July 7, 2006
PACE Plus Medicare Legislation
PACE Plus Medicare Legislation Highlights
Effective Monday, July 10, 2006:
Pharmacy providers will be reimbursed the lower of eighty-eight (88%) of the average wholesale cost of the prescription drug dispensed, plus the dispensing fee minus the copay and any TPL amounts or the pharmacy’s usual charge for the drug dispensed or the FUL (Federal Upper Limits), plus the dispensing fee minus the copayment and any TPL amounts.
Dispensing physicians or certified registered nursed practitioners will be paid the lower of eighty-eight (88%) of the average wholesale cost of the prescription drug dispensed, minus the copay and any TPL amounts or the dispensing physicians or certified registered nurse practitioner ’s usual charge for the drug dispensed or the FUL (Federal Upper Limits, minus the copayment and any TPL amounts.
Effective September 1, 2006, in coordination with the enrollment of PACE and PACENET cardholders into recommended Part D plans:
PACE will only accept Part D claims submitted to PACE/PACENET from those PACE/PACENET providers participating in the cardholder’s Part D plan.
PACE will accept claims with a day’s supply greater than 30 days for cardholders utilizing a Medicare Part D plans mail order benefit.
Providers may review the new legislation by accessing the Department of Aging’s website at www.AGING.STATE.PA.US. Click on the blue PACE Card and access the PACE/PACENET Reports and Publications topic.