72 Pa. Stat. § 3761-502
The following words and phrases when used in this chapter shall have the meanings given to them in this section unless the context clearly indicates otherwise:
"A-rated generic therapeutically equivalent drug." A drug product that the Commissioner of Food and Drugs of the United States Food and Drug Administration has approved as safe and effective and has determined to be therapeutically equivalent, as listed in "The Approved Drug Products with Therapeutic Equivalence Evaluations" (Food and Drug Administration "Orange Book"), with a specific "A" code designation only.
"Average wholesale cost." The cost of a dispensed drug based upon the price published in a national drug pricing system in current use by the Department of Aging as the average wholesale price of a prescription drug in the most common package size.
"Average wholesale price." Average wholesale cost.
"Board." The Pharmaceutical Assistance Advisory Board.
"Claimant." An eligible person who is enrolled in the program.
"CMS." The Centers for Medicare and Medicaid Services of the United States.
"Department." The Department of Aging of the Commonwealth.
"DESI." The Drug Efficacy Study Implementation List.
"Eligible person." A resident of the Commonwealth for no less than 90 days, who is 65 years of age or older, whose annual income is less than the maximum annual income and who is not otherwise qualified for public assistance under the act of June 13, 1967 (P.L. 31, No. 21), known as the Public Welfare Code.
"FDA." The United States Food and Drug Administration of the Public Health Service of the Department of Health and Human Services.
"Health maintenance organization." An organized system which combines the delivery and financing of health care and which provides basic health services to voluntarily enrolled subscribers for a fixed prepaid fee.
"Income." All income from whatever source derived, including, but not limited to, salaries, wages, bonuses, commissions, income from self-employment, alimony, support money, cash public assistance and relief, the gross amount of any pensions or annuities, including railroad retirement benefits, all benefits received under the Social Security Act (49 Stat. 620, 42 U.S.C. § 301 et. seq.) net of amounts withheld for Medicare Part B premium payment, all benefits received under State unemployment insurance laws , all interest received from the Federal Government or any state government or any instrumentality or political subdivision thereof, realized capital gains, rentals, workmen's compensation and the gross amount of loss of time insurance benefits, life insurance benefits and proceeds, except the first $10,000 of the total of death benefits payments, and gifts of cash or property, other than transfers by gift between members of a household, in excess of a total value of $300, but shall not include surplus food or other relief in kind supplied by a government agency or property tax rebate nor shall the term include any State veterans' benefit payments.
"LEP" or "late enrollment penalty." The amount added to the Part D plan premium of either:
The LEP is considered a part of the plan premium.
"Less expensive." The lowest net cost to the program. The net cost shall include the amount paid by the Commonwealth to a pharmacy for a drug under a current retail pharmacy reimbursement formula less any discount or rebates, including those paid during the previous calendar quarter and inclusive of all dispensing fees.
"Maintenance medication." A medication prescribed for a chronic, long-term condition and taken on a regular, recurring basis.
"Maximum annual income." For PACE eligibility, the term shall mean annual income which shall not exceed $14,500 in the case of single persons nor $17,700 in the case of the combined annual income of persons married to each other. For PACENET eligibility, the term shall mean the annual income limits established under section 519. Persons may, in reporting income to the Department of Aging, round the amount of each source of income and the income total to the nearest whole dollar, whereby any amount which is less than 50¢ is eliminated.
"Medicare advantage." A plan of health benefits coverage offered under a policy, contract or plan by an organization certified under 42 U.S.C. § 1395w-26 (relating to establishment of standards) and formerly referred to as Medicare+Choice.
"Medicare Advantage Prescription Drug Plan." A Medicare advantage plan that provides qualified prescription drug coverage as set forth in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ( Public Law 108-173, 117 Stat. 2066).
"Medication synchronization." The coordination of prescription drug filling or refilling by a pharmacy or dispensing physician for a program participant taking two or more medications for the purpose of improving medication adherence.
"PACE." The Pharmaceutical Assistance Contract for the Elderly program provided for in this chapter.
"PACENET." The Pharmaceutical Assistance Contract for the Elderly Needs Enhancement Tier provided for in this chapter.
"Part D." A Federal program to offer voluntary prescription drug benefits to Medicare enrollees, as set forth in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173, 117 Stat. 2066).
"Part D plan" or "PDP." A prescription drug plan approved under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ( Public Law 108-173, 117 Stat. 2066) in the PDP region that includes this Commonwealth and approved by the Department of Aging of the Commonwealth and the Centers for Medicare and Medicaid Services of the United States for coordination of benefits with the programs established under this chapter.
"Pharmacy." A pharmacy licensed by the Commonwealth.
"Preferred provider organization." An entity organized and operating under 40 Pa.C.S. Ch. 63 (relating to professional health services plan corporations).
"Prescription drug." All drugs requiring a prescription in this Commonwealth, insulin, insulin syringes and insulin needles. Experimental drugs or drugs prescribed for wrinkle removal or hair growth are prohibited.
"Private contractor." A person, partnership or corporate entity who enters into a contract with the Commonwealth to provide services under the provisions of this chapter.
"Program." The Pharmaceutical Assistance Contract for the Elderly (PACE) and the Pharmaceutical Assistance Contract for the Elderly Needs Enhancement Tier (PACENET) as established by this chapter.
"Provider." A pharmacy, dispensing physician or certified registered nurse practitioner enrolled as a provider in the program.
"Regional benchmark premium." The average Part D premium calculated annually by the Centers for Medicare and Medicaid Services of the United States for PDPs in the PDP region that includes this Commonwealth.
"State veterans' benefit payments." Service-connected compensation or payments provided to a veteran or an unmarried surviving spouse of a veteran by a State agency or authorized under State law.
72 P.S. § 3761-502