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Trenton, NJ 08625-0360
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The Division of Senior Benefits and Utilization Management propose to readopt with amendments N.J.A.C. 8:83, the Pharmaceutical Assistance to the Aged and Disabled (PAAD) Eligibility Manual.
The PAAD Eligibility Manual sets forth the policies and procedures regarding the assistance to persons whose level of income disqualifies them for Medicaid, but who have significant needs for prescription drugs and cannot pay the full cost of these drugs. PAAD also provides assistance to eligible individuals for the purchase of insulin needles, insulin syringes, and for the purchase of needles and syringes used for medication that can be injected for the treatment of multiple sclerosis.
A primary goal of the proposed amendments is to provide for full coordination between the PAAD program and Medicare Part D. The Federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established a new Part D program for voluntary prescription drug coverage effective January 1, 2006. This new federal law also provides premium and cost sharing subsidies of prescription drug coverage for certain individuals with low income and resources. The fiscal year 2009 State Appropriations Act requires the Department to coordinate the benefits of the PAAD program with the prescription drug benefits of the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003 as the primary payer (P.L. 2007, c.111, p. 99). Therefore, the proposed amendments would require beneficiaries to submit the information necessary for PAAD to enroll them in Medicare Part D and apply for the low income subsidy, if they qualify.
The proposed amendments would allow beneficiary use of out-of-state mail order pharmacies when the pharmacy is part of a beneficiary’s Medicare Part D prescription drug plan pharmacy network.
When PAAD is the primary payer, the proposed amendments require prior authorization from PAAD for coverage of a brand name drug when a generic equivalent is available.
The proposed amendments also provide that PAAD would pay the Medicare Part D premium costs on behalf of PAAD beneficiaries to authorized Medicare prescription drug plans in an amount up to the benchmark amount set for
The proposed amendments provide for the implementation of initiatives mandated by the State fiscal year 2009 Appropriations Act, P.L. 2008, c.35. These initiatives include the increase of the PAAD co-payment from $5 to $6 for generic drugs and to $7 for brand name drugs. Other initiatives are changes to pharmacy reimbursement, and pharmacy fees, and the deletion of coverage for diabetic testing supplies.
In addition, the proposed amendments provide that benefits incorrectly paid to a beneficiary because of an unanticipated payment received by the beneficiary would be recoverable in accordance with N.J.S.A. 30:4D-21.4.
The notice of proposal appears in the August 4, 2008 issue of the New Jersey Register.
The public has until October 3, 2008 to comment on the proposal. Persons wishing to comment on the proposal must submit their comments in writing to Ruth Charbonneau, Director, Office of Legal and Regulatory Affairs, New Jersey Department of Health and Senior Services,
Department of Health
P. O. Box 360, Trenton, NJ 08625-0360