Pennsylvania Statutes Title 40 P.S. Insurance § 4541. Definitions

The following words and phrases when used in this chapter shall have the meanings given to them in this section unless the context clearly indicates otherwise:

“A-rated generic therapeutically equivalent drug.” A drug product that the Commissioner of Food and Drugs of the United States Food and Drug Administration has approved as safe and effective and has determined to be therapeutically equivalent, as listed in “The Approved Drug Products with Therapeutic Equivalence Evaluations” (Food and Drug Administration “Orange Book”), with a specific “A” code designation only.

“Claimant.” An eligible person who is enrolled in the program.

“Department.” The Department of Aging of the Commonwealth.

“Less expensive.” The lowest net cost to the program. The net cost shall include the amount paid by the Commonwealth to a pharmacy for a drug under a current retail pharmacy reimbursement formula less any discount or rebates, including those paid during the previous calendar quarter and inclusive of all dispensing fees.

“NADAC per unit.” The current National Average Drug Acquisition Cost per unit.

“Prescription drug.” All drugs requiring a prescription in this Commonwealth, insulin, insulin syringes and insulin needles. Experimental drugs or drugs prescribed for wrinkle removal or hair growth are prohibited.

“Program.” The Pharmaceutical Assistance Contract for the Elderly (PACE) and the Pharmaceutical Assistance Contract for the Elderly Needs Enhancement Tier (PACENET) as established by the act of August 26, 1971 (P.L. 351, No. 91),  1 known as the State Lottery Law.

“Provider.” A pharmacy, dispensing physician or certified registered nurse practitioner enrolled as a provider in the program.

“Wholesale acquisition cost.” The cost of a dispensed drug based upon the price published in a national drug pricing system in current use by the Department of Aging as the wholesale acquisition cost of a prescription drug in the most common package size.