(a)  Persons eligible for assistance under the provisions of this chapter include any resident of the state who is at least sixty-five (65) years of age or at least fifty-five (55) years of age and receiving social security disability benefits. State and consumer co-payment shares for these persons shall be determined as follows:

(1)  For unmarried persons or married persons living separate and apart whose income for the calendar year immediately preceding the year in which assistance is sought is:

(i)  Less than nineteen thousand three hundred forty-one dollars ($19,341) the state shall provide reimbursement such that the consumer shall pay no more than forty percent (40%) of the cost of the prescriptions.

(ii)  More than nineteen thousand three hundred forty-one dollars ($19,341) and less than, twenty-four thousand two hundred and eighty dollars ($24,280) the state shall provide reimbursement such that the consumer shall pay no more than seventy percent (70%) of the cost of the prescriptions; and

(iii)  More than twenty-four thousand two hundred and eighty dollars ($24,280) and less than forty-two thousand four hundred and ninety-three dollars ($42,493), the state shall provide reimbursement such that the consumer shall pay no more than eighty-five percent (85%) of the cost of prescriptions.

(2)  For married persons whose income for the calendar year immediately preceding the year in which assistance is sought hereunder when combined with any income of the person‘s spouse in the same year is:

(i)  Twenty-four thousand one hundred and seventy-nine dollars ($24,179) or less, the state shall provide reimbursement such that the consumer shall pay no more than forty percent (40%) of the cost of the prescriptions;

(ii)  More than twenty-four thousand one hundred and seventy-nine dollars ($24,179) and less than thirty thousand three hundred and fifty-two dollars ($30,352), the state shall provide reimbursement such that the consumer shall pay no more than seventy percent (70%) of the cost of prescriptions; and

(iii)  More than thirty thousand three hundred and fifty-two dollars ($30,352) and less than forty-eight thousand five hundred and sixty-three dollars ($48,563), the state shall provide reimbursement such that the consumer shall pay no more than eighty-five percent (85%) of the cost of prescriptions.

(3)  Eligibility may also be determined by using income data for the ninety (90) days prior to application for benefits and projecting that income on an annual basis. The income levels shall not include those sums of money expended for medical and pharmaceutical that exceed three percent (3%) of the applicant’s annual income or three percent (3%) of the applicant’s preceding ninety (90) day income computed on an annual basis.

(4)  For persons on social security disability benefits who are: (i) unmarried or married and living separate and apart with income for the calendar year immediately preceding the year in which assistance is sought that is less than forty-two thousand four hundred and ninety-three dollars ($42,493); or (ii) married with income that is less than forty-eight thousand five hundred and sixty-three dollars ($48,563) the state shall provide reimbursement such that the consumer shall pay no more than eighty-five percent (85%) of the cost.

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Terms Used In Rhode Island General Laws 42-66.2-5

  • Additional drugs: means non-injectable drugs which require a physician's prescription according to federal law and which are contained in the American Hospital Formulary Service pharmacologic-therapeutic classifications categories that have not been determined by the federal "Drug Efficacy and Safety Implementation (DESI) Commission" to lack substantial evidence of effectiveness, which are not included in the definition of drugs as defined in this subdivision. See Rhode Island General Laws 42-66.2-3
  • Consumer: means any full-time resident of the state who fulfills the eligibility requirements set forth in Rhode Island General Laws 42-66.2-3
  • person: may be construed to extend to and include co-partnerships and bodies corporate and politic. See Rhode Island General Laws 43-3-6

(b)  On July 1 of each year, the maximum amount of allowable income for both unmarried and married residents set forth in subsection (a) shall be increased by a percentage equal to the percentage of the cost of living adjustment provided for social security recipients.

(c)  The fact that some of a person’s prescription drug expenses are paid or reimbursable either in whole or in part, under the provisions of the federal Medicare program shall not disqualify that person, if he or she is otherwise eligible, to receive assistance under this chapter, provided that if the federal share equals or exceeds sixty percent (60%) of the cost the state shall make no payment.

(d)  For all additional drugs, the consumer shall pay one hundred percent (100%) of the cost of prescriptions as set forth in § 42-66.2-4.

(e)  To promote coordination of benefits between the pharmaceutical assistance program created under this chapter and the Medicare Part D prescription drug program created in the federal Medicare Prescription Drug, Improvement and Modernization Act of 2003, RIPAE enrollees must apply for and enroll in the Medicare Part D prescription drug program.

History of Section.
P.L. 1985, ch. 343, § 1; P.L. 1987, ch. 429, § 2; P.L. 1989, ch. 472, § 1; P.L. 1989, ch. 527, § 1; P.L. 1992, ch. 133, art. 52, § 1; P.L. 1998, ch. 108, § 1; P.L. 2000, ch. 55, art. 30, § 2; P.L. 2000, ch. 143, § 2; P.L. 2000, ch. 195, § 1; P.L. 2000, ch. 253, § 2; P.L. 2002, ch. 65, art. 37, § 1; P.L. 2003, ch. 128, § 1; P.L. 2003, ch. 319, § 1; P.L. 2003, ch. 404, § 1; P.L. 2004, ch. 262, § 1; P.L. 2004, ch. 466, § 1; P.L. 2004, ch. 595, art. 41, § 1; P.L. 2005, ch. 117, art. 28, § 1; P.L. 2008, ch. 100, art. 8, § 2; P.L. 2011, ch. 151, art. 23, § 4.