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

Table of Contents

Sec. 17b-490. (Formerly Sec. 17a-340). Definitions.
Sec. 17b-491. (Formerly Sec. 17a-342). Pharmaceutical Assistance Program. Copayments. Reimbursement of prescriptions based on price paid by pharmacy and actual package size. Rebates and utilization review required for participating pharmaceutical manufacturers. Contracts for supplemental rebates.
Sec. 17b-491b. Reimbursement formula for drugs used to treat hemophilia A.
Sec. 17b-492. (Formerly Sec. 17a-343). Eligibility. Application period. Registration fee. ConnPACE program requirements. Payment for original and replacement prescriptions. Application prior to exhausting coverage. Regulations.
Sec. 17b-492a. Participating pharmacy. Requirements.
Sec. 17b-493. (Formerly Sec. 17a-344). Generic substitution required.
Sec. 17b-499a. Pharmacy outreach program. Established. Purpose. Duties. Report. Contract for Medicaid therapy management services.

      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: (A) Products prescribed for cosmetic purposes as specified in regulations adopted pursuant to section 17b-494; (B) on and after September 15, 1991, diet pills, smoking cessation gum, contraceptives, multivitamin combinations, cough preparations and antihistamines; (C) drugs for the treatment of erectile dysfunction, unless such drug is prescribed to treat a condition other than sexual or erectile dysfunction, for which the drug has been approved by the Food and Drug Administration; and (D) drugs for the treatment of erectile dysfunction for persons who have been convicted of a sexual offense who are required to register with the Commissioner of Emergency Services and Public Protection pursuant to chapter 969, and (3) insulin and insulin syringes;

      (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. 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; P.A. 05-280, S. 14, 20; P.A. 06-188, S. 11; P.A. 11-44, S. 88; 11-51, S. 134.)

      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 Subdiv. (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 Subdivs. (i) and (j) defining "pharmaceutical manufacturer" and "wholesale price"; P.A. 92-196 amended Subdiv. (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 Subdiv. (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; P.A. 05-280 amended Subdiv. (b)(2) by designating existing exceptions as Subparas. (A) and (B) and adding Subpara. (C) excluding drugs for the treatment of erectile dysfunction for persons convicted of a sexual offense who are required to register with the Commissioner of Public Safety pursuant to chapter 969 from definition of "prescription drugs", amended Subdiv. (b)(3) by deleting "insulin needles" from said definition, amended Subdiv. (h) by making a technical change and added Subdivs. (k) to (o) defining "assets", "low income subsidy", "Medicare Part D covered prescription drugs", "Medicare Part D plan" and "gap in standard Medicare Part D coverage", effective July 1, 2005; P.A. 06-188 amended Subdiv. (b)(2) by redefining "prescription drugs" to exclude drugs for the treatment of erectile dysfunction unless such drug is prescribed to treat a condition other than sexual or erectile dysfunction and has been approved by the Food and Drug Administration, effective July 1, 2006; P.A. 11-44 amended Subdiv. (g) by redefining "income" to delete exclusion of Medicare Part B premium payments and deleted former Subdivs. (k) to (o) defining "assets", "low income subsidy", "Medicare Part D covered prescription drugs", "Medicare Part D plan" and "Gap in standard Medicare Part D coverage", effective July 1, 2011; pursuant to P.A. 11-51, "Commissioner of Public Safety" was changed editorially by the Revisors to "Commissioner of Emergency Services and Public Protection" in Subdiv. (b), effective July 1, 2011.

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      Sec. 17b-491. (Formerly Sec. 17a-342). Pharmaceutical Assistance Program. Copayments. Reimbursement of prescriptions based on price paid by pharmacy and actual package size. Rebates and utilization review required for participating pharmaceutical manufacturers. Contracts for supplemental rebates. (a) There shall be a "Connecticut Pharmaceutical Assistance Contract to the Elderly and the Disabled Program" which shall be within the Department of Social Services. The program shall consist of payments by the state to pharmacies for the reasonable cost of prescription drugs dispensed to eligible persons minus a copayment charge. The pharmacy shall collect the copayment charge from the eligible person at the time of each purchase of prescription drugs, and shall not waive, discount or rebate in whole or in part such amount. The copayment for each prescription shall not exceed sixteen dollars and twenty-five cents.

      (b) On January 1, 2002, and annually thereafter, the commissioner shall increase the income limits established in subsection (a) of this section that set the appropriate participant copayment by the increase in the annual inflation adjustment in Social Security income, if any. Each such adjustment shall be determined to the nearest one hundred dollars.

      (c) Notwithstanding the provisions of subsection (a) of this section, effective September 15, 1991, payment by the state to a pharmacy under the program may be based on the price paid directly by a pharmacy to a pharmaceutical manufacturer for drugs dispensed under the program minus the copayment charge, plus the dispensing fee, if the direct price paid by the pharmacy is lower than the reasonable cost of such drugs.

      (d) Effective September 15, 1991, reimbursement to a pharmacy for prescription drugs dispensed under the program shall be based upon actual package size costs of drugs purchased by the pharmacy in units larger than or smaller than one hundred.

      (e) Participation by a pharmaceutical manufacturer shall require that the department shall receive a rebate from the pharmaceutical manufacturer for prescriptions covered under the program. Rebate amounts for brand name prescription drugs shall be equal to those under the Medicaid program. Rebate amounts for generic prescription drugs shall be established by the commissioner, provided such amounts may not be less than those under the Medicaid program. A participating pharmaceutical manufacturer shall make quarterly rebate payments to the department for the total number of dosage units of each form and strength of a prescription drug which the department reports as reimbursed to providers of prescription drugs, provided such payments shall not be due until thirty days following the manufacturer's receipt of utilization data from the department including the number of dosage units reimbursed to providers of prescription drugs during the quarter for which payment is due. The department may enter into contracts for supplemental rebates for drugs that are on a preferred drug list or formulary established by the department.

      (f) All prescription drugs of a pharmaceutical manufacturer that participates in the program pursuant to subsection (e) of this section shall be subject to prospective drug utilization review. Any prescription drug of a manufacturer that does not participate in the program shall not be reimbursable, unless the department determines the prescription drug is essential to program participants.

      (P.A. 85-573, S. 6, 18; P.A. 87-3, S. 3, 9; S.A. 90-18, S. 18, 32; June Sp. Sess. P.A. 91-8, S. 46, 63; P.A. 92-196, S. 2, 4; P.A. 93-80, S. 51, 67; 93-262, S. 1, 87; 93-418, S. 36, 41; P.A. 95-351, S. 19, 30; June 18 Sp. Sess. P.A. 97-2, S. 132, 165; June Sp. Sess. P.A. 00-2, S. 40, 44, 53; May 9 Sp. Sess. P.A. 02-7, S. 15; P.A. 03-2, S. 14; P.A. 04-16, S. 17; 04-104, S. 1; P.A. 05-280, S. 21; P.A. 07-217, S. 75; P.A. 08-1, S. 1; P.A. 09-14, S. 1; P.A. 11-44, S. 142.)

      History: P.A. 87-3 deleted reference to "pilot", expanded the program to include the disabled and restated the payments to pharmacies to be the reasonable cost of prescription drugs minus a $4 copayment charge; S.A. 90-18 raised copayment charge $6 and added provisions re calculation of annual increases in charged amount on and after July 1, 1991; Sec. 17-513 transferred to Sec. 17a-342 in 1991; June Sp. Sess. P.A. 91-8 raised copayment and prescription charges from $6 to $10, deleted the language re the commissioner's authority to increase the copayment charges, and added Subsecs. (b) to (f), inclusive, basing payment made by the state to a pharmacy on the price paid by a pharmacy to the pharmaceutical manufacturer, basing reimbursement to the pharmacy on the actual package size of the prescription and detailing implementation and review of a prescription drug rebate agreement program; P.A. 92-196 amended Subsec. (d) by deleting provisions requiring the commissioner to enter into rebate agreements with manufacturers and adding provisions re application process for manufacturers to participate in program and amended Subsec. (f) for consistency; P.A. 93-80 amended Subsec. (a) to increase copayment charge from $10 to $15, and amended Subsec. (d) to change rebate paid to department by participating pharmaceutical manufacturer from 11% of the average manufacturer price to the basic rebate supplied by the manufacturer under Section 1927 of Title XIX of the Social Security Act, effective July 1, 1993; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department on aging, effective July 1, 1993; P.A. 93-418 reduced the copayment charge from $15 to $12 for each prescription, effective July 1, 1993; Sec. 17a-342 transferred to Sec. 17b-491 in 1995; P.A. 95-351 required the department to receive a rebate from a pharmaceutical manufacturer in an amount equal to the Medicaid rebate, deleting former Subsec. (e) re quarterly payments, payment discrepancies and independent audits and relettering Subsec. (f) as (e), effective July 1, 1995; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (e) by deleting provision requiring that all prescription drugs of a pharmaceutical manufacturer participating in the program pursuant to Subsec. (d) be immediately available, the cost of such drug reimbursed and not be subject to any restrictions and added provision requiring that such drugs be subject to prospective drug utilization review, effective July 1, 1997; June Sp. Sess. P.A. 00-2 amended Subsec. (d) by deleting references to the rebate supplied under the Social Security Act and by adding language re rebate amounts for brand name drugs equaling those under the Medicaid program and provision allowing the commissioner to establish rebate amounts for generic drugs, and amended Subsec. (e) by deleting provisions exempting prescription drugs of participating manufacturers from prior authorization, effective July 1, 2000; May 9 Sp. Sess. P.A. 02-7 amended Subsec. (a) by deleting provision re $12 copayment charge and adding Subdivs. (1) to (3) re copayment requirements for individuals determined eligible for program on or after September 1, 2002, added new Subsecs. (b) and (c) re copayment rates for individuals determined eligible for program prior to September 1, 2002, and re increased income limits, respectively, and redesignated existing Subsecs. (b) to (e) as Subsecs. (d) to (g), effective September 1, 2002; P.A. 03-2 amended Subsec. (a) by deleting "For an individual who is determined eligible to participate in the program on or after September 1, 2002, said" re copayment rates, by changing copayment rate from $12 to $16.25, changing income threshold for unmarried participants from $15,900 to $20,300 and changing income threshold for married participants, with combined spousal income, from $12,500 to $27,500 in Subdiv. (1), by deleting former Subdiv.(2) re middle tier of copayment rates, and by redesignating existing Subdiv. (3) as new Subdiv. (2), amending said Subdiv. to increase income thresholds from $20,000 to $20,300 in Subpara. (A) and from $27,100 to $27,500 in Subpara. (3) and adding "equals or" in both Subparas., deleted former Subsec. (b) re differing copayments for those determined eligible for the program prior to September 1, 2002, redesignated existing Subsecs. (c) to (g), inclusive, as Subsecs. (b) to (f), inclusive, and changed internal references contained therein, effective February 28, 2003; P.A. 04-16 made a technical change in Subsec. (a)(1); P.A. 04-104 amended Subsec. (a) to add "Except for a replacement prescription dispensed pursuant to section 17b-492" re required copayments, effective July 1, 2004; P.A. 05-280 amended Subsec. (a) by deleting former Subdivs. (1) and (2) re copayments under program and substituting provision that such copayments shall not exceed $16.25 and by deleting provision that excepted replacement prescriptions dispensed pursuant to Sec. 17b-492 from copayment requirement, effective July 1, 2005; P.A. 07-217 made a technical change in Subsec. (c), effective July 12, 2007; P.A. 08-1 amended Subsec. (e) to require pharmaceutical manufacturer participating in program to provide rebate to department for prescriptions covered by department pursuant to Sec. 17b-265e(c), effective April 4, 2008; P.A. 09-14 amended Subsec. (e) by deleting provisions re application form and issuance of certificate of participation to pharmaceutical manufacturer and by adding provision re contracts for supplemental rebates, effective April 23, 2009; P.A. 11-44 amended Subsec. (e) by deleting provision re prescriptions covered by Sec. 17b-265e(c), effective July 1, 2011.

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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 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; P.A. 04-76, S. 22; P.A. 11-44, S. 131.)

      History: June Sp. Sess. P.A. 00-2 effective July 1, 2000; P.A. 04-76 deleted reference to "general assistance"; P.A. 11-44 deleted "state-administered general assistance", effective July 1, 2011.

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      Sec. 17b-492. (Formerly Sec. 17a-343). Eligibility. Application period. Registration fee. ConnPACE program requirements. Payment for original and replacement prescriptions. Application prior to exhausting 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 current annual income at the time of application or redetermination, 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 eligible for Medicare or insured under a policy which provides full or partial coverage for prescription drugs once a deductible is met, and (4) on and after September 15, 1991, who pays an annual forty-five-dollar registration fee to the Department of Social Services. On January 1, 2012, 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. On and after October 1, 2009, new applications to participate in the ConnPACE program may be accepted only from the fifteenth day of November through the thirty-first day of December each year, except that individuals may apply within thirty-one days of (A) reaching sixty-five years of age, or (B) becoming eligible for Social Security Disability Income or Supplemental Security Income.

      (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. The pharmacy shall make reasonable efforts to ascertain the existence of other insurance or assistance.

      (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.

      (c) Any eligible resident who (1) is insured under a policy, 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 (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. 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; P.A. 05-280, S. 22; Nov. 2 Sp. Sess. P.A. 05-2, S. 3, 4; Nov. 2 Sp. Sess. P.A. 05-3, S. 2; P.A. 09-2, S. 15; Sept. Sp. Sess. P.A. 09-5, S. 33, 47; P.A. 10-26, S. 4; 10-179, S. 59; P.A. 11-44, S. 89.)

      History: P.A. 87-3 restated eligibility to include the disabled, changed the income limits to $13,300 for unmarried persons and $16,000 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 $13,800 for unmarried persons and $16,600 for married persons and added a $15 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 $15 to an annual fee of $25, 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 $25 to $30, effective February 28, 2003; June 30 Sp. Sess. P.A. 03-3 added new Subsec. (a)(4) limiting program eligibility to unmarried individuals with available assets below $100,000 and married individuals with assets below $125,000, 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, 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 $20,800 for unmarried persons and increasing the combined income level for married persons to $28,100, 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 135% 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; P.A. 05-280 amended Subsec. (a) by changing "annual income" to "current annual income at the time of application or redetermination" in Subdiv. (2), repositioning "once a deductible is met" and adding reference to coverage under Medicare Part D in Subdiv. (3) and deleting provision re accepting applications from persons eligible for program, amended Subsec. (b) by adding "or benefits provided under Medicare Part D" in Subdiv. (1), adding new Subdiv. (2) re Medicare Part D, redesignating existing Subdiv. (2) as Subdiv. (3) and amending same by deleting provision re no copayment required for replacement prescription, amended Subsec. (d) by making technical changes and adding language re provisions of Subdivs. (1) and (2) to remain in effect until effective date of the Medicare Part D program, added new Subsecs. (e) and (f) re Medicare Part D and redesignated existing Subsec. (e) as Subsec. (g), effective July 1, 2005; Nov. 2 Sp. Sess. P.A. 05-2 amended Subsec. (b)(2) by deleting former Subpara. (A) re department's authority to pay for a prescription drug at the lowest price established by the Medicare Part D plan for a preferred drug in the same therapeutic class and category, with the client responsible for any cost differential, and by redesignating existing Subparas. (B) and (C) as Subparas. (A) and (B), and amended Subsec. (f) by providing that applicant or recipient, prior to selecting a Medicare Part D plan, shall have the opportunity to consult with commissioner or commissioner's designated agent concerning selection of a plan that best meets the prescription drug needs of such applicant or recipient, effective December 1, 2005; Nov. 2 Sp. Sess. P.A. 05-3 amended Subsec. (f) by changing "shall" to "may" re commissioner's acting as authorized representative of a ConnPACE applicant or recipient, adding provision clarifying commissioner's authority to enroll such applicant or recipient in a Medicare Part D plan, and deleting provision re commissioner's authority to sign required forms on behalf of such applicant or recipient, effective December 1, 2005; P.A. 09-2 amended Subsec. (f) to add provision re facilitating enrollment in Medicare savings program and to make conforming changes, effective April 1, 2009; Sept. Sp. Sess. P.A. 09-5 amended Subsec. (a) by increasing registration fee from $30 to $45, by changing date commissioner is to begin increasing income limits from January 1, 1998, to January 1, 2012, and by adding provision specifying when new applications may be accepted and amended Subsec. (f) by adding provision requiring certain applicants to enroll in a benchmark plan and inserting references to benchmark plan, effective October 5, 2009; P.A. 10-26 made a technical change in Subsec. (f), effective May 10, 2010; P.A. 10-179 amended Subsec. (a) by changing last day to receive new applications for ConnPACE program from 30th to 31st day of December, effective May 7, 2010; P.A. 11-44 amended Subsec. (a)(3) by adding provision limiting eligibility to resident not eligible for Medicare and deleting exception re Medicare prescription drug discount card, amended Subsec. (b)(1) by deleting exception re Medicare prescription drug discount card or Medicare Part D benefits, deleted former Subsec. (b)(2) re responsibilities of Medicare Part D beneficiary, redesignated existing Subsec. (b)(3) as Subsec. (b)(2), amended Subsec. (c) by deleting provisions re Medicare prescription drug discount card, deleted former Subsecs. (d), (e) and (f) re Medicare Part D and redesignated existing Subsec. (g) as Subsec. (d), effective July 1, 2011.

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      Sec. 17b-492a. Participating pharmacy. Requirements. Section 17b-492a is repealed, effective July 1, 2011.

      (P.A. 04-6, S. 2; P.A. 11-44, S. 178.)

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      Sec. 17b-493. (Formerly Sec. 17a-344). Generic substitution required. A pharmacist shall, except as limited by subsections (c), (e) and (i) 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; P.A. 11-44, S. 151.)

      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; P.A. 11-44 added references to Sec. 20-619(e) and (i).

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      Sec. 17b-499a. Pharmacy outreach program. Established. Purpose. Duties. Report. Contract for Medicaid therapy management services. (a) There is established a pharmacy outreach program, administered by participating manufacturers through a toll-free telephone number, for the purpose of assisting residents of this state in obtaining reduced cost or no cost prescription medications or nonprescription medications from participating manufacturers and educating such residents about all available programs in Connecticut relating to such medications. The department, within available appropriations, shall oversee such program.

      (b) The pharmacy outreach program shall assist eligible persons in procuring free or low cost prescription medications or nonprescription medications by: (1) Evaluating the likelihood that such eligible person will qualify to receive reduced cost or no cost prescription medications or nonprescription medications from a participating manufacturer based upon such participating manufacturer's eligibility requirements for participation in such manufacturer's voluntary drug assistance program; (2) aiding eligible persons who qualify to receive such reduced cost or no cost prescription medications or nonprescription medications in receiving such medications from such participating manufacturers; and (3) assisting any physician licensed in this state with communications to any such participating manufacturer that concern the application of any such eligible person for participation in such participating manufacturer's voluntary drug assistance program.

      (c) The pharmacy outreach program shall: (1) Create and maintain a state-wide toll-free telephone number staffed by individuals who are qualified to advise eligible persons on questions such persons may have about access to reduced cost or no cost prescription drugs or nonprescription drugs; (2) sponsor and organize materials and information, in conjunction with other organizations, concerning issues relating to access to affordable prescription medications; and (3) offer and provide information on prescription medications and nonprescription medications, including, but not limited to, information on drug interactions and drug abuse.

      (d) Not later than January 15, 2006, and annually thereafter, upon the request of the joint standing committees of the General Assembly having cognizance of matters relating to human services and general law, the Department of Social Services shall report, in accordance with section 11-4a, on the number of telephone calls received by the pharmacy outreach program, the number of prescriptions requested and issued through the program and any other information relating to the program that the department deems relevant.

      (e) The Commissioner of Social Services shall contract with a patient-centered medical home, health home or a pharmacy organization, which may include a school of pharmacy, to provide Medicaid therapy management services, including, but not limited to, (1) a review of the medical and prescription history of recipients of benefits under the Medicaid program, and (2) the development of patient medication action plans to reduce adverse medication interaction and related health problems.

      (P.A. 05-269, S. 2; P.A. 11-44, S. 143; 11-61, S. 127.)

      History: P.A. 05-269 effective July 13, 2005; P.A. 11-44 added Subsec. (e) re contract for Medicaid therapy management services, effective July 1, 2011; P.A. 11-61 amended Subsec. (e) by adding provision allowing commissioner to contract with a patient-centered medical home or health home, effective July 1, 2011.

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