Bill Text: NJ A3 | 2022-2023 | Regular Session | Amended
Bill Title: Revises income eligibility criteria for, and provides for promotion of, PAAD and Senior Gold Prescription Discount Program; establishes "Senior Save Navigator Grant Program" to assist applicants with NJ Save applications.
Sponsorship: Partisan Bill (Democrat 15)
Status: (Introduced - Dead) 2023-06-30 - Substituted by S3 (2R) [A3 Detail]
Download: New_Jersey-2022-A3-Amended.html
[Second Reprint]
ASSEMBLY, No. 3
STATE OF NEW JERSEY
220th LEGISLATURE
INTRODUCED MAY 18, 2023
Sponsored by:
Assemblyman P. CHRISTOPHER TULLY
District 38 (Bergen and Passaic)
Assemblyman PAUL D. MORIARTY
District 4 (Camden and Gloucester)
Assemblywoman ANGELA V. MCKNIGHT
District 31 (Hudson)
Assemblyman ROY FREIMAN
District 16 (Hunterdon, Mercer, Middlesex and Somerset)
Assemblywoman ANNETTE QUIJANO
District 20 (Union)
Assemblyman RAJ MUKHERJI
District 33 (Hudson)
Assemblywoman LISA SWAIN
District 38 (Bergen and Passaic)
Assemblywoman LINDA S. CARTER
District 22 (Middlesex, Somerset and Union)
SYNOPSIS
Revises income eligibility criteria for, and provides for promotion of, PAAD and Senior Gold Prescription Discount Program; establishes "Senior Save Navigator Grant Program" to assist applicants with NJ Save applications.
CURRENT VERSION OF TEXT
As reported by the Assembly Budget Committee on June 28, 2023, with amendments.
An Act concerning prescription assistance 2[and] ,2 amending 2and supplementing2 P.L.1975, c.194 2,2 and 2[P.L.2001, c.96] supplementing Title 30 of the Revised Statutes2.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 2 of P.L.1975, c.194 (C.30:4D-21) is amended to read as follows:
2. a. Any resident of this State who is either a recipient of disability insurance benefits under Title II of the federal Social Security Act (42 U.S.C. s. 401 et seq.) or 65 years of age and over and whose annual income is less than [$38,769 if single or, if married, whose annual income combined with that of his spouse is less than $45,270] 2[or equal to 400 percent of the federal poverty level, whether single or married] $52,142 if single or, if married, whose annual income combined with that of the person's spouse is less than $59,2092, shall be eligible for "Pharmaceutical Assistance to the Aged and Disabled" if [he] the person is not otherwise qualified for assistance under P.L.1968, c.413 (C.30:4D-1 et seq.). Annual income shall not include gain from the sale of a principal residence that is excluded from gross income pursuant to N.J.S.54A:6-9.
b. (1) [Except as provided in paragraph (2) of this subsection, beginning January 1, 1996 and annually thereafter, the income eligibility limits provided in subsection a. of this section shall increase by the amount of the maximum Social Security benefit cost-of-living increase for that year for single and married persons, respectively. The commissioner shall adopt the new income limits annually by regulation pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).] 2[(Deleted by amendment, P.L. , c. (C. )(pending before the Legislature as this bill).)] Except as provided in paragraph (2) of this subsection, beginning January 1, 1996 and annually thereafter, the income eligibility limits provided in subsection a. of this section shall increase by the amount of the maximum Social Security benefit cost-of-living increase for that year for single and married persons, respectively. The commissioner shall adopt the new income limits annually by regulation pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).2
(2) [No cost-of-living increase shall be applied under paragraph (1) of this subsection in calendar year 2022. The cost-of-living increase shall resume beginning January 1, 2023, and the income eligibility limits shall be annually increased thereafter consistent with the requirements of paragraph (1) of this subsection.] 2[(Deleted by amendment, P.L. , c. (C. )(pending before the Legislature as this bill).)] No cost-of-living increase shall be applied under paragraph (1) of this subsection in calendar year 2024. The cost-of-living increase shall resume beginning January 1, 2025, and the income eligibility limits shall be annually increased thereafter consistent with the requirements of paragraph (1) of this subsection.2
(cf: P.L.2021, c.131, s.1)
2[2. Section 3 of P.L.2001, c.96 (C.30:4D-45) is amended to read as follows:
3. a. There is established the "Senior Gold Prescription Discount Program" in the Department of Human Services.
b. A resident of this State shall be eligible for the program if the person is:
(1) either 65 years of age or older or a recipient of disability insurance benefits under Title II of the federal Social Security Act (42 U.S.C. s.401 et seq.);
(2) receiving an annual income, the amount of which is [not] more than [$10,000 above] the applicable PAAD income eligibility limits for single and married persons[, which amount is to be determined on the same basis as income is determined for the purpose of eligibility for PAAD] as established pursuant to section 1[4 of P.L.2000, c.28] 2 of P.L.1975, c.1941 (C.30:4D-21); and
(3) not eligible for any other program of State-funded prescription drug benefits.
c. The program shall provide a payment to a pharmacy that is participating in the program for the reasonable cost of one or more prescription drugs purchased by an eligible person who presents an identification card issued by the program in an amount that exceeds the copayment paid by the eligible person. The payments to pharmacies shall commence no later than 120 days after the effective date of [this act] P.L.2001, c.96 (C.30:4D-43 et seq.) or after enactment, whichever is later.
At the time of each purchase of a prescription drug, the eligible person shall pay a copayment that shall not be waived, discounted, or rebated in whole or in part, and shall be equal to:
(1) $15 plus [50%] 50 percent of the remaining amount of the reasonable cost for the prescription drug, or the reasonable cost for the prescription drug, whichever is less; or
(2) $15, or the reasonable cost for the prescription drug, whichever is less, in the case of an eligible person who has incurred out-of-pocket expenditures, including copayments and deductibles, for the purchase of prescription drugs, which are not reimbursable by any other plan of assistance or insurance and are credited to that person's account for each 12-month period of eligibility in accordance with procedures established by the commissioner, in the following amounts: $2,000 for a single person and $3,000 for a married couple. These out-of-pocket expense amounts shall include only expenses incurred on or after the date that the person received proof of eligibility for the program from the department.
d. If an interchangeable drug product contained in the latest list approved and published by the Drug Utilization Review Council pursuant to section 7 of P.L.1977, c.240 (C.24:6E-6) is available for the prescribed prescription drug, an eligible person shall either:
(1) purchase an interchangeable drug product, the cost of which is equal to or less than the maximum allowable cost as determined by the commissioner; or
(2) if the prescriber specifically indicates that substitution is not permissible, purchase the prescribed drug product that is higher in cost than the maximum allowable cost as determined by the commissioner and pay the amount of the price above that maximum allowable cost, in addition to the amount of the copayment paid by the eligible person pursuant to subsection c. of this section.
e. An eligible person whose prescription drug costs are covered in part by any other program or plan of assistance or insurance may be required to receive reduced assistance under the Senior Gold Prescription Discount Program. If an eligible person's prescription drug costs are covered in whole or in part by any other program or plan of assistance or insurance, the other program or plan shall be the primary payer and the Senior Gold Prescription Discount Program shall be the payer of last resort.
f. The commissioner may establish limits on the day supply or maximum quantity of prescription drugs which may be purchased by an eligible person under the program in a manner equivalent to those established for prescription drug purchases under PAAD.
g. An eligible person under the program shall, upon the submission of an application and proof of expenditure as the department may prescribe, be reimbursed for [50%] 50 percent of the cost of each prescription drug purchased by that person in an amount that exceeds the required copayment, during the period commencing 30 days after the person's properly completed application was received by the department and ending on the date on which the person received proof of eligibility from the department; except that no reimbursement under this act shall be made for a prescription drug purchased prior to the effective date of [this act] P.L.2001, c.96 (C.30:4D-43 et seq.).
h. The commissioner shall by regulation provide for:
(1) arrangements for providing notice of the availability of the program and the distribution of application forms therefor;
(2) a system of payments to pharmacies that includes the same dispensing fee structure that is used for PAAD and a system for determining eligibility for the program, including evidence of complete or partial coverage of prescription drug costs by any other program or plan of assistance or insurance; [and]
(3) the issuance of program identification cards to persons who are determined eligible for the program; and
(4) a system of automatic enrollment in the Senior Gold Prescription Discount Program, in which any New Jersey resident, 65 years of age or older, who presents at a pharmacy that is participating in the program to purchase a prescription drug, shall be automatically enrolled in the program. In a method and manner prescribed by the commissioner, the pharmacy shall collect, and submit to the Department of Human Services, the name, age, address, phone number, and any information necessary to comply with the provisions of subsection e. of this section of an individual who qualifies for automatic enrollment under this paragraph. The pharmacy shall also issue an individual who qualifies for automatic enrollment under this paragraph a program identification card, which card shall provide the individual immediate access to the applicable Senior Gold Prescription Discount Program benefits, and a NJSAVE application with instructions to submit the printed application, or an online application, to the department in order to be screened for additional programs. As used in this paragraph, "NJSAVE application" means the application administered by the Division of Aging Services in the Department of Human Services which screens and enrolls eligible applicants, at a minimum, in the following programs: the Pharmaceutical Assistance to the Aged and Disabled program; the Lifeline Utility Assistance program; the Qualified Medicare Beneficiary Program; the Specified Low-Income Medicare Beneficiary Program; the Qualifying Individual Program; the Low Income Subsidy Program under Medicare Part D; and the Hearing Aid Assistance to the Aged and Disabled program.
If, at the end of the month following the month in which a pharmacy automatically enrolled an individual in the Senior Gold Prescription Discount Program, the department has not received the individual's NJSAVE application, the department shall mail the individual an NJSAVE application with instructions for the individual to submit the printed application or an online application to the department in order to be screened for additional programs. This notice shall provide information on the eligibility criteria, and benefits available, for each program screened with the NJSAVE application.
(cf: P.L.2012, c.17, s.387)]2
2[3. This act shall take effect immediately.]2
22. (New Section) Notwithstanding any other provision of law to the contrary, a community retail pharmacy practice site shall prominently display at the point of sale for pharmaceuticals signage or promotional materials, promulgated by the Commissioner of Human Services, providing information about the "Pharmaceutical Assistance to the Aged and Disabled" program established pursuant to P.L.1975, c.194 (C.30:4D-20 et seq.). Payments to the pharmacy pursuant to section 3 of P.L.1975, c.194 (C.30:4D-22) may be withheld for any day that the pharmacy fails to display the signage or promotional materials required under this section, as determined by the commissioner.2
23. (New section) Notwithstanding any other provision of law to the contrary, a community retail pharmacy practice site shall prominently display at the point of sale for pharmaceuticals signage or promotional materials, promulgated by the Commissioner of Human Services, providing information about the "Senior Gold Prescription Discount Program" established pursuant to P.L.2001, c.96 (C.30:4D-43 et seq.). Payments to the pharmacy pursuant to subsection c. of section 3 of P.L.2001, c.96 (C.30:4D-45) may be withheld for any day that the pharmacy fails to display the signage or promotional materials required under this section, as determined by the commissioner.2
24. (New section) In addition to the reimbursement required pursuant to section 1 of P.L. 1979, c.27 (C.30:4D-34), any eligible person under the Pharmaceutical Assistance to the Aged and Disabled program, upon receiving proof of eligibility from the department and submitting proof of expenditure to the department, as the department may prescribe, shall be reimbursed for the remainder of the costs of all prescription drugs purchased by such person in an amount equal to the value of the benefit the person would have received had that person been enrolled in the Pharmaceutical Assistance to the Aged and Disabled program at the time of purchase, minus the required copayment per prescription, during the period commencing 30 days before such person's properly completed application was received by the department and ending on the date on which such person received proof of eligibility from the department; provided, however, that no reimbursement under this section shall be made for any prescription drug purchased prior to the first day of the fourth month next following the effective date of sections 2 through 6 of P.L. , c. (C. ) (pending before the Legislature as this bill).2
25. (New section) In addition to the reimbursement required pursuant to subsection g. of section 3 of P.L. 2001, c.96 (C.30:4D-45), any eligible person under the Senior Gold Prescription Discount Program, upon receiving proof of eligibility from the department and submitting proof of expenditure to the department, as the department may prescribe, shall be reimbursed for the remainder of the costs of all prescription drugs purchased by such person in an amount equal to the value of the benefit the person would have received had that person been enrolled in the Senior Gold Prescription Discount Program at the time of purchase, minus the required copayment per prescription, during the period commencing 30 days before such person's properly completed application was received by the department and ending on the date on which such person received proof of eligibility from the department; provided, however, that no reimbursement under this section shall be made for any prescription drug purchased prior to the first day of the fourth month next following the effective date of sections 2 through 6 of P.L. , c. (C. ) (pending before the Legislature as this bill).2
26. (New section) a. There is established in the Department of Human Services a "Senior Save Navigator Grant Program" to promote awareness of, and to assist applicants with the submission of, the NJSave application, as well as to support an applicant's enrollment in the programs accessible through the NJSave application, including the "Pharmaceutical Assistance to the Aged and Disabled" program established pursuant to P.L.1975, c.194 (C.30:4D-20 et seq.) and the "Senior Gold Prescription Discount Program" established pursuant to P.L.2001, c.96 (C.30:4D-43 et seq.).
b. Via a process and method determined by the Commissioner of Human Services, the Senior Save Navigator Grant Program shall fund the recruitment, training, and cost of Senior Save Navigators. Senior Save Navigators shall conduct outreach and assist residents in completing the NJSave application, and provide residents information about programs available through the NJSave application for which they may be eligible.2
27. (New section) There is appropriated the sum of $6,700,000 from the General Fund to the Department of Human Services to effectuate the provisions of sections 2 through 6 of this act.2
28. Section 1 of this act shall take effect January 1, 2024. Sections 2 through 7 of this act shall take effect immediately, but the Commissioner of Human Services shall not withhold payment pursuant to sections 2 and 3 of this act for a pharmacist's or pharmacy's failure to display a poster until the first day of the first month next following the commissioner's promulgation of the poster or posters required by those sections.2
