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Current as of January 01, 2026 | Updated by Findlaw Staff
The department:
(1) Shall identify the Part D plan or plans with which the department has entered into a contract under section 534 1 that meet the prescription drug needs and pharmacy preferences of a claimant.
(2) May require that the claimant enroll in the Part D plan or program that meets the prescription drug needs and pharmacy preferences of the claimant in the most cost-effective manner for the Commonwealth.
(3) Shall initiate enrollment on behalf of the claimant in the Part D plan recommended by the department unless the claimant notifies the department that the claimant wishes to enroll in another Part D plan.
(4) Shall file and pursue appeals in accordance with CMS regulations with a claimant's Part D plan on the claimant's behalf to request exceptions to the plan's tiered cost-sharing structure or to request a nonformulary Part D drug.
(5) Shall assist claimants the department believes to be eligible for the LIS in making an application to the Social Security Administration.
(6) Shall provide at least ten days for the claimant to decline enrollment in the recommended plan.
(7) Shall develop and distribute language, when recommending enrollment, notifying claimants of:
(i) The ability to decline enrollment in the recommended Part D plan.
(ii) The ability to file and pursue appeals to the recommended Part D plan on their own behalf.
(iii) The possibility that their choice of plan may affect their medical coverage if they are enrolled in a Medicare advantage plan, if applicable.
Cite this article: FindLaw.com - Pennsylvania Statutes Title 72 P.S. Taxation and Fiscal Affairs § 3761-533. Powers of the department - last updated January 01, 2026 | https://codes.findlaw.com/pa/title-72-ps-taxation-and-fiscal-affairs/pa-st-sect-72-3761-533/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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