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A07492 Summary:

BILL NOA07492
 
SAME ASSAME AS S05622
 
SPONSORGottfried
 
COSPNSRMcDonald, Abinanti, Pheffer Amato, Titone, Solages, Jaffee, Garbarino, Raia, Sepulveda
 
MLTSPNSRHevesi
 
Amd 367-a & 364-j, Soc Serv L
 
Provides for the synchronization of multiple prescriptions for recipients of medical assistance.
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A07492 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          7492
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                     April 27, 2017
                                       ___________
 
        Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
          Committee on Health
 
        AN ACT to amend the social services law, in relation to  synchronization
          of multiple prescriptions
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Subdivision 9 of section 367-a of the social  services  law
     2  is amended by adding a new paragraph (i) to read as follows:
     3    (i)(i) The department of health shall establish a program for synchro-
     4  nization of medications when it is agreed among the recipient, a provid-
     5  er  and  a pharmacist that synchronization of multiple prescriptions for
     6  the treatment of a chronic illness  is  in  the  best  interest  of  the
     7  patient  for  the  management or treatment of a chronic illness provided
     8  that the medications:
     9    (A) are covered by the department of health pursuant to this title;
    10    (B) are used for treatment and management of chronic  conditions  that
    11  are subject to refills;
    12    (C)  are  not  a  schedule  II  controlled substance or a schedule III
    13  controlled substance containing hydrocodone;
    14    (D) meet all prior authorization criteria specific to the  medications
    15  at the time of the synchronization request;
    16    (E)  are  of a formulation that can be effectively split over required
    17  short fill periods to achieve synchronization; and
    18    (F) do not have quantity  limits  or  dose  optimization  criteria  or
    19  requirements that would be violated in fulfilling synchronization.
    20    (ii) The department of health shall not deny coverage for the dispens-
    21  ing  of  a medication by a network pharmacy for a partial supply when it
    22  is for the purpose of  synchronizing  the  patient's  medications.  When
    23  applicable  to  permit  synchronization,  the department of health shall
    24  allow a  pharmacy  to  override  any  denial  codes  indicating  that  a
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11066-01-7

        A. 7492                             2
 
     1  prescription  is  being refilled too soon for the purposes of medication
     2  synchronization.
     3    (iii)  To permit synchronization, the department of health shall apply
     4  a prorated daily cost-sharing rate to  any  medication  dispensed  by  a
     5  network pharmacy pursuant to this section.
     6    (iv)  The  dispensing  fee  paid  to  a network pharmacy contracted to
     7  provide services pursuant to this section for a partial  supply  associ-
     8  ated  with  a medication synchronization shall be paid in full and shall
     9  not be prorated.
    10    (v) The requirement of this  paragraph  applies  only  once  for  each
    11  prescription  drug  subject  to  medication  synchronization except when
    12  either of the following occurs:
    13    (I) the prescriber changes the dosage or frequency  of  administration
    14  of the prescription drug subject to a medication synchronization; or
    15    (II) the prescriber prescribes a different drug.
    16    (vi)  Nothing in this paragraph shall be deemed to require health care
    17  practitioners and pharmacists to synchronize the refilling  of  multiple
    18  prescriptions for a recipient.
    19    §  2.  Subdivision  4  of  section 364-j of the social services law is
    20  amended by adding a new paragraph (w) to read as follows:
    21    (w)(i) The  department  of  health  or  a  managed  care  organization
    22  contracted  to provide services pursuant to this section shall establish
    23  a program for synchronization of medications when it is agreed among the
    24  recipient, a provider and a pharmacist that synchronization of  multiple
    25  prescriptions  for  the  treatment  of  a chronic illness is in the best
    26  interest of the patient for the management or  treatment  of  a  chronic
    27  illness provided that the medications:
    28    (A)  are  covered  by Medicaid services or a managed care organization
    29  contracted to provide services pursuant to this chapter;
    30    (B) are used for treatment and management of chronic  conditions  that
    31  are subject to refills;
    32    (C)  are  not  a  schedule  II  controlled substance or a schedule III
    33  controlled substance containing hydrocodone;
    34    (D) meet all prior authorization criteria specific to the  medications
    35  at the time of the synchronization request;
    36    (E)  are  of a formulation that can be effectively split over required
    37  short fill periods to achieve synchronization; and
    38   (F) do not have  quantity  limits  or  dose  optimization  criteria  or
    39  requirements that would be violated in fulfilling synchronization.
    40    (ii)   The  department  of  health  or  a  managed  care  organization
    41  contracted to provide services under this section shall not deny  cover-
    42  age  for  the  dispensing  of  a  medication by a network pharmacy for a
    43  partial supply when it is for the purpose of synchronizing the patient's
    44  medications. When applicable to permit synchronization,  the  department
    45  of  health or a managed care organization contracted to provide services
    46  under this title shall allow a pharmacy to  override  any  denial  codes
    47  indicating  that  a  prescription  is  being  refilled  too soon for the
    48  purposes of medication synchronization.
    49    (iii) To permit synchronization, the department of health or a managed
    50  care organization contracted to provide services pursuant to this  title
    51  shall  apply  a  prorated  daily  cost-sharing  rate  to  any medication
    52  dispensed by a network pharmacy pursuant to this section.
    53    (iv) The dispensing fee paid  to  a  network  pharmacy  contracted  to
    54  provide  services  pursuant to this section for a partial supply associ-
    55  ated with a medication synchronization shall be paid in full  and  shall
    56  not be prorated.

        A. 7492                             3
 
     1    (v)  The  requirement  of  this  paragraph  applies only once for each
     2  prescription drug subject  to  medication  synchronization  except  when
     3  either of the following occurs:
     4    (A)  the  prescriber changes the dosage or frequency of administration
     5  of the prescription drug subject to a medication synchronization; or
     6    (B) the prescriber prescribes a different drug.
     7    (vi) Nothing in this paragraph shall be deemed to require health  care
     8  practitioners  and  pharmacists to synchronize the refilling of multiple
     9  prescriptions for a covered individual.
    10    § 3. This act shall take effect on the one hundred twentieth day after
    11  it shall have become a law, and shall apply to  policies  and  contracts
    12  issued,  renewed,  modified,  altered  or amended on or after such date;
    13  provided that:
    14    (a) the amendments to subdivision 9 of section  367-a  of  the  social
    15  services  law,  made  by  section  one of this act, shall not affect the
    16  expiration of such subdivision, and shall expire therewith; and
    17    (b) the amendments to section 364-j of the social services  law,  made
    18  by section two of this act, shall not affect the repeal of such section,
    19  and shall be deemed repealed therewith.
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