New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 167B - SENIOR GOLD PRESCRIPTION PROGRAM MANUAL
Subchapter 6 - ELIGIBILITY REQUIREMENTS
Section 10:167B-6.5 - Recipient of other assistance and pharmaceutical coverage
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The Senior Gold Prescription Discount Act provides that an eligible person whose prescription drug costs are covered in part by any other program or plan of assistance or insurance may be required to receive reduced assistance under the Program. If an eligible person's prescription drug costs are covered in whole or in part by any other program or plan of assistance of insurance, the other program or plan shall be the primary payer, and the Program shall be the payer of last resort.
(b) Individuals with coverage described in (a) above must submit their prescriptions for payment to the other program or plan of assistance or insurance for payment before submitting the prescription for payment by the Senior Gold Prescription Discount Program.
(c) The Senior Gold Prescription Discount Act establishes the co-payment for each prescription to be paid by an eligible individual.
(d) At the time of each purchase of a prescription drug, the eligible person shall pay a co-payment that shall not be waived, discounted or rebated in whole or in part.
(e) When an eligible individual has prescription costs paid in part by any other program or plan of assistance or insurance, the amount paid by the Program, when combined with the payment made by the other program or plan of assistance or insurance, shall not exceed the amount that the Program would pay if no other coverage was available.
