Section 247. Cost-sharing responsibilities of eligible program participants for comprehensive coverage

1. Registration  fee.  Eligible  individuals
  meeting  the  registration fee requirements of this section may purchase
  prescribed covered drugs for an amount specified by subdivision three of
  this section, subject  to  the  limits  on  point  of  sale  co-payments
  specified by subdivision four of this section.
    2.  Registration  fee  schedule. Eligible individuals electing to meet
  the requirements of this subdivision shall pay a quarterly  registration
  fee  in  a  manner and form determined by the executive director; at the
  option of the participant, the registration fee may be paid annually  in
  a lump sum upon the beginning of the annual coverage period. No eligible
  individual  electing  to meet the requirements of this subdivision shall
  have his participation in the program lapse by virtue of non-payment  of
  the  applicable  registration  fee  unless  the  contractor has provided
  notification of the amount and due date thereof, and  more  than  thirty
  days  have  elapsed  since the due date of the individual's registration
  fee. The registration fee to be charged to eligible program participants
  for comprehensive coverage under this option shall be in accordance with
  the following schedule:
    (a) Quarterly  registration  fees  for  unmarried  individual  program
  participants:
  individual income of $5,000 or less............................. $2.00
  individual income of $5,001 to $6,000........................... $2.00
  individual income of $6,001 to $7,000........................... $4.00
  individual income of $7,001 to $8,000........................... $5.50
  individual income of $8,001 to $9,000........................... $7.00
  individual income of $9,001 to $10,000...........................$9.00
  individual income of $10,001 to $11,000........................ $10.00
  individual income of $11,001 to $12,000........................ $11.50
  individual income of $12,001 to $13,000........................ $13.50
  individual income of $13,001 to $14,000........................ $15.00
  individual income of $14,001 to $15,000........................ $20.00
  individual income of $15,001 to $16,000........................ $27.50
  individual income of $16,001 to $17,000........................ $35.00
  individual income of $17,001 to $18,000........................ $42.50
  individual income of $18,001 to $19,000........................ $50.00
  individual income of $19,001 to $20,000........................ $57.50
    (b)  Quarterly  registration  fees for each married individual program
  participant:
  joint income of $5,000 or less.................................. $2.00
  joint income of $5,001 to $6,000................................ $2.00
  joint income of $6,001 to $7,000................................ $3.00
  joint income of $7,001 to $8,000................................ $4.00
  joint income of $8,001 to $9,000................................ $5.00
  joint income of $9,001 to $10,000................................$6.00
  joint income of $10,001 to $11,000.............................. $7.00
  joint income of $11,001 to $12,000.............................. $8.00
  joint income of $12,001 to $13,000.............................. $9.00
  joint income of $13,001 to $14,000............................. $10.00
  joint income of $14,001 to $15,000............................. $10.00
  joint income of $15,001 to $16,000............................. $21.00
  joint income of $16,001 to $17,000............................. $26.50
  joint income of $17,001 to $18,000............................. $31.50
  joint income of $18,001 to $19,000............................. $37.50
  joint income of $19,001 to $20,000............................. $43.00
  joint income of $20,001 to $21,000............................. $48.50
  joint income of $21,001 to $22,000............................. $54.00
  joint income of $22,001 to $23,000............................. $59.50

  joint income of $23,001 to $24,000............................. $65.00
  joint income of $24,001 to $25,000............................. $68.75
  joint income of $25,001 to $26,000..............................$75.00
    (c)  In  the event that the state expenditures per participant meeting
  the registration fee requirements  of  this  subdivision,  exclusive  of
  expenditures  for program administration, in the program year commencing
  October first, nineteen hundred eighty-eight, and in each  program  year
  thereafter,  exceed  such expenditures in the previous program year by a
  minimum of ten percent, the annual registration fees set forth  in  this
  subdivision  may,  unless  otherwise  provided  by  law,  be  increased,
  pro-rata, for the subsequent program year, provided that  such  increase
  shall  not exceed 7.5 percent of the prior year registration fees as may
  have been adjusted in accordance with this paragraph.
    (d) In the event that the state  expenditures  per  such  participant,
  incurred  pursuant  to  this  subdivision, exclusive of expenditures for
  program administration, in the program year  commencing  October  first,
  nineteen  hundred eighty-eight, and in each program year thereafter, are
  less than such expenditures in the previous program year by a minimum of
  ten percent, the annual registration fees set forth in this  subdivision
  may,  unless  otherwise provided by law, be decreased, pro-rata, for the
  subsequent program year, provided that such decrease  shall  not  exceed
  7.5  percent  of  the  prior  year  registration  fees  as may have been
  adjusted in accordance with this paragraph.
    (e) The determination to adjust annual registration fees set forth  in
  this  subdivision  shall follow a review of such factors as the relative
  financial capacity of the state and such eligible  program  participants
  to support such adjustments and changes in the consumer price index. The
  frequency  of such adjustments shall not exceed once in any program year
  and such adjustments shall not become effective for  individual  program
  participants  prior  to the first day of the next annual coverage period
  for each participant.
    3. Point of sale co-payment. (a) Upon satisfaction of the registration
  fee pursuant to this section an eligible program participant must pay  a
  point  of  sale  co-payment  as  set  forth  in  paragraph  (b)  of this
  subdivision at the time of each purchase of a  covered  drug  prescribed
  for  such  individual. Such co-payment shall not be waived or reduced in
  whole or in part, subject to the limits provided by subdivision four  of
  this section.
    (b)  The  point  of  sale  co-payment  amounts which are to be charged
  eligible program participants shall be in accordance with the  following
  schedule:
  For each prescription of covered drugs costing $15.00 or less.....$3.00
  For each prescription of covered drugs costing $15.01 to $35.00...$7.00
  For each prescription of covered drugs costing $35.01 to $55.00..$15.00
  For each prescription of covered drugs costing $55.01 or more....$20.00
    (c)  For  the  purposes  of  the  foregoing  schedule of point of sale
  co-payments, "costing" shall mean  the  amount  of  reimbursement  which
  shall  be  paid  by  the  state  to a participating provider pharmacy in
  accordance with section two hundred fifty of this title plus  the  point
  of sale co-payment, calculated as of the date of sale.
    4.  Limits  on  point of sale co-payments. During each annual coverage
  period no point of sale co-payment as set forth in subdivision three  of
  this  section  shall  be  required  to be made for the remainder of such
  period by any eligible program  participant  who  has  already  incurred
  co-payments in excess of the limits set forth in the following schedule:
    (a)  Limits  on  co-payments  by unmarried individual eligible program
  participants:
  individual income of $5,000 or less................. no more than $340

  individual income of $5,001 to $6,000............... no more than $408
  individual income of $6,001 to $7,000............... no more than $476
  individual income of $7,001 to $8,000............... no more than $544
  individual income of $8,001 to $9,000............... no more than $612
  individual income of $9,001 to $10,000.............. no more than $700
  individual income of $10,001 to $11,000............. no more than $720
  individual income of $11,001 to $12,000............. no more than $827
  individual income of $12,001 to $13,000............. no more than $896
  individual income of $13,001 to $14,000............. no more than $964
  individual income of $14,001 to $15,000........... no more than $1,016
  individual income of $15,001 to $16,000........... no more than $1,034
  individual income of $16,001 to $17,000........... no more than $1,052
  individual income of $17,001 to $18,000........... no more than $1,070
  individual income of $18,001 to $19,000........... no more than $1,088
  individual income of $19,001 to $20,000........... no more than $1,160
    (b)  Limits on co-payments by each married individual eligible program
  participant:
  joint income of $5,000 or less...................... no more than $291
  joint income of $5,001 to $6,000.................... no more than $342
  joint income of $6,001 to $7,000.................... no more than $399
  joint income of $7,001 to $8,000.................... no more than $456
  joint income of $8,001 to $9,000.................... no more than $513
  joint income of $9,001 to $10,000................... no more than $570
  joint income of $10,001 to $11,000.................. no more than $622
  joint income of $11,001 to 12,000....................no more than $641
  joint income of $12,001 to $13,000.................. no more than $660
  joint income of $13,001 to $14,000.................. no more than $684
  joint income of $14,001 to $15,000.................. no more than $710
  joint income of $15,001 to $16,000.................. no more than $826
  joint income of $16,001 to $17,000.................. no more than $877
  joint income of $17,001 to $18,000.................. no more than $928
  joint income of $18,001 to $19,000.................. no more than $980
  joint income of $19,001 to $20,000.................. no more than $990
  joint income of $20,001 to $21,000................ no more than $1,008
  joint income of $21,001 to $22,000................ no more than $1,026
  joint income of $22,001 to $23,000................ no more than $1,044
  joint income of $23,001 to $24,000................ no more than $1,062
  joint income of $24,001 to $25,000................ no more than $1,080
  joint income of $25,001 to $26,000.................no more than $1,150
    (c) Effective October first, nineteen hundred eighty-eight, the limits
  on point of sale co-payments as set forth in  this  subdivision  may  be
  adjusted   by  the  panel  on  the  anniversary  date  of  each  program
  participant's annual coverage period, and such adjustment  shall  be  in
  effect  for the duration of that annual coverage period. Any such annual
  adjustment shall be made using  a  percentage  adjustment  factor  which
  shall  not  exceed  one-half  of the difference between the year-to-year
  percentage increase in the consumer price index for all urban consumers,
  as published by the United States Department of Labor, and,  if  larger,
  the  year-to-year  percentage  increase in the aggregate average cost of
  covered drugs purchased under this title, which year-to-year  percentage
  increase  in such cost shall be determined by comparison of such cost in
  the same month of each of the appropriate  successive  years;  provided,
  however,  that for any such adjustment based wholly on experience in the
  program year commencing October first,  nineteen  hundred  eighty-seven,
  the year-to-year percentage increase in such cost shall be determined by
  comparison  of  such cost in each of two months no less than five months
  apart  and  within  such  program  year,  which  comparison   shall   be
  annualized.  Such percentage adjustment factor shall be the same as that

  used to determine any similar annual  adjustment  for  the  same  annual
  coverage  periods  pursuant  to  the  provisions  of subdivision four of
  section two hundred forty-eight of this title.
    (d)  Such  annual  adjustments  shall be calculated by multiplying the
  percentage adjustment  factor  by  (1)  ten  percent  and  applying  the
  resulting percentage to the upper income limitation of each income level
  for  unmarried  individuals  contained  in  this subdivision, and by (2)
  seven and one-half percent and applying the resulting percentage to  the
  upper  income  limitation  of  each income level for married individuals
  contained in this subdivision; each result of such  calculations,  minus
  any  applicable  registration fee increases made pursuant to subdivision
  two of this section and plus  the  result  of  applying  the  percentage
  adjustment  factor  to the sum of any such annual adjustments applicable
  thereto for any prior annual coverage period, shall  be  the  amount  by
  which  the  limit  on  co-payments  for  each  such  income level may be
  adjusted, and such amount shall be in addition to  any  such  amount  or
  amounts applicable to prior annual coverage periods.
    (e)   The  determination  to  adjust  the  limits  on  point  of  sale
  co-payments set forth in this subdivision shall follow a review of  such
  factors  as  the  relative  financial  capacity  of  the  state and such
  eligible program participants to support such adjustments.