2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-280. (Formerly Sec. 17-134bb). - Reimbursement rate for covered outpatient drugs under the Medicaid program.

(a) Effective on and after April 1, 2017, the Commissioner of Social Services shall revise the reimbursement methodology and professional dispensing fees for covered outpatient drugs under the Medicaid program to meet the requirements of federal regulations implementing changes to Section 1927 of the Social Security Act. Any such revision to the reimbursement methodology and professional dispensing fees for covered outpatient drugs under the Medicaid program shall conform with procedures established by the Centers for Medicare and Medicaid Services to reflect actual acquisition costs and shall not adversely impact access to such outpatient drugs.
(b) The Department of Social Services shall pay for an original prescription that is otherwise eligible for payment and as many refills as ordered by a licensed authorized practitioner within twelve months, provided controlled substances as described in subsection (h) of section 21a-249 shall not be included in the provisions of this subsection. The department shall pay a professional dispensing fee pursuant to subsection (a) of this section for each approved refill.
(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; Sept. Sp. Sess. P.A. 09-5, S. 71; P.A. 10-179, S. 23; P.A. 11-44, S. 76; June 12 Sp. Sess. P.A. 12-1, S. 18; Dec. Sp. Sess. P.A. 12-1, S. 22; P.A. 13-139, S. 8; 13-234, S. 81, 99; June Sp. Sess. P.A. 15-5, S. 381, 399; June Sp. Sess. P.A. 17-2, S. 570.)
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; Sept. Sp. Sess. P.A. 09-5 amended Subsec. (a) by changing professional fee from $3.15 to $2.65 and adding provision applying fee to drugs dispensed under state-administered general assistance program, effective October 5, 2009; P.A. 10-179 amended Subsec. (a) by changing professional fee per prescription from $2.65 to $2.90, effective May 7, 2010; P.A. 11-44 amended Subsec. (a) by replacing names of medical assistance programs with “medical assistance programs administered by the Department of Social Services”, restating provision re professional fee to require state to pay fee to licensed pharmacies, decreasing professional fee from $2.90 to $2, decreasing rate to average wholesale price minus sixteen per cent, and making technical changes, effective July 1, 2011; June 12 Sp. Sess. P.A. 12-1 amended Subsec. (a) by adding provision permitting commissioner to establish reimbursement rate for independent pharmacies, added Subsec. (c) defining “independent pharmacy”, “community pharmacy” and “legend drug” and added Subsec. (d) requiring commissioner to submit an amendment to the Medicaid state plan to establish the independent pharmacy rate; Dec. Sp. Sess. P.A. 12-1 amended Subsec. (a) to replace 14% with 15% in Subpara. (B) and to replace $2.00 with $1.75 re professional fee, effective December 21, 2012; P.A. 13-139 amended Subsec. (a) by substituting “individuals with intellectual disabilities” for “the mentally retarded”; P.A. 13-234 amended Subsec. (a) to delete provision re reimbursement rates for independent pharmacies and deleted former Subsecs. (c) and (d) re definition of “independent pharmacy” and state plan amendment to establish independent pharmacy rate, effective July 1, 2013, and further amended Subsec. (a) to delete reference to ConnPACE, effective January 1, 2014; June Sp. Sess. P.A. 15-5 amended Subsec. (a) to reduce average wholesale price rate basis from minus 16 per cent to minus 16.5 per cent and the professional fee from $1.70 to $1.40, effective July 1, 2015, and added Subsec. (c) re payment within 12 months and professional license fee, effective August 1, 2015; June Sp. Sess. P.A. 17-2 amended Subsec. (a) to replace provisions re reimbursement for drugs under medical assistance programs and dispensing fee with provision re commissioner to revise reimbursement methodology and professional dispensing fees for covered outpatient drugs under the Medicaid program to meet requirements of federal regulations, deleted former Subsec. (b) re enhanced dispensing fee, redesignated Subsec. (c) as Subsec. (b) and amended same to replace “professional license fee” with “professional dispensing fee”, effective October 31, 2017.
Cited. 233 C. 557.