PRIOR PRINTER'S NO. 593 PRINTER'S NO. 1095
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, LEMMOND AND BAKER,
FEBRUARY 21, 1989
SENATOR TILGHMAN, APPROPRIATIONS, RE-REPORTED AS AMENDED,
MAY 22, 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.
1 (b) Payment to a pharmacy for compensable legend and
2 nonlegend drugs will be the average wholesale price (AWP) of the
3 drug plus a three dollar and fifty cents ($3.50) dispensing fee
4 or the pharmacy's usual and customary reimbursement from third <--
5 party payors CHARGE TO THE SELF-PAYING PUBLIC, whichever is <--
6 lower. The dispensing fee shall be adjusted on July 1, 1990, and
7 on July 1 of each year thereafter to reflect any increase or
8 decrease in the Federal Consumer Price Index. For purposes of <--
9 medical assistance reimbursement, the usual and customary charge
10 of a pharmacy is defined as the lesser of:
11 (1) Twenty-five cents (25¢) per prescription higher than the
12 usual and customary charge to the self-paying public; or
13 (2) The pharmacy's lowest dispensing fee plus product cost
14 payable to the provider for third party prescriptions under any
15 other contracts or agreements entered into by the pharmacy after
16 the effective date of this section.
17 (c) The Department of Public Welfare shall adopt regulations
18 in consultation with the Pharmacy Subcommittee of the Medical
19 Assistance Advisory Committee to the department regarding the
20 upper limits reimbursement for multisource drugs and these
21 regulations shall be subject to the act of June 25, 1982
22 (P.L.633, No.181), known as the "Regulatory Review Act."
23 Section 2. This act shall take effect July 1, 1989.
B13L67RZ/19890S0555B1095 - 2 -