Sec. 17b-280. (Formerly Sec. 17-134bb). Reimbursement rate for legend drugs. Dispensing fee. Reimbursement for over-the-counter drugs and products. Dispensing fee exception. Enhanced dispensing fee.
Sec. 17b-280. (Formerly Sec. 17-134bb). Reimbursement rate for legend
drugs. Dispensing fee. Reimbursement for over-the-counter drugs and products.
Dispensing fee exception. Enhanced dispensing fee. (a) The state shall reimburse for
all legend drugs provided under the Medicaid, state-administered general assistance,
ConnPACE and Connecticut AIDS drug assistance programs at the lower of (1) the rate
established by the Centers for Medicare and Medicaid Services as the federal acquisition
cost, (2) the average wholesale price minus fourteen per cent, or (3) an equivalent percentage as established under the Medicaid state plan. The commissioner shall also establish a professional fee of three dollars and fifteen cents for each prescription to be paid
to licensed pharmacies for dispensing drugs to Medicaid, ConnPACE and Connecticut
AIDS drug assistance recipients in accordance with federal regulations; and on and after
September 4, 1991, payment for legend and nonlegend drugs provided to Medicaid
recipients shall be based upon the actual package size dispensed. Effective October 1,
1991, reimbursement for over-the-counter drugs for such recipients shall be limited to
those over-the-counter drugs and products published in the Connecticut Formulary, or
the cross reference list, issued by the commissioner. The cost of all over-the-counter
drugs and products provided to residents of nursing facilities, chronic disease hospitals,
and intermediate care facilities for the mentally retarded shall be included in the facilities' per diem rate. Notwithstanding the provisions of this subsection, no dispensing fee
shall be issued for a prescription drug dispensed to a ConnPACE or Medicaid recipient
who is a Medicare Part D beneficiary when the prescription drug is a Medicare Part D
drug, as defined in Public Law 108-173, the Medicare Prescription Drug, Improvement,
and Modernization Act of 2003.
(b) The Department of Social Services may provide an enhanced dispensing fee to a
pharmacy enrolled in the federal Office of Pharmacy Affairs Section 340B drug discount
program established pursuant to 42 USC 256b or a pharmacy under contract to provide
services under said program.
(P.A. 89-296, S. 2, 9; June Sp. Sess. P.A. 91-8, S. 9, 63; May 9 Sp. Sess. P.A. 02-1, S. 122; P.A. 03-2, S. 11; June 30
Sp. Sess. P.A. 03-3, S. 52; P.A. 04-76, S. 20; 04-258, S. 10; May Sp. Sess. P.A. 04-2, S. 85; P.A. 05-280, S. 4.)
History: June Sp. Sess. P.A. 91-8 divided the subsection into Subdivs., substituted "Medicaid" for "medical aid" and
June 30 Sp. Sess. P.A. 03-3 relettered existing provision as Subsec. (a), provision amended to provide effective October
1, 2003 professional dispensing fee paid to pharmacies lowered from $3.60 to $3.30, added new Subsec. (b) to allow
commissioner to provide an enhanced dispensing fee to a pharmacy enrolled in, or under contract to provide services,
under the federal Office of Pharmacy Affairs drug discount program, effective August 20, 2003, added a new Subdiv. (2)
re payment for legend and nonlegend drugs and basing the payment on the actual package size dispensed, limitation on
the reimbursement of over-the-counter drugs as of October 1, 1991, and the inclusion in the rate of the cost of over-the-counter drugs for nursing facilities, chronic disease hospitals and the intermediate care facilities for the mentally retarded;
Sec. 17-134bb transferred to Sec. 17b-280 in 1995; May 9 Sp. Sess. P.A. 02-1 amended Subdiv. (1) to provide that
reimbursement for legend drugs applies to the Medicaid, state-administered general assistance, general assistance, ConnPACE and Connecticut AIDS drug assistance programs and that, effective September 1, 2002, the dispensing fee paid
to licensed pharmacists is $3.85 per prescription, effective July 1, 2002; P.A. 03-2 deleted "Notwithstanding any provision
of the regulations of Connecticut state agencies concerning payment for drugs provide to Medicaid recipients (1) effective
July 1, 1989", provided that effective March 1, 2003, the dispensing fee is $3.60 per prescription and made technical
changes, effective February 28, 2003; June 30 Sp. Sess. P.A. 03-3 designated existing provisions as Subsec. (a) and,
effective October 1, 2003, lowered professional dispensing fee paid to pharmacies from $3.60 to $3.30 and added new
Subsec.(b) re enhanced dispensing fee to pharmacy enrolled in, or under contract to provide services under, the federal
Office of Pharmacy Affairs drug discount program, effective August 20, 2003; P.A. 04-76 amended Subsec. (a) by deleting
references to "general assistance"; P.A. 04-258 amended Subsec. (a) by deleting "Effective October 1, 2003," and by
lowering the professional dispensing fee paid to pharmacies from $3.30 to $3.15, effective July 1, 2004; May Sp. Sess.
P.A. 04-2 amended Subsec. (a) to delete "state-administered general assistance" from the list of programs for which
commissioner pays a professional fee to licensed pharmacies for dispensing drugs to program recipients, effective July 1,
2004; P.A. 05-280 amended Subsec. (a) by substituting "Centers for Medicare and Medicaid Services" for "Health Care
Finance Administration", providing that reimbursement rate for legend drugs shall be the lower of rate established by said
Centers, the average wholesale price minus 14% or an equivalent percentage as established under the Medicaid state plan,
deleting language re commissioner's authority to establish and periodically revise estimated acquisition cost in accordance
with federal regulations, and providing that no dispensing fee shall be issued for prescription drugs dispensed to a ConnPACE or Medicaid recipient who is a Medicare Part D beneficiary when the prescription drug is a Medicare Part D drug,
effective July 1, 2005.
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557.