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Pennsylvania Statutes Title 40 P.S. Insurance § 4542. Program payment

Current as of January 01, 2025 | Updated by Findlaw Staff

In addition to the requirements under section 509 of the act of August 26, 1971 (P.L. 351, No. 91),  1 known as the State Lottery Law, the department shall administer the program in accordance with the following:

(1) If the NADAC per unit is available, the program payment shall be the lower of the following amounts:

(i) the NADAC per unit:

(A) with the addition of a professional dispensing fee of $13 per prescription; and

(B) the subtraction of the copayment; or

(ii) the pharmacy's usual and customary charge for the drug dispensed with the subtraction of the copayment.

(2) If the NADAC per unit is unavailable, the program payment shall be the lower of the following amounts:

(i) the wholesale acquisition cost plus 3.2%:

(A) with the addition of a professional dispensing fee of $13 per prescription; and

(B) the subtraction of the copayment; or

(ii) the pharmacy's usual and customary charge for the drug dispensed with the subtraction of the copayment.

1 72 P.S. § 3761-509.
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Cite this article: FindLaw.com - Pennsylvania Statutes Title 40 P.S. Insurance § 4542. Program payment - last updated January 01, 2025 | https://codes.findlaw.com/pa/title-40-ps-insurance/pa-st-sect-40-4542/

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