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A07492 Summary:

BILL NOA07492A
 
SAME ASNo Same As
 
SPONSORGottfried
 
COSPNSRMcDonald, Abinanti, Pheffer Amato, Titone, Solages, Jaffee, Garbarino, Raia, Sepulveda, Steck
 
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--A
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                     April 27, 2017
                                       ___________
 
        Introduced  by  M.  of  A. GOTTFRIED, McDONALD, ABINANTI, PHEFFER AMATO,
          TITONE, SOLAGES, JAFFEE, GARBARINO, RAIA, STECK -- Multi-Sponsored  by
          --  M.  of  A.  HEVESI  --  read once and referred to the Committee on
          Health -- recommitted to the Committee on Health  in  accordance  with
          Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered
          reprinted as amended and recommitted to said committee
 
        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 pharmacy for a partial supply when  it  is  for
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11066-02-8

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

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