prescription to be delivered to the pharmacy and billed by the supplier to the department. For each prescription dispensed through designated suppliers, the department shall pay the dispensing pharmacy a handling fee not to exceed four hundred per cent of the dispensing fee established pursuant to section 17b-280. In no event shall the provisions of this subsection be construed to allow the commissioner to purchase all prescription drugs covered under the Medicaid, state-administered general assistance, general assistance and ConnPACE programs under one contract.
(c)Notwithstanding the provisions of section 17b-262 and any regulation adopted thereunder, on or after July 1, 2000, the Commissioner of Social Services may establish a schedule of maximum quantities of oral dosage units permitted to be dispensed at one time for prescriptions covered under the Medicaid, state-administered general assistance and general assistance programs based on a review of utilization patterns.
(d)A plan or schedule established pursuant to subsection (a), (b) or (c) of this section and any revisions thereto shall be submitted to the joint standing committees of the General Assembly having cognizance of matters relating to public health, human services and appropriations and the budgets of state agencies. Within sixty days of receipt of such a plan or schedule or revisions thereto, said joint standing committees of the General Assembly shall approve or deny the plan or schedule or any revisions thereto and advise the commissioner of their approval or denial of the plan or schedule or any revisions thereto. The plan or schedule or any revisions thereto shall be deemed approved unless all committees vote to reject such plan or schedule or revisions thereto within sixty days of receipt of such plan or schedule or revisions thereto.
(June Sp. Sess. P.A. 00-2, S. 36, 53.)
History: June Sp. Sess. P.A. 00-2 effective July 1, 2000.

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Sec.17b-491b.Reimbursement formula for drugs used to treat hemophilia A. The maximum allowable cost paid for Factor VIII pharmaceuticals under the Medicaid, state-administered general assistance, general assistance and ConnPACE programs shall be the actual acquisition cost plus eight per cent. The Commissioner of Social Services may designate specific suppliers of Factor VIII pharmaceuticals from which a dispensing pharmacy shall order the prescription to be delivered to the pharmacy and billed by the supplier to the Department of Social Services. If the commissioner so designates specific suppliers of Factor VIII pharmaceuticals, the department shall pay the dispensing pharmacy a handling fee equal to eight per cent of the actual acquisition cost for such prescription.
(June Sp. Sess. P.A. 00-2, S. 35, 53.)
History: June Sp. Sess. P.A. 00-2 effective July 1, 2000.

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Sec.17b-492.(Formerly Sec. 17a-343). Eligibility. Registration fee. Regulations. (a) Eligibility for participation in the program shall be limited to any resident (1) who is sixty-five years of age or older or who is disabled, (2) whose annual income, if unmarried, is less than thirteen thousand eight hundred dollars, or whose annual income, if married, when combined with that of his spouse is less than sixteen thousand six hundred dollars, (3) who is not insured under a policy which provides full or partial coverage for prescription drugs once a deductible amount is met, and (4) on and after September 15, 1991, who pays an annual twenty-five-dollar registration fee to the Department of Social Services. On January 1, 1998, and annually thereafter, the commissioner shall, by the adoption of regulations in accordance with chapter 54, increase the income limits established under this subsection over those of the previous fiscal year to reflect the annual inflation adjustment in Social Security income, if any. Each such adjustment shall be determined to the nearest one hundred dollars.
(b)Payment for a prescription under the program shall be made only if no other plan of insurance or assistance is available to an eligible person for such prescription at the time of dispensing. The pharmacy shall make reasonable efforts to ascertain the existence of other insurance or assistance.
(c)Any eligible resident who (1) is insured under a policy which provides full or partial coverage for prescription drugs and (2) expects to exhaust such coverage, may apply to participate in the program prior to the exhaustion of such coverage. Such application shall be valid for the applicable income year. To be included in the program, on or after the date the applicant exhausts such coverage, he or his designee shall notify the department that such coverage is exhausted and, if required by the department, shall submit evidence of exhaustion of coverage. Not later than ten days after an eligible resident submits such evidence, he shall be included in the program. The program shall (A) cover prescriptions that are not covered by any other plan of insurance or assistance available to the eligible resident and that meet the requirements of this chapter and (B) retroactively cover such prescriptions filled after or concurrently with the exhaustion of such coverage. Nothing in this subsection shall be construed to prevent a resident from applying to participate in the program as otherwise permitted by this chapter and regulations adopted pursuant to this chapter.
(d)The Commissioner of Social Services may adopt regulations in accordance with the provisions of chapter 54 to implement the provisions of subsection (c) of this section. Such regulations may provide for the electronic transmission of relevant coverage information between a pharmacist and the department or between an insurer and the department in order to expedite applications and notice.
(P.A. 85-573, S. 7, 18; P.A. 87-3, S. 4, 9; June Sp. Sess. P.A. 91-8, S. 47, 63; P.A. 92-196, S. 3, 4; P.A. 93-262, S. 1, 87; P.A. 95-160, S. 1, 69; P.A. 96-139, S. 12, 13; June 18 Sp. Sess. P.A. 97-2, S. 128, 165; P.A. 98-194, S. 1, 2.)
History: P.A. 87-3 restated eligibility to include the disabled, changed the income limits to thirteen thousand three hundred dollars for unmarried persons and sixteen thousand for married, provided for annual adjustments and restated Subsec. (b) re ineligibility; Sec. 17-514 transferred to Sec. 17a-343 in 1991; June Sp. Sess. P.A. 91-8 changed the income limits to thirteen thousand eight hundred dollars for unmarried persons and sixteen thousand six hundred dollars for married persons and added a fifteen dollar registration fee; P.A. 92-196 amended Subsec. (a) by limiting eligibility to those not insured under a policy providing full or partial prescription coverage once a deductible is met; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department on aging, effective July 1, 1993; Sec. 17a-343 transferred to Sec. 17b-492 in 1995; P.A. 95-160 increased the registration fee of fifteen dollars to an annual fee of twenty-five dollars, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (a) to require the commissioner to increase the income limits to reflect any annual inflation adjustment in Social Security income after January 1, 1998, effective July 1, 1997; P.A. 98-194 added Subsecs. (c) and (d), extending program to eligible residents who exhaust prescription drug insurance coverage, effective July 1, 1998.

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Sec.17b-493.(Formerly Sec. 17a-344). Generic substitution required. A pharmacist shall, except as limited by subsection (c) of section 20-619 and section 17b- 274, substitute a therapeutically and chemically equivalent generic drug product for a prescribed drug product when filling a prescription for an eligible person under the program.
(P.A. 85-573, S. 8, 18; June Sp. Sess. P.A. 91-8, S. 48, 63; P.A. 95-264, S. 69; June Sp. Sess. P.A. 00-2, S. 41, 53.)
History: Sec. 17-515 transferred to Sec. 17a-344 in 1991; June Sp. Sess. P.A. 91-8 required that a pharmacist provide a generic drug product, eliminating the previous discretionary authority; Sec. 17a-344 transferred to Sec. 17b-493 in 1995; P.A. 95-264 made a technical change; June Sp. Sess. P.A. 00-2 added reference to Sec. 17b-274 as an additional limitation on substitution of generic drug products, effective July 1, 2000.

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Sec.17b-494.(Formerly Sec. 17a-345). Regulations. The Commissioner of Social Services shall adopt regulations, in accordance with the provisions of chapter 54, to establish (1) a system for determining eligibility and disqualification under the program, including provisions for an identification number and a renewable, nontransferable identification card; (2) requirements for the use of the identification number and card by the pharmacy and the eligible person; (3) a system of payments; (4) limitations on the maximum quantity per prescription which shall not exceed a thirty-day supply or one hundred twenty oral dosage units whichever is greater; (5) requirements as to records to be kept by the pharmacy, including patient profiles; (6) products prescribed for cosmetic and other purposes which shall not be covered under the program; and (7) such other provisions as are necessary to implement the provisions of sections 17b-490 to 17b-495, inclusive.
(P.A. 85-573, S. 9, 18; P.A. 87-3, S. 5, 9; P.A. 90-89, S. 2; June Sp. Sess. P.A. 91-8, S. 49, 63; P.A. 93-262, S. 1, 87.)
History: P.A. 87-3 deleted reference to the annual participation fee, restated the quantity limitation to be the greater of a thirty-day supply or one hundred twenty oral dosage units and deleted Subsec. (b) re deposit of the annual participation fee; P.A. 90-89 required the commissioner to adopt regulations establishing products prescribed for cosmetic purposes which shall not be covered under the program; Sec. 17-516 transferred to Sec. 17a-345 in 1991; June Sp. Sess. P.A. 91-8 added reference to Secs. 17a-340 and 17a-342 to 17a-346, inclusive, and made other technical corrections; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department on aging, effective July 1, 1993; Sec. 17a-345 transferred to Sec. 17b-494 in 1995.

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Sec.17b-495.(Formerly Sec. 17a-346). Contract with fiscal intermediary. Reports. (a) The commissioner may enter into an agreement with a fiscal intermediary which may be an agency of the state, or a person, firm or public or nonprofit corporation, for the administration of the whole or any part of the program. Any such contract shall be subject to the provisions of sections 4a-57 and 4a-59, except that preference shall be given to persons, firms or corporations doing business in the state.
(b)The contract shall require the fiscal intermediary to submit quarterly reports to the commissioner on the operation of the program, including financial and utilization statistics as to drug use by therapeutic category, actuarial projections, an outline of problems encountered in the administration of the program and suggested solutions to the same and any recommendations to enhance the program.
(c)The commissioner shall verify the propriety and reasonableness of payments to providers, through field audit examinations and other reasonable means, to the extent possible within available appropriations. The commissioner shall submit an annual report, on or before February first of each year, to the Secretary of the Office of Policy and Management and the chairpersons of the joint standing committee of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies outlining the program for carrying out such verifications and including the results of such verifications.
(d)The commissioner shall submit quarterly reports, within thirty days after the end of each fiscal quarter, to the Governor and the chairpersons of the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies and public health. The report shall include a copy of the most recent report of the fiscal intermediary, if any, and (1) the number of consumers eligible for the program, (2) the number of consumers utilizing the program, (3) an outline of and a report on the educational outreach program, (4) the number of appeals, (5) an outline of problems encountered in the administration of the program and suggested solutions and any recommendations to enhance the program.
(P.A. 85-573, S. 10, 18; 86-403, S. 92, 132; P.A. 87-3, S. 6, 9; P.A. 91-190, S. 2, 9; June Sp. Sess. P.A. 91-8, S. 50, 63.)
History: P.A. 86-403 made technical change in Subsec. (b), substituting "commissioner" for "secretary"; P.A. 87-3 inserted new Subsec. (c) re verification of reasonableness of payments and relettered former subsection as (d), adding provision re reporting to the advisory board; Sec. 17-517 transferred to Sec. 17a-346 in 1991; P.A. 91-190 amended Subsecs. (c) and (d) to eliminate requirement that annual and quarterly reports be submitted to chairpersons of pharmaceutical assistance advisory board established pursuant to Sec. 17a-341 to reflect repeal of said section; June Sp. Sess. P.A. 91-8 deleted references to the generic incentive dispensing fee in Subsec. (c); Sec. 17a-346 transferred to Sec. 17b-495 in 1995.

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Sec.17b-496.(Formerly Sec. 17a-347). Hearing. Any person aggrieved by any action of the commissioner in connection with the administration of the program shall have a right to a hearing before the commissioner in accordance with the provisions of chapter 54.
(P.A. 85-573, S. 11, 18.)
History: Sec. 17-518 transferred to Sec. 17a-347 in 1991; Sec. 17a-347 transferred to Sec. 17b-496 in 1995.

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Sec.17b-497.(Formerly Sec. 17a-348). Penalties. (a) Any person acting for a pharmacy who submits a false or fraudulent claim under sections 17b-490 to 17b-498, inclusive, or the regulations adopted pursuant to section 17b-494, or who aids or abets another in the submission of a false or fraudulent claim, or otherwise violates any provision of sections 17b-490 to 17b-498, inclusive, or said regulations, shall be subject to a fine of not less than one thousand dollars or imprisonment for a term of not more than one year, or both.
(b)Any person who wilfully misrepresents any fact in connection with obtaining an identification number or card, or misuses such identification number or card to obtain prescription drugs shall be subject to suspension of eligibility for a period of not more than one year for a first offense and a permanent revocation of eligibility for a second offense.
(c)Any pharmacy found guilty of a violation under subsection (a) shall be immediately terminated from participation in the program, and shall be liable to the state for five times the value of any material gain received.
(d)Any person found guilty of a violation under subsection (b) of this section shall be liable to the state for five times the value of any material gain received.
(P.A. 85-573, S. 12, 18; P.A. 88-364, S. 78, 123; P.A. 96-169, S. 14.)
History: P.A. 88-364 substituted references to Sec. 17-521 for references to Sec. 17-522; Sec. 17-519 transferred to Sec. 17a-348 in 1991; Sec. 17a-348 transferred to Sec. 17b-497 in 1995; P.A. 96-169 amended Subsec. (a) to increase minimum fine from five hundred dollars to one thousand dollars, amended Subsec. (c) to replace "subject to immediate termination of" with "immediately terminated from" and increased amount of liability to state from "three" to "five" times the value of material gain received in both Subsecs. (c) and (d).

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Sec.17b-498.(Formerly Sec. 17a-349). Educational outreach program. The Commissioner of Social Services shall undertake an educational outreach program to make known the provisions of the program to the public, with emphasis on reaching the elderly and the disabled in the state through the various local and state-wide agencies and organizations concerned with the elderly and the disabled, and to all pharmacies in the state.
(P.A. 85-573, S. 14, 18; P.A. 87-3, S. 7, 9; P.A. 93-262, S. 1, 87.)
History: P.A. 87-3 added references to the disabled; Sec. 17-521 transferred to Sec. 17a-349 in 1991; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department on aging, effective July 1, 1993; Sec. 17a-349 transferred to Sec. 17b-498 in 1995.

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Secs.17b-499 to 17b-519.Reserved for future use.
Note: Chapter 319gg is also reserved for future use.

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CHAPTER 319ffCONNECTICUT PHARMACEUTICAL ASSISTANCE CONTRACT TO THE ELDERLY AND THE DISABLED PROGRAM

CHAPTER 319ff
CONNECTICUT PHARMACEUTICAL ASSISTANCE CONTRACT
TO THE ELDERLY AND THE DISABLED PROGRAM