PRINTER'S NO. 593
No. 555 Session of 1989
INTRODUCED BY RHOADES, PETERSON, DAWIDA, WILLIAMS, CORMAN,
HOPPER, ROCKS, O'PAKE, LYNCH, PUNT, STEWART, AFFLERBACH,
MUSTO, SALVATORE, MADIGAN, HELFRICK, FISHER, BELL, ROSS,
STAPLETON, REIBMAN, BRIGHTBILL, SHUMAKER, SHAFFER, JONES,
LEWIS, PORTERFIELD, WILT, BODACK AND LEMMOND,
FEBRUARY 21, 1989
REFERRED TO PUBLIC HEALTH AND WELFARE, FEBRUARY 21, 1989
AN ACT
1 Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
2 act to consolidate, editorially revise, and codify the public
3 welfare laws of the Commonwealth," further providing for
4 payments for pharmaceutical services.
5 The General Assembly of the Commonwealth of Pennsylvania
6 hereby enacts as follows:
7 Section 1. The act of June 13, 1967 (P.L.31, No.21), known
8 as the Public Welfare Code, is amended by adding a section to
9 read:
10 Section 441.3. Payments for Pharmaceutical Services.--(a)
11 Under no circumstances shall the provider be paid an amount that
12 exceeds the usual and customary charge to the self-paying public
13 plus twenty-five cents (25¢) or the usual and customary
14 reimbursement from other third party prescription plans under
15 contracts or agreements entered into subsequent to the effective
16 date of this section.
17 (b) Payment to a pharmacy for compensable legend and
1 nonlegend drugs will be the average wholesale price (AWP) of the
2 drug plus a three dollar and fifty cents ($3.50) dispensing fee
3 or the pharmacy's usual and customary reimbursement from third
4 party payors, whichever is lower. The dispensing fee shall be
5 adjusted on July 1, 1990, and on July 1 of each year thereafter
6 to reflect any increase or decrease in the Federal Consumer
7 Price Index. For purposes of medical assistance reimbursement,
8 the usual and customary charge of a pharmacy is defined as the
9 lesser of:
10 (1) Twenty-five cents (25¢) per prescription higher than the
11 usual and customary charge to the self-paying public; or
12 (2) The pharmacy's lowest dispensing fee plus product cost
13 payable to the provider for third party prescriptions under any
14 other contracts or agreements entered into by the pharmacy after
15 the effective date of this section.
16 (c) The Department of Public Welfare shall adopt regulations
17 in consultation with the Pharmacy Subcommittee of the Medical
18 Assistance Advisory Committee to the department regarding the
19 upper limits reimbursement for multisource drugs and these
20 regulations shall be subject to the act of June 25, 1982
21 (P.L.633, No.181), known as the "Regulatory Review Act."
22 Section 2. This act shall take effect July 1, 1989.
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