Sec. 17b-492. (Formerly Sec. 17a-343). Eligibility. Registration fee. Use of
Medicare prescription drug discount card. Payment for original and replacement
prescriptions. Application prior to exhausting other coverage. 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 twenty thousand eight hundred dollars, or whose annual income, if married,
when combined with that of the resident's spouse is less than twenty-eight thousand
one hundred dollars, (3) who is not insured under a policy which provides full or partial
coverage for prescription drugs, except for a Medicare prescription drug discount card
endorsed by the Secretary of Health and Human Services in accordance with Public
Law 108-173, the Medicare Prescription Drug, Improvement and Modernization Act
of 2003, once a deductible amount is met, and (4) on and after September 15, 1991,
who pays an annual thirty-dollar registration fee to the Department of Social Services.
Effective January 1, 2002, the commissioner shall commence accepting applications
from individuals who will become eligible to participate in the program as of April 1,
2002. On January 1, 1998, and annually thereafter, the commissioner shall 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) (1) 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, except for benefits received from an endorsed Medicare prescription drug discount card. The pharmacy shall make reasonable efforts to ascertain
the existence of other insurance or assistance, including the subsidy provided by an
endorsed Medicare prescription drug discount card. A Medicare prescription drug discount card beneficiary shall be responsible for the payment of any Medicare prescription
drug discount card coinsurance requirements, provided such requirements do not exceed
the ConnPACE program copayment requirements. If a Medicare prescription drug discount card beneficiary's coinsurance requirements exceed the ConnPACE copayment
requirements, the Department of Social Services shall make payment to the pharmacy
to cover costs in excess of the ConnPACE copayment amount. If the cost to such beneficiary exceeds the remaining available Medicare prescription drug discount card subsidy,
the beneficiary shall not be responsible for any payment in excess of the amount of the
ConnPACE program copayment requirement. In such cases, the Department of Social
Services shall make payment to the pharmacy to cover costs in excess of the ConnPACE
copayment amount.
(2) Payment for a replacement prescription under the program shall be made only
if the eligible person signs a statement, on such form as the commissioner prescribes
and subject to penalty under section 17b-497, that the prescription drug is lost or was
stolen or destroyed and the person has made a good faith effort to recover the prescription
drug, except that payment for a replacement prescription shall not be made on behalf
of a person more than twice in a calendar year. No copayment shall be required for such
replacement prescription.
(c) Any eligible resident who (1) is insured under a policy, including an endorsed
Medicare prescription drug discount card, 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, the applicant or the applicant's 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, such resident shall be included in the program. The
program shall, except for those beneficiaries with an endorsed Medicare prescription
drug discount card, (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) (1) As a condition of eligibility for participation in the ConnPACE program, a
resident with an income at or below one hundred thirty-five per cent of the federal
poverty level, who is Medicare Part A or Part B eligible, shall obtain annually an endorsed Medicare prescription drug discount card designated by the Commissioner of
Social Services for use in conjunction with the ConnPACE program. The commissioner
shall be the authorized representative of such resident for the purpose of enrolling a
resident in the transitional assistance program of Public Law 108-173, the Medicare
Prescription Drug Improvement and Modernization Act of 2003. As the authorized
representative for this purpose, the commissioner may sign required forms and enroll
such resident in an endorsed Medicare prescription drug discount card on his or her
behalf. Such resident shall have the opportunity to select an endorsed Medicare prescription drug discount card designated by the commissioner for use in conjunction with the
ConnPACE program, and shall be notified of such opportunity by the commissioner.
In the event that such resident does not select an endorsed Medicare prescription drug
discount card designated by the commissioner for use in conjunction with the ConnPACE program within a reasonable period of time, as determined by the commissioner,
the department shall enroll the resident in an endorsed Medicare prescription drug discount card designated by the commissioner.
(2) The commissioner may require, as a condition of eligibility for participation in
the ConnPACE program, that a resident with an income above one hundred thirty-five
per cent of the federal poverty level, who is Medicare Part A or Part B eligible, obtain
an endorsed Medicare prescription drug discount card designated by the commissioner
for use in conjunction with the ConnPACE program if obtaining such discount card is
determined by the commissioner to be cost-effective to the state. In such an event, the
commissioner may provide payment for any Medicare prescription drug discount card
enrollment fees.
(e) 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. The commissioner may implement
the policies and procedures necessary to carry out the provisions of this section while
in the process of adopting such policies and procedures in regulation form, provided
notice of intent to adopt the regulations is published not later than twenty days after the
date of implementation. Such policies and procedures shall be valid until the time the
final regulations are adopted.
(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; June Sp.
Sess. P.A. 01-2, S. 22, 69; June Sp. Sess. P.A. 01-9, S. 129, 131; May 9 Sp. Sess. P.A. 02-7, S. 16; P.A. 03-2, S. 15; June
30 Sp. Sess. P.A. 03-3, S. 58; P.A. 04-6, S. 1; 04-101, S. 2; 04-104, S. 2; 04-258, S. 12.)
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; June Sp. Sess. P.A. 01-2 amended Subsec. (a) to make a technical change for purposes
of gender neutrality, to change annual income limits applicable after April 1, 2002, or in the case of a federal waiver,
after July 1, 2002, and to require the commissioner, effective January 1, 2002, to commence accepting applications from
individuals who will become eligible to participate in the program as of April 2, 2002, and amended Subsec. (c) to make
technical changes, effective July 1, 2001; June Sp. Sess. P.A. 01-9 revised effective date of June Sp. Sess. P.A. 01-2 but
without affecting this section; May 9 Sp. Sess. P.A. 02-7 amended Subsec. (a) by deleting requirement that commissioner
adopt regulations re increased eligibility income limits, effective September 1, 2002; P.A. 03-2 amended Subsec. (a)(4)
to increase annual registration fee from twenty-five dollars to thirty dollars, effective February 28, 2003; June 30 Sp. Sess.
P.A. 03-3 amended Subsec. (a) by adding new Subdiv. (4) limiting program eligibility to unmarried individuals with
available assets below one hundred thousand dollars and married individuals with assets below one hundred twenty-five
thousand dollars, and providing that asset limit for married individuals be determined by combining value of assets available
to both spouses and that for purposes of section "available assets" are those considered available under the Connecticut
Home Care Program for the Elderly, and by redesignating existing Subdiv. (4) as Subdiv. (5), effective August 20, 2003;
P.A. 04-6 amended Subsec. (a)(2)(A) by deleting Subpara. (A) designator, increasing income eligibility level to twenty
thousand eight hundred dollars for unmarried persons and increasing the combined income level for married persons to
twenty-eight thousand one hundred dollars, deleted Subsec. (a)(2)(B) re income levels in the event of waiver being granted,
amended Subsecs. (a) to (c), inclusive, by adding provisions re use of Medicare prescription drug discount cards by program
beneficiaries, added new Subsec. (d) requiring that persons with income at or below one hundred thirty-five per cent of the
federal poverty level obtain Medicare prescription drug discount card as a condition of program eligibility, and redesignated
existing Subsec. (d) as Subsec. (e) and added provisions authorizing commissioner to implement policies and procedures
relative to section while in process of adopting such policies and procedures as regulation, effective March 30, 2004; P.A.
04-101 amended Subsec. (d) to insert Subdiv. (1) and (2) designators and, in Subdiv. (1), inserted "annually" re requirement
to obtain a discount card, required that the commissioner be the authorized representative of a resident in enrolling the
resident in the transitional assistance program, authorized the commissioner to enroll the resident and allowed the resident
to select an endorsed discount card, effective April 28, 2004; P.A. 04-104 amended Subsec. (b) to designate existing
provisions as Subdiv. (1) and add Subdiv. (2) re payment for replacement prescriptions, effective July 1, 2004; P.A. 04-258 eliminated former Subsec. (a)(4) re asset limits used in making program eligibility determinations and redesignated
existing Subsec. (a)(5) as new Subsec. (a)(4), effective June 1, 2004.
Sec. 17b-492a. Participating pharmacy. Requirements. On and after March 30,
2004, only a pharmacy, as defined in subsection (a) of section 17b-490, that accepts all
Medicare prescription drug discount cards that are (1) endorsed by the Secretary of
Health and Human Services in accordance with Public Law 108-173, the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and (2) designated by the Commissioner of Social Services for use in conjunction with the ConnPACE
program, may participate in the ConnPACE program. In addition, the commissioner
may require, as a condition for such participation, that a pharmacy accept any endorsed
drug discount card, if so required under federal law.
(P.A. 04-6, S. 2.)
History: P.A. 04-6 effective March 30, 2004.
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.
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.
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 biannual reports, in accordance with section 11-4a, 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. Each 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;
P.A. 03-268, S. 10; P.A. 04-16, S. 13.)
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;
P.A. 03-268 amended Subsec. (d) to require that commissioner submit biannual reports rather than quarterly reports and
to add reference to Sec. 11-4a; P.A. 04-16 made a technical change in Subsec. (d).
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.
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
a replacement prescription pursuant to section 17b-492 or in connection with obtaining
an identification number or card, or who 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; P.A. 04-104, S. 3.)
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); P.A. 04-104 amended Subsec. (b) to include a wilful
misrepresentation in connection with obtaining a replacement prescription and to make a technical change, effective July
1, 2004.
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.