Bureau of Pharmaceutical Assistance (PACE/PACENET)
The Bureau of Pharmaceutical Assistance has responsibility for the operations of the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE). Although routine daily operations involving application adjudication, claims adjudication, and management information system functions are contracted to First Health, the bureau has numerous related responsibilities beyond overseeing this contract. Chief among these are managing activities related to the pharmaceutical manufacturers' rebate program; prospective, retrospective and surveillance drug utilization review; pharmacy audits and investigations; CME-accredited training for physicians and pharmacists; and coordinating and directing comprehensive longitudinal-research, semiannual actuarial analyses, and related research necessary for the evaluation and formulation of program policy.
The bureau also provides staff support to the Pharmaceutical Assistance Review Board. This eight-person board is comprised of: the Secretary of Aging (Chair), the Secretary of Revenue, the Secretary of Health, four public members appointed by the legislative leaders, and one physician appointed by the Governor. The board meets quarterly to review program and financial reports and to make recommendations concerning program policies and procedures.
To accomplish its mission, the bureau is organized into four functional areas or divisions, which are:
Cardholder Applications and Enrollments
The Cardholder Applications and Enrollments Division oversees all activities in this area and manages the applicant/enrollee appeal process. This division also coordinates the yearly comparison of the PACE enrollee file with the Department of Revenue's Income Tax File to verify income reported on their state income tax returns with the information enrollees have reported on their PACE application.
The Compliance Division monitors provider enrollment activities and drug utilization patterns, coordinates the provider audit activity, and investigates instances of suspected fraud and abuse.
The Operations Division oversees the administrative activities of the PACE contractor, resolves non-routine administrative problems, and ensures that program standards are being met or exceeded.
The Research Division prepares the PACE Annual Report and other routine and ad hoc reports, coordinates and supports a wide range of external research activities involving the program such as longitudinal studies and actuarial analyses, conducts computer simulations on program policy options, and directs activities related to the pharmaceutical manufacturers rebate and prospective DUR programs.
For additional information on the PACE/PACENET programs click here.