S01086 Summary:

BILL NO    S01086 

SAME AS    No same as 

SPONSOR    MAZIARZ

COSPNSR    AVELLA

MLTSPNSR   

Add S271-a, Pub Health L

Provides for pharmacy benefit management and the procurement of prescription
drugs to be dispensed to patients, or the administration or management of
prescription drug benefits; sets forth definitions; provides for funds received
by a pharmacy benefit manager to be received by the pharmacy in trust for the
health plan or provider and provides for accountability of such funds.
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S01086 Actions:

BILL NO    S01086 

01/09/2013 REFERRED TO HEALTH
01/08/2014 REFERRED TO HEALTH
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S01086 Text:

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                         1086

                              2013-2014 Regular Sessions

                                   I N  S E N A T E

                                      (PREFILED)

                                    January 9, 2013
                                      ___________

       Introduced  by  Sen. MAZIARZ -- read twice and ordered printed, and when
         printed to be committed to the Committee on Health

       AN ACT to amend the public health law, in relation to  pharmacy  benefit
         managers

         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:

    1    Section 1. The public health law is amended by adding  a  new  section
    2  271-a to read as follows:
    3    S  271-A.  PHARMACY BENEFIT MANAGERS. 1. DEFINITIONS.  AS USED IN THIS
    4  SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
    5    (A) "HEALTH PLAN OR PROVIDER" MEANS AN ENTITY  FOR  WHICH  A  PHARMACY
    6  BENEFIT  MANAGER PROVIDES PHARMACY BENEFIT MANAGEMENT INCLUDING, BUT NOT
    7  LIMITED TO: (I) A HEALTH BENEFIT PLAN OR  OTHER  ENTITY  THAT  APPROVES,
    8  PROVIDES, ARRANGES FOR, OR PAYS FOR HEALTH CARE ITEMS OR SERVICES, UNDER
    9  WHICH  PRESCRIPTION  DRUGS FOR BENEFICIARIES OF THE ENTITY ARE PURCHASED
   10  OR WHICH PROVIDES OR ARRANGES REIMBURSEMENT IN WHOLE OR IN PART FOR  THE
   11  PURCHASE  OF  PRESCRIPTION  DRUGS;  OR  (II)  A  HEALTH CARE PROVIDER OR
   12  PROFESSIONAL,  INCLUDING  A  STATE  OR  LOCAL  GOVERNMENT  ENTITY,  THAT
   13  ACQUIRES  PRESCRIPTION DRUGS TO USE OR DISPENSE IN PROVIDING HEALTH CARE
   14  TO PATIENTS.
   15    (B) "PHARMACY BENEFIT MANAGEMENT" MEANS  THE  SERVICE  PROVIDED  TO  A
   16  HEALTH  PLAN  OR PROVIDER, DIRECTLY OR THROUGH ANOTHER ENTITY, INCLUDING
   17  THE PROCUREMENT OF PRESCRIPTION DRUGS TO BE DISPENSED  TO  PATIENTS,  OR
   18  THE  ADMINISTRATION OR MANAGEMENT OF PRESCRIPTION DRUG BENEFITS, INCLUD-
   19  ING BUT NOT LIMITED TO, ANY OF THE FOLLOWING:
   20    (I) MAIL SERVICE PHARMACY;
   21    (II) CLAIMS PROCESSING,  RETAIL  NETWORK  MANAGEMENT,  OR  PAYMENT  OF
   22  CLAIMS TO PHARMACIES FOR DISPENSING PRESCRIPTION DRUGS;
   23    (III)  CLINICAL  OR OTHER FORMULARY OR PREFERRED DRUG LIST DEVELOPMENT
   24  OR MANAGEMENT;

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD02296-01-3
       S. 1086                             2

    1    (IV) NEGOTIATION OR  ADMINISTRATION  OF  REBATES,  DISCOUNTS,  PAYMENT
    2  DIFFERENTIALS,  OR  OTHER  INCENTIVES,  FOR  THE INCLUSION OF PARTICULAR
    3  PRESCRIPTION DRUGS IN A PARTICULAR CATEGORY OR TO PROMOTE  THE  PURCHASE
    4  OF PARTICULAR PRESCRIPTION DRUGS;
    5    (V)  PATIENT  COMPLIANCE, THERAPEUTIC INTERVENTION, OR GENERIC SUBSTI-
    6  TUTION PROGRAMS; AND
    7    (VI) DISEASE MANAGEMENT.
    8    (C) "PHARMACY BENEFIT MANAGER" MEANS ANY ENTITY THAT PERFORMS PHARMACY
    9  BENEFIT MANAGEMENT FOR A HEALTH PLAN OR PROVIDER.
   10    2. APPLICATION OF SECTION.  THIS SECTION APPLIES TO THE  PROVIDING  OF
   11  PHARMACY  BENEFIT  MANAGEMENT BY A PHARMACY BENEFIT MANAGER TO A PARTIC-
   12  ULAR HEALTH PLAN OR PROVIDER.
   13    3. DUTY, ACCOUNTABILITY AND TRANSPARENCY.   (A) THE  PHARMACY  BENEFIT
   14  MANAGER  SHALL  HAVE A FIDUCIARY RELATIONSHIP WITH AND OBLIGATION TO THE
   15  HEALTH PLAN OR PROVIDER, AND SHALL PERFORM PHARMACY  BENEFIT  MANAGEMENT
   16  WITH CARE, SKILL, PRUDENCE, DILIGENCE, AND PROFESSIONALISM.
   17    (B)  ALL FUNDS RECEIVED BY THE PHARMACY BENEFIT MANAGER IN RELATION TO
   18  PROVIDING PHARMACY BENEFIT MANAGEMENT SHALL BE RECEIVED BY THE  PHARMACY
   19  BENEFIT  MANAGER  IN  TRUST FOR THE HEALTH PLAN OR PROVIDER AND SHALL BE
   20  USED OR DISTRIBUTED ONLY PURSUANT  TO  THE  PHARMACY  BENEFIT  MANAGER'S
   21  CONTRACT  WITH THE HEALTH PLAN OR PROVIDER OR APPLICABLE LAW; EXCEPT FOR
   22  ANY FEE OR PAYMENT EXPRESSLY PROVIDED FOR IN THE  CONTRACT  BETWEEN  THE
   23  PHARMACY  BENEFIT  MANAGER AND THE HEALTH PLAN OR PROVIDER TO COMPENSATE
   24  THE PHARMACY BENEFIT MANAGER FOR ITS SERVICES.
   25    (C) THE PHARMACY BENEFIT MANAGER SHALL  PERIODICALLY  ACCOUNT  TO  THE
   26  HEALTH  PLAN  OR PROVIDER FOR ALL FUNDS RECEIVED BY THE PHARMACY BENEFIT
   27  MANAGER. THE HEALTH PLAN OR PROVIDER SHALL HAVE ACCESS TO ALL  FINANCIAL
   28  AND  UTILIZATION INFORMATION OF THE PHARMACY BENEFIT MANAGER IN RELATION
   29  TO PHARMACY BENEFIT MANAGEMENT PROVIDED TO THE HEALTH PLAN OR PROVIDER.
   30    (D) THE PHARMACY BENEFIT MANAGER SHALL  DISCLOSE  IN  WRITING  TO  THE
   31  HEALTH  PLAN  OR  PROVIDER  THE  TERMS AND CONDITIONS OF ANY CONTRACT OR
   32  ARRANGEMENT BETWEEN THE PHARMACY BENEFIT MANAGER AND ANY PARTY  RELATING
   33  TO PHARMACY BENEFIT MANAGEMENT PROVIDED TO THE HEALTH PLAN OR PROVIDER.
   34    (E)  THE  PHARMACY  BENEFIT  MANAGER  SHALL DISCLOSE IN WRITING TO THE
   35  HEALTH PLAN OR PROVIDER ANY  ACTIVITY,  POLICY,  PRACTICE,  CONTRACT  OR
   36  ARRANGEMENT  OF THE PHARMACY BENEFIT MANAGER THAT DIRECTLY OR INDIRECTLY
   37  PRESENTS ANY CONFLICT OF INTEREST WITH THE  PHARMACY  BENEFIT  MANAGER'S
   38  RELATIONSHIP WITH OR OBLIGATION TO THE HEALTH PLAN OR PROVIDER.
   39    (F)  ANY  INFORMATION  REQUIRED  TO BE DISCLOSED BY A PHARMACY BENEFIT
   40  MANAGER TO A HEALTH PLAN OR PROVIDER UNDER THIS SECTION THAT IS  REASON-
   41  ABLY  DESIGNATED BY THE PHARMACY BENEFIT MANAGER AS PROPRIETARY OR TRADE
   42  SECRET INFORMATION SHALL BE KEPT CONFIDENTIAL  BY  THE  HEALTH  PLAN  OR
   43  PROVIDER,  EXCEPT  AS REQUIRED OR PERMITTED BY LAW, INCLUDING DISCLOSURE
   44  NECESSARY TO PROSECUTE OR DEFEND ANY LEGITIMATE LEGAL CLAIM OR CAUSE  OF
   45  ACTION.
   46    4.  PRESCRIPTIONS.    A PHARMACY BENEFIT MANAGER MAY NOT SUBSTITUTE OR
   47  CAUSE THE SUBSTITUTING OF ONE PRESCRIPTION DRUG FOR ANOTHER IN  DISPENS-
   48  ING  A  PRESCRIPTION,  OR  ALTER OR CAUSE THE ALTERING OF THE TERMS OF A
   49  PRESCRIPTION, EXCEPT WITH THE APPROVAL OF THE PRESCRIBER OR AS EXPLICIT-
   50  LY REQUIRED OR PERMITTED BY LAW.
   51    S 2. Severability.  If any provision of this act, or  any  application
   52  of  any  provision  of  this act, is held to be invalid, or ruled by any
   53  federal agency to violate or be inconsistent with any applicable federal
   54  law or regulation, that shall not affect the validity  or  effectiveness
   55  of  any  other provision of this act, or of any other application of any
   56  provision of this act.
       S. 1086                             3

    1    S 3. This act shall take effect on the ninetieth day  after  it  shall
    2  become  a  law  and  shall  apply to any contract for providing pharmacy
    3  benefit management made or renewed on or after that date.
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