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-491a. Prior authorization requirements for prescription drugs. Schedule for dispensing of maximum quantities of oral dosage units. Submission of schedule and revisions thereto to General Assembly.

Sec. 17b-491b. Reimbursement formula for drugs used to treat hemophilia A.

Sec. 17b-491c. Rebates for prescription drugs covered under Connecticut AIDS drug assistance program and state medical assistance programs. Calculation of unit rebate amounts. Contracts for supplemental rebates. Pharmaceutical manufacturers’ participation in program. Rebates for new drugs. Payment for medically necessary drugs.

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-492b. Authority of Commissioner of Developmental Services with respect to the Medicare Part D program.

Sec. 17b-492c. Authority of Commissioner of Mental Health and Addiction Services with respect to the Medicare Part D program.

Sec. 17b-492d. Council to advise on implementation of Medicare Part D program. Duties. Membership. Annual report.

Sec. 17b-493. (Formerly Sec. 17a-344). Generic substitution required.

Sec. 17b-494. (Formerly Sec. 17a-345). Regulations.

Sec. 17b-495. (Formerly Sec. 17a-346). Contract with fiscal intermediary. Reports.

Sec. 17b-496. (Formerly Sec. 17a-347). Hearing.

Sec. 17b-497. (Formerly Sec. 17a-348). Penalties.

Sec. 17b-498. (Formerly Sec. 17a-349). Educational outreach program.

Sec. 17b-499. Pharmacy outreach program: Definitions.

Sec. 17b-499a. Pharmacy outreach program. Established. Purpose. Duties. Report. Contract for Medicaid therapy management services.

Secs. 17b-500 to 17b-519. Reserved


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.

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.

Sec. 17b-491a. Prior authorization requirements for prescription drugs. Schedule for dispensing of maximum quantities of oral dosage units. Submission of schedule and revisions thereto to General Assembly. (a) The Commissioner of Social Services may require prior authorization of any prescription for a drug covered under a medical assistance program administered by the Department of Social Services, including an over-the-counter drug. The authorization for a brand name drug product shall be valid for one year from the date the prescription is first filled. 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.

(b) When prior authorization is required for coverage of a prescription drug under a medical assistance program administered by the Department of Social Services and a pharmacist is unable to obtain the prescribing physician’s authorization at the time the prescription is presented to be filled, the pharmacist shall dispense a one-time fourteen-day supply. The commissioner shall process a prior authorization request from a physician or pharmacist not later than two hours after the commissioner’s receipt of the request. 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.

(c) The Commissioner of Social Services, not later than October 1, 2012, shall issue a flier to pharmacies for distribution to Medicaid recipients who receive such one-time prescription supplies in the absence of prior prescription authorization. The flier shall notify recipients that (1) prior authorization is required for the prescription to be fully filled, (2) the fourteen-day supply is a one-time supply, and (3) recipients must contact the prescriber to arrange for prior authorization of a full prescription. The commissioner shall require pharmacists who receive Medicaid reimbursements for prescriptions to provide said flier to such Medicaid recipients.

(d) 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 a medical assistance program administered by the Department of Social Services, including prescriptions for over-the-counter drugs, based on a review of utilization patterns.

(e) A schedule established pursuant to subsection (d) of this section and on and after July 1, 2005, 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 schedule or revisions thereto, said joint standing committees of the General Assembly shall approve or deny the schedule or any revisions thereto and advise the commissioner of their approval or denial of the schedule or any revisions thereto. The schedule or any revisions thereto shall be deemed approved unless all committees vote to reject such schedule or revisions thereto within sixty days of receipt of such schedule or revisions thereto.

(June Sp. Sess. P.A. 00-2, S. 36, 53; P.A. 04-76, S. 21; P.A. 05-280, S. 17; Sept. Sp. Sess. P.A. 09-5, S. 34; P.A. 10-26, S. 3; June 12 Sp. Sess. P.A. 12-1, S. 27.)

History: June Sp. Sess. P.A. 00-2 effective July 1, 2000; P.A. 04-76 amended Subsecs. (a) to (c), inclusive, by deleting references to “general assistance”; P.A. 05-280 amended Subsec. (a) by replacing “establish a plan for the” with “require” re prior authorization, removing former Subdiv. (1) designator, “initial” and “that costs five hundred dollars or more for a thirty day supply or”, redesignating existing Subdiv. (2) as Subdiv. (1), adding new Subdiv. (2) re prior authorization requirement for brand name drugs when a chemically equivalent generic drug product substitution is available, and providing that authorization for brand name drug shall be valid for one year from the date the initial prescription is first filled, amended Subsec. (b) by deleting provision that required commissioner to establish a plan for designating certain suppliers of prescription drugs to be used by pharmacies when ordering prescription drugs and amended Subsec. (d) by adding “on and after July 1, 2005,” re submission of plan revisions to General Assembly, effective July 13, 2005; Sept. Sp. Sess. P.A. 09-5 amended Subsec. (a) by replacing provision re specific medical assistance programs with provision re medical assistance programs administered by department, adding provision allowing commissioner to require prior authorization for over-the-counter drugs, deleting provisions re prior authorization for early refill of prescription drug and for brand name drugs when equivalent generic drug substitution is available, and deleting provision re prior authorization deemed granted if not granted or denied within 2 hours, amended Subsec. (b) by replacing former provisions re designation of specific suppliers with provisions requiring pharmacist to dispense a 14-day drug supply when prior authorization for drug is required and physician’s authorization cannot be obtained and re prior authorization deemed granted if not granted or denied within 2 hours, amended Subsec. (c) by replacing provision re specific medical assistance programs with provision re medical assistance programs administered by department, adding provision allowing commissioner to establish schedule of maximum quantities of oral dosage units for over-the-counter drugs and amended Subsec. (d) by deleting references to plan, effective October 5, 2009; P.A. 10-26 made a technical change in Subsec. (d), effective May 10, 2010; June 12 Sp. Sess. P.A. 12-1 added new Subsec. (c) re flier for Medicaid recipients who receive a one-time supply of a prescription, redesignated existing Subsecs. (c) and (d) as Subsecs. (d) and (e) and substituted “subsection (d)” for “subsection (c)” in redesignated Subsec. (e), effective July 1, 2012.

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.

Sec. 17b-491c. Rebates for prescription drugs covered under Connecticut AIDS drug assistance program and state medical assistance programs. Calculation of unit rebate amounts. Contracts for supplemental rebates. Pharmaceutical manufacturers’ participation in program. Rebates for new drugs. Payment for medically necessary drugs. (a) On and after February 1, 2008, any pharmaceutical manufacturer of a prescription drug covered by the Department of Social Services under the Connecticut AIDS drug assistance program or a state medical assistance program administered by the department that is a federally qualified state pharmacy assistance program shall provide rebates to the department for prescription drugs paid for by the department under such program in unit rebate amounts equal to the unit rebate amounts paid under the Medicaid program.

(b) On and after February 1, 2008, any pharmaceutical manufacturer of a prescription drug covered by the department under a state medical assistance program that is not a federally qualified state pharmacy assistance program shall provide rebates to the department. The unit rebate amount shall be calculated as follows: (1) For noninnovator multiple source drugs, the average manufacturer’s price multiplied by eleven per cent, and (2) for single source or innovator drugs, the greater of the average manufacturer’s price multiplied by fifteen and one-tenth per cent or the average manufacturer’s price minus best price. In the event the calculated rebate would establish a new Medicaid best price, the unit rebate amount will be capped at the average manufacturer’s price minus best price.

(c) The department may enter into contracts for supplemental rebates for drugs that are on a preferred drug list or formulary established by the department.

(d) Pharmaceutical manufacturers shall submit written confirmation of participation on a form prescribed by the Commissioner of Social Services, that states the terms of participation, including, but not limited to, the process by which a manufacturer may discontinue participation. The department shall provide advance notice to participating manufacturers if a new pharmacy assistance program is established and shall provide the manufacturers with the opportunity to discontinue participation. The department shall promptly notify participating manufacturers if a state pharmacy assistance program becomes disqualified. If a program becomes disqualified and a manufacturer has paid rebates at the rate for a qualified program, the department shall reimburse the manufacturer the amount overpaid as a result of disqualification.

(e) A manufacturer shall not be required to provide a rebate for a prescription drug that is new to the marketplace until the quarter in which the manufacturer has established a Medicaid best price for the product.

(f) No payment shall be made by the department for the prescription drugs of a manufacturer that does not provide rebates to the department pursuant to this section unless a specific drug is determined by the department to be medically necessary for an individual client.

(P.A. 08-1, S. 3; P.A. 09-14, S. 3.)

History: P.A. 08-1 effective April 4, 2008; P.A. 09-14 designated existing provisions as Subsec. (a) and amended same to require payment of rebates for drugs covered under Connecticut AIDS drug assistance program or state medical assistance program that is a federally qualified state pharmacy assistance program in amounts equal to unit rebate amounts under Medicaid program, added Subsec. (b) re method for calculating unit rebate amounts under state medical assistance program that is not a federally qualified state pharmacy assistance program, added Subsec. (c) re contracts for supplemental rebates, added Subsec. (d) re pharmaceutical manufacturers’ participation in program and pharmacy assistance program disqualification, added Subsec. (e) re rebates for new drugs and added Subsec. (f) re payment for drugs that are medically necessary, effective April 23, 2009.

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. The commissioner shall not consider as income Aid and Attendance pension benefits granted to a veteran, as defined in section 27-103, or the surviving spouse of such veteran. 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; P.A. 12-208, S. 4.)

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; P.A. 12-208 amended Subsec. (a) to add provision re income disregard for veterans’ Aid and Attendance pension benefits, effective July 1, 2012.

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.)

Sec. 17b-492b. Authority of Commissioner of Developmental Services with respect to the Medicare Part D program. The Commissioner of Developmental Services, or the commissioner’s designee, may be the authorized representative of an applicant or recipient of services provided by the Department of Developmental Services for the purpose of submitting an application to the Social Security Administration to obtain the low income subsidy benefit provided under Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. As the authorized representative for this purpose, the commissioner, or the commissioner’s designee, may also sign required forms and enroll the applicant or recipient in a Medicare Part D plan on the applicant’s or recipient’s behalf. The applicant or recipient shall have the opportunity to select a Medicare Part D plan and shall be notified of such opportunity by the commissioner. In the event that such applicant or recipient does not select a Medicare Part D plan within a reasonable period of time, as determined by the commissioner, the department shall enroll the applicant or recipient in a Medicare Part D plan designated by the commissioner in accordance with said act. The applicant or recipient shall appoint the commissioner, or the commissioner’s designee, as such applicant’s or recipient’s authorized representative for the purpose of appealing any denial of Medicare Part D benefits and for any other purpose allowed under said act and deemed necessary by the commissioner.

(P.A. 05-280, S. 28; P.A. 07-73, S. 2(a), (b).)

History: P.A. 05-280 effective July 1, 2005; pursuant to P.A. 07-73 “Commissioner of Mental Retardation” and “Department of Mental Retardation” were changed editorially by the Revisors to “Commissioner of Developmental Services” and “Department of Developmental Services”, effective October 1, 2007.

Sec. 17b-492c. Authority of Commissioner of Mental Health and Addiction Services with respect to the Medicare Part D program. (a) The Commissioner of Mental Health and Addiction Services, or the commissioner’s designee, may be the authorized representative of an applicant or recipient of services provided by the Department of Mental Health and Addiction Services for the purpose of submitting an application to the Social Security Administration to obtain the low income subsidy benefit provided under Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. As the authorized representative for this purpose, the commissioner, or the commissioner’s designee, may also sign required forms and enroll the applicant or recipient in a Medicare Part D plan on the applicant’s or recipient’s behalf. The applicant or recipient shall have the opportunity to select a Medicare Part D plan and shall be notified of such opportunity by the commissioner. In the event that such applicant or recipient does not select a Medicare Part D plan within a reasonable period of time, as determined by the commissioner, the department shall enroll the applicant or recipient in a Medicare Part D plan designated by the commissioner in accordance with said act. The applicant or recipient shall appoint the commissioner, or the commissioner’s designee, as such applicant’s or recipient’s authorized representative for the purpose of appealing any denial of Medicare Part D benefits and for any other purpose allowed under said act and deemed necessary by the commissioner.

(b) Notwithstanding the provisions of section 4a-12, the Commissioner of Mental Health and Addiction Services, after consultation with the Commissioner of Administrative Services, may (1) bill or enter into a contract with a private entity to bill for prescriptions under the Medicare Part D program, and (2) enter into agreements and other contractual arrangements, including negotiated reimbursement rates for Medicare Part D plans, for the support of persons aided, cared for or treated by the Department of Mental Health and Addiction Services.

(P.A. 05-280, S. 29; Sept. Sp. Sess. P.A. 09-3, S. 53.)

History: P.A. 05-280 effective July 1, 2005; Sept. Sp. Sess. P.A. 09-3 designated existing provisions as Subsec. (a) and added Subsec. (b) re authority of Commissioner of Mental Health and Addiction Services to bill for prescriptions under Medicare Part D program and enter into agreements and other contractual arrangements, including negotiated reimbursement rates for Medicare Part D plans, for support of persons assisted by Department of Mental Health and Addiction Services, effective October 6, 2009.

Sec. 17b-492d. Council to advise on implementation of Medicare Part D program. Duties. Membership. Annual report. Section 17b-492d is repealed, effective October 5, 2009.

(P.A. 06-170, S. 1; Sept. Sp. Sess. P.A. 09-5, S. 89.)

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).

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) of this section 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; P.A. 07-217, S. 76.)

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 $500 to $1,000, 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; P.A. 07-217 made a technical change in Subsec. (c), effective July 12, 2007.

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.

Sec. 17b-499. Pharmacy outreach program: Definitions. As used in this section and section 17b-499a:

(1) “Eligible person” means any person who is a resident of Connecticut at the time such person files an application for prescription medications or nonprescription medications with a participating manufacturer;

(2) “Department” means the Department of Social Services;

(3) “Participating manufacturer” means a pharmaceutical manufacturer that offers prescription medications or nonprescription medications at a reduced cost or at no cost to persons pursuant to a voluntary drug assistance program established by such manufacturer;

(4) “Prescription medications” means prescription drugs that have been approved as safe and effective by the federal Food and Drug Administration or that are otherwise legally marketed and manufactured in the United States and manufactured and offered by pharmaceutical companies.

(P.A. 05-269, S. 1.)

History: P.A. 05-269 effective July 13, 2005.

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.

Secs. 17b-500 to 17b-519. Reserved for future use.

Note: Chapter 319gg is also reserved for future use.