§ 42-66.2-6 - Responsibilities of department of elderly affairs.
SECTION 42-66.2-6
§ 42-66.2-6 Responsibilities of departmentof elderly affairs. – (a) Determination of eligibility. The department shall adopt regulationsrelating to the determination of eligibility of prospective consumers and thedetermination and elimination of program abuse. The department has the powerto declare ineligible any consumer who abuses or misuses the establishedprescription plan. The department has the power to investigate cases ofsuspected provider or consumer fraud.
(b) Rebates for expenses prohibited. (1) Asystem of rebates or reimbursements to the consumer for pharmaceutical expensesshall be prohibited.
(2) Subdivision (1) shall not be interpreted to exclude otherconsumers not participating in the pharmaceutical assistance to the elderlyprogram from receiving financial offers or redeemable coupons that areavailable to only those who have paid for the service or product through directcash payment, insurance premiums, or cost sharing with an employer.
(c) Program criteria. The program includes thefollowing criteria:
(1) Collection of the co-payment by pharmacies is mandatory;
(2) Senior citizens participating in the program are notrequired to maintain records of each transaction but shall sign a receipt foreligible and additional drugs;
(3) A system of rebates or reimbursements to the consumer forpharmaceutical expenses is prohibited;
(ii) This subdivision shall not be interpreted to excludeother consumers from receiving financial offers or redeemable coupons that areavailable to only those who have paid for the service or product through directcash payment, insurance premiums, or cost sharing with an employer.
(4) Prescription benefits for any single prescription may bedispensed in the amounts authorized by the physician, and agreed to by theconsumer, up to a maximum of a one hundred (100) day supply or two hundred(200) doses, whichever is less and/or a one hundred (100) day supply or onequart of liquid, whichever is less; provided, however, that disposable insulinsyringes are dispersed in a quantity of one hundred (100);
(5) Experimental drugs are excluded from the program;
(6) A system of mail order delivery for prescriptions isallowed under this program; and
(7) Eligible and additional drugs must be dispensed withinone year of the original prescription order.
(d) The director shall issue an eligibility card containing aprogram ID number and the time period for which the card is valid.
(e) The director shall provide a mechanism, within thedepartment, to handle all public inquiries concerning the program.
(f) The director shall establish a process, in accordancewith the Administrative Procedures Act, chapter 35 of this title, to provide anappeals hearing on the determination of eligibility.
(g) The director shall forward to the contractor a list ofall eligible consumers.
(h) Expenditures for multiple sclerosis drugs shall notexceed thirty thousand dollars ($30,000).
(i) Generic drug substitution is mandatory when there is anavailable generic drug equivalent.