New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 167B - SENIOR GOLD PRESCRIPTION PROGRAM MANUAL
Subchapter 4 - SCOPE OF SERVICE
Section 10:167B-4.3 - Amounts of reimbursement
Universal Citation: NJ Admin Code 10:167B-4.3
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The Program shall provide a payment to a pharmacy that is participating in the Program for the reasonable cost of one or more prescription drugs purchased by an eligible person who presents an identification card issued by the program in an amount that exceeds the co-payment paid by the eligible person.
(b) At the time of each purchase of a prescription drug, the eligible person shall pay a co-payment to the participating pharmacy that shall not be waived, discounted or rebated in whole or in part, and shall be equal to:
1. $ 15.00 plus 50 percent of the remaining amount of the reasonable cost
for the prescription drug, or the reasonable cost for the drug, whichever is less; or
2. $ 15.00, or the reasonable cost for the drug, whichever is less, in the
case of an eligible person who has incurred out-of-pocket expenditures, including co-payments and
deductibles, for the purchase of prescription drugs, which are not reimbursable by any other plan of
assistance or insurance and are credited to that person's account in the following amounts: $ 2,000 annually
for a single person and $ 3,000 annually for a married couple. These amounts shall be incurred on or after
the date that the person received proof of eligibility for the program from the Department.
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