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For Release:
April 20, 2009

Heather Howard

For Further Information Contact:
Office of Communications
(609) 984-7160

DHSS Proposes to Readopt and Amend N.J.A.C. 8:83C, which Regulates the Provision of Pharmaceutical Services under the Pharmaceutical Assistance to the Aged and Disabled Program


       The Division of Senior Benefits and Utilization Management of the Department of Health and Senior Services proposes to readopt with amendments N.J.A.C. 8:83C, which regulates the provision of pharmaceutical services under the Pharmaceutical Assistance to the Aged and Disabled Program (PAAD).  The Department has reviewed the existing regulations and has determined that they are necessary, adequate, reasonable, proper and responsive for the purpose for which they were originally promulgated.  However, the Department has identified areas where the rules need to be updated.


There are several proposed amendments that are necessitated by mandates in the Fiscal Year 2009 Appropriations Act, P.L. 2008, c.35.  These proposed amendments eliminate coverage for diabetic testing supplies, allow PAAD beneficiaries to use mail order pharmacies or specialty pharmacies covered under their Medicare Part D prescription plan, and allow beneficiaries to use mail order when it is required by their primary payer other than Part D.   The PAAD Program already requires eligible beneficiaries to enroll in Medicare Part D.   Additionally, the Act mandates changes to refill requirements, pharmacy reimbursement, prescription pricing and pharmacy fees.


The Department has also proposed amendments to the current rules to allow for more efficient administration of the program and to add protections to PAAD beneficiary prescriptions.  For example, the proposed readoption continues to require that all pharmacy services providers that wish to participate in PAAD obtain a Medicaid provider number.  It also proposes to require all providers to maintain a Medicaid provider number for continued participation in PAAD.  Other amendments include changes to the methods that are used in providing dispensing fees and application of days supply limitations when PAAD is the secondary payer.  The proposal also allows prescriptions to be transmitted by fax and electronically in accordance with Board of Pharmacy regulations.  To more efficiently coordinate benefits when Medicare Part D is the primary payer, the Department also proposes that pharmacies, upon notification by PAAD, reverse the denial of a claim and reprocess it when the claim has been successfully appealed through the Medicare Part D appeal process.


The rules would be updated to eliminate reference to the Drug Utilization Review Council and to reference the current version of the electronic format used for point of sale submission of claims that complies with the National Council Prescription Drug Program standards.


       The notice of proposal appears in the April 20, 2009 issue of the New Jersey Register.


       The public has until June 19, 2009 to comment on the proposal.  Persons wishing to comment on the proposal must submit their comments in writing to Ruth Charbonneau, Director, Office of Legal and Regulatory Affairs, New Jersey Department of Health and Senior Services, PO Box 360, Trenton, NJ 08625.  Written comments on the proposal must be postmarked on or before June 20, 2009, which is the close of the 60-day public comment period for the proposal.

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