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A09271 Summary:

COSPNSRThiele, Rodriguez, Mosley, Magnarelli, Lupardo, Crespo, Blake, Galef, Jaffee, Seawright, Montesano, Titone, Gunther, Lifton, Sepulveda, Robinson, Hooper, Dinowitz, Otis, Russell, Abinanti, Hyndman, Ortiz
MLTSPNSRCook, Crouch, Davila, Englebright, Glick, Markey, Simon, Weinstein
Add 365-i, rpld 364-j subs 25 & 25-a, Soc Serv L; amd 270 & 272, add 274-a, Pub Health L
Extends the preferred drug program to medicaid managed care providers and offers the program to other health plans.
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A09271 Text:

                STATE OF NEW YORK
                   IN ASSEMBLY
                                    February 10, 2016
        Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
          Committee on Health
        AN ACT to amend the social services law and the public  health  law,  in
          relation  to  extending the preferred drug program to medicaid managed
          care providers and offering the program to other health plans; and  to
          repeal certain provisions of the social services law relating thereto

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Legislative findings. This legislature finds that the costs
     2  of many prescription drugs in the market have been escalating  unreason-
     3  ably.  The  preferred  drug program and the clinical drug review program
     4  under the public health law provide effective  mechanisms  for  assuring
     5  access  to  quality,  effective and safe drugs to patients at reasonable
     6  cost. Providing prescription  drugs  to  Medicaid  managed  health  care
     7  provider  participants through these programs will maximize the Medicaid
     8  program's ability  to  negotiate  more  substantial  rebates  with  drug
     9  manufacturers  (effectively,  lower  prices),  while protecting Medicaid
    10  managed care provider participants. Offering non-Medicaid  health  plans
    11  the  opportunity  to  use these programs will help lower costs for those
    12  health plans and those who pay their premiums, while protecting individ-
    13  uals covered by those plans, and will also further increase the  negoti-
    14  ating power of the programs.
    15    §  2. The social services law is amended by adding a new section 365-i
    16  to read as follows:
    17    § 365-i. Prescription drugs in medicaid managed  care  programs.    1.
    18  Definitions. (a) The definitions of terms in section two hundred seventy
    19  of the public health law shall apply to this section.
    20    (b)  As  used  in  this  section,  unless the context clearly requires
    21  otherwise:
    22    (i) "Managed care  provider"  means  a  managed  care  provider  under
    23  section  three hundred sixty-four-j of this article, a managed long term
    24  care plan under section forty-four hundred three-f of the public  health
    25  law,  or any other entity that provides or arranges for the provision of
    26  medical assistance services and supplies  to  participants  directly  or
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 9271                             2
     1  indirectly (including by referral), including case management, including
     2  the managed care provider's authorized agents.
     3    (ii)  "Participant" means a medical assistance recipient who receives,
     4  is required to receive or elects to receive his or her  medical  assist-
     5  ance services from a managed care provider.
     6    2.  Providing  and payment for prescription drugs for medicaid managed
     7  care provider participants. Prescription drugs eligible  for  reimburse-
     8  ment  under this article prescribed in relation to a service provided by
     9  a managed care provider  shall  be  provided  and  paid  for  under  the
    10  preferred  drug program and the clinical drug review program under title
    11  one of article two-A of the public health law. The managed care provider
    12  shall account to and reimburse the department for the net  cost  to  the
    13  department  for  prescription drugs provided to the managed care provid-
    14  er's participants. Payment for prescription drugs shall be  included  in
    15  the  capitation  payments  to  the managed care provider for services or
    16  supplies provided to a managed care provider's participants.
    17    § 3. Section 270 of the public health law is amended by adding  a  new
    18  subdivision 15 to read as follows:
    19    15.  "Third-party  health  care  payer"  has its ordinary meanings and
    20  includes an entity such as a  fiscal  administrator,  or  administrative
    21  services  provider  that  participates in the administration of a third-
    22  party health care payer system.
    23    § 4. The public health law is amended by adding a new section 274-a to
    24  read as follows:
    25    § 274-a. Use of  preferred  drug  program  and  clinical  drug  review
    26  program.  The  commissioner  shall  contract with any third-party health
    27  care payer that so chooses, to use the preferred drug  program  and  the
    28  clinical  drug  review program to provide and pay for prescription drugs
    29  for the third-party health care payer's  enrollees.  To  contract  under
    30  this  section,  the third-party health care payer shall provide coverage
    31  for prescription drugs authorized  under  this  title.  The  third-party
    32  health  care payer shall account to and reimburse the department for the
    33  net cost to the department for prescription drugs provided to the third-
    34  party health care payer's enrollees. The contract  shall  include  terms
    35  required by the commissioner.
    36    §  5.  Section 272 of the public health law is amended by adding a new
    37  subdivision 12 to read as follows:
    38    12. No prior authorization shall be required under the preferred  drug
    39  program  for:  (a)  atypical  anti-psychotics; (b) anti-depressants; (c)
    40  anti-retrovirals used in the treatment of HIV/AIDS;  (d)  anti-rejection
    41  drugs  used  in  the  treatment  of  organ  and  tissue transplants; (e)
    42  seizure, epilepsy, endocrine, hematologic  and  immunologic  therapeutic
    43  classes; and (f) any other therapeutic class for the treatment of mental
    44  illness  or  HIV/AIDS,  recommended by the committee and approved by the
    45  commissioner under this title.
    46    § 6. Subdivisions 25 and 25-a of section 364-j of the social  services
    47  law are REPEALED.
    48    § 7. This act shall take effect on the one hundred eightieth day after
    49  it  shall have become a law; provided, however, that the commissioner of
    50  health is immediately authorized and directed to take actions  necessary
    51  to implement this act when it takes effect.
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