240 – Short Title.
§ 240. Short title. This title shall be known and may be cited as the “program for elderly pharmaceutical insurance coverage”.
241 – Definitions.
§ 241. Definitions. For purposes of this title, the terms: 1. “Covered drug” shall mean a drug dispensed subject to a legally authorized prescription pursuant to section sixty-eight hundred ten of the education law, and insulin, an insulin syringe, or an insulin needle. Such term shall not include: (a) any drug determined by the commissioner […]
242 – Program Eligibility.
§ 242. Program eligibility. 1. Persons eligible for comprehensive coverage under section two hundred forty-seven of this title shall include: (a) any unmarried resident who is at least sixty-five years of age and whose income for the calendar year immediately preceding the effective date of the annual coverage period beginning on or after January first, […]
243 – Pharmaceutical Insurance Contract.
§ 243. Pharmaceutical insurance contract. 1. The commissioner of health shall, subject to the approval of the director of the budget, enter into a contract with one or more contractors to assist in carrying out the provisions of this title. Such contractual arrangements shall be made subject to a competitive process pursuant to the state […]
244 – Powers of the Commissioner of Health.
§ 244. Powers of the commissioner of health. The powers of the commissioner of health in administering the elderly pharmaceutical insurance coverage program shall include but not be limited to the following: 1. subject to the approval of the director of the budget, promulgating program regulations pursuant to section two hundred forty-six of this title; […]
246 – Regulations.
§ 246. Regulations. Program regulations shall: 1. Provide for a process of determining and redetermining eligibility for participation in this program including provisions for submission of proof of income, age, and residency and information on existing complete or partial coverage of prescription drug expenses under a third party assistance or insurance plan; 2. Provide for […]
247 – Cost-Sharing Responsibilities of Eligible Program Participants for Comprehensive Coverage.
§ 247. Cost-sharing responsibilities of eligible program participants for comprehensive coverage. 1. Registration fee. Eligible individuals meeting the registration fee requirements of this section may purchase prescribed covered drugs for an amount specified by subdivision three of this section, subject to the limits on point of sale co-payments specified by subdivision four of this section. […]
248 – Cost-Sharing Responsibilities of Eligible Program Participants for Catastrophic Coverage.
§ 248. Cost-sharing responsibilities of eligible program participants for catastrophic coverage. 1. Deductible. Eligible individuals meeting the deductible requirements of this section may purchase prescribed covered drugs for an amount specified by subdivision three of this section, subject to the limits on point of sale co-payments specified by subdivision four of this section. 2. Deductible […]
249 – Participating Provider Pharmacies.
§ 249. Participating provider pharmacies. 1. The state shall offer an opportunity to participate in this program to all provider pharmacies as defined in section two hundred forty-one of this title, provided, however, that the participation of pharmacies registered in the state pursuant to section sixty-eight hundred eight-b of the education law shall be limited […]
250 – Reimbursement to Participating Provider Pharmacies.
§ 250. Reimbursement to participating provider pharmacies. 1. The amount of reimbursement which shall be paid by the state to a participating provider pharmacy for any covered drug filled or refilled for any eligible program participant shall be equal to the allowed amount defined as follows, minus the point of sale co-payment as required by […]
251 – Penalties for Fraud and Abuse.
§ 251. Penalties for fraud and abuse. 1. Any person who knowingly makes a false statement or representation, or who by deliberate concealment of any material fact, or by impersonation or other fraudulent device, obtains or attempts to obtain or aids or abets any person to obtain any benefit under this title to which he […]
252 – Procedures for Determinations Relating to Package, or Form of Dosage or Administration, of Certain Drugs.
§ 252. Procedures for determinations relating to package, or form of dosage or administration, of certain drugs. 1. If the department of health makes an initial determination that a particular package, or form of dosage or administration, of a drug shall be excluded in accordance with the provisions of paragraph (b) of subdivision one of […]
253 – Utilization of Out-of-State Provider Pharmacies; Necessity and Convenience.
§ 253. Utilization of out-of-state provider pharmacies; necessity and convenience. 1. In counties having a population of seventy-five thousand or less that are in proximity to the state boundary and which are determined by the commissioner of health to be not adequately served by provider pharmacies registered in New York, and in Fishers Island in […]
254 – Cost of Living Adjustment.
§ 254. Cost of living adjustment. 1. Within amounts appropriated, the commissioner of health shall adjust the program eligibility standards set forth in subdivision two of section two hundred forty-two of this title to account for increases in the cost of living. 2. The commissioner shall further adjust individual and joint income categories set forth […]