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drugs and medications furnished under the program, including | | covered prescription and nonprescription drugs, medications | | and medical supplies, under the following terms. |
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| | | (1)__For the basic component of the program, the total | | cost to an enrollee for the purchase of any covered | | drug or medication may not exceed the sum of $2 plus | | 20% of the price allowed for that drug or medication | | under program rules. |
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| | | (2)__For the supplemental component of the program, the | | total cost to an enrollee for the purchase of any | | covered drug or medication may not exceed: |
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| | | (a)__For a brand name drug or medication, the cost | | to the program for that drug or medication minus | | the $2 paid by the program; and |
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| | | (b)__For a generic drug or medication, the sum of | | $2 plus 20% of the price allowed for that drug or | | medication under program rules. |
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| | | (3)__For the catastrophic component of the program, the | | commissioner shall establish annual limits on the costs | | incurred by enrollees for drugs and medications covered | | under the program on or prior to May 31, 2001.__After | | the limit is reached, the program must pay 80% of the | | cost of each drug and medication covered by the | | supplemental component of the program on May 31, 2001 | | minus $2.__Any remaining amount is paid by the | | enrollee.__The limits must be set by the commissioner | | by rule as necessary to operate the program within the | | program budget. |
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| | | H.__Payment must be denied for drugs from manufacturers that | | do not enter into a rebate agreement with the department. |
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| | | (1)__Each agreement must provide that the manufacturer | | make rebate payments for both the basic and | | supplemental components of the program to the | | department according to the following schedule. |
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| | | (a)__From October 1, 1992 to October 1, 1998, the rebate | | percentage is equal to the percentage recommended by the federal | | Center for Medicare and Medicaid Services of the manufacturer's | | wholesale price for the total number of dosage units of each form | | and strength of a prescription drug that the department reports | | as reimbursed to providers of prescription drugs, provided | | payments are not due |
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