Presentment; copayment; procedure

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  • (a) In order to receive the benefits of the Program, a certified individual must present his identification card, provided for in section 43 of this chapter, and pay in full a copayment of six dollars ($6.00) to a pharmacy for the first prescription drug, and a one dollar co-payment for each additional prescription drug.

  • (b) In order to receive reimbursement for the reasonable costs of prescription drugs sold to certified individuals in excess of the copayments required by subsection (a) of this section, a pharmacy must forward written invoices documenting each such sale to the Commissioner within ninety (90) days from the date of such sale; provided, that the written invoices shall contain information required by the Commissioner to verify the nature and extent of each such sale.

  • (c) No later than forty-five (45) days from the date of receipt of a written invoice under subsection (b) of this section, the Commissioner shall:

    • (i) make a determination regarding the amount, if any, of the reimbursement to be made to a pharmacy on the submitted written invoice;

    • (ii) notify the pharmacy in writing of such determination; and

    • (iii) notify the Commissioner of Finance in writing of such determination.

  • (d) No sooner than twenty (20) days and not later than forty-five (45) days from the date of receipt of a written notification of determination under subsection (c) of this section, the Commissioner of Finance shall reimburse the pharmacy specified in such written notification, in the amount specified, from funds available in the Pharmaceutical Assistance to the Aged Special Fund established under Title 33, section 3073 of this Code; provided, that if the Commissioner fails to meet the requirements of subsection (c) of this section within the time period specified, or if the Commissioner of Finance fails to reimburse a pharmacy within the time period specified in this subsection, the pharmacy shall be entitled to interest on the specified amount at the rate of five percent (5%) per annum for the time period to the date of reimbursement.


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