STATE OF NEW YORK
________________________________________________________________________
5196--B
2017-2018 Regular Sessions
IN SENATE
March 13, 2017
___________
Introduced by Sens. LANZA, AVELLA -- read twice and ordered printed, and
when printed to be committed to the Committee on Insurance -- commit-
tee discharged, bill amended, ordered reprinted as amended and recom-
mitted to said committee -- recommitted to the Committee on Insurance
in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill
amended, ordered reprinted as amended and recommitted to said commit-
tee
AN ACT to amend the insurance 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. The insurance law is amended by adding a new section 3224-d
2 to read as follows:
3 § 3224-d. Prescription synchronization. (a) Every individual or group
4 health insurance policy providing prescription drug coverage when appli-
5 cable to permit synchronization shall permit and apply a daily pro-rated
6 cost-sharing rate to prescriptions that are dispensed by a network phar-
7 macy for less than a thirty day supply, when it is agreed among the
8 covered individual, a health care practitioner, and a pharmacist that
9 synchronization of multiple prescriptions for the treatment of a chronic
10 illness is in the best interest of the covered individual for the
11 management or treatment of that chronic illness provided that all of the
12 following apply:
13 (i) The medications are covered by the policy or plan.
14 (ii) The medications are used for treatment and management of chronic
15 conditions that are subject to refills.
16 (iii) The medications are not a Schedule II controlled substance or a
17 Schedule III controlled substance containing hydrocodone.
18 (iv) The medications meet all prior authorization criteria specific to
19 medications at the time of the synchronization request.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD08926-05-8
S. 5196--B 2
1 (v) The medications are of a formulation that can be effectively split
2 over required short fill periods to achieve synchronization.
3 (vi) The medications do not have quantity limits or dose optimization
4 criteria or requirements that would be violated in fulfilling synchroni-
5 zation.
6 (b) No individual or group health insurance policy providing
7 prescription drug coverage shall deny coverage for the dispensing of a
8 medication for partial fill when it is for purposes of synchronizing the
9 patient's medications. When applicable to permit synchronization, every
10 individual or group health insurance policy must allow a pharmacy to
11 override any denial codes indicating that a prescription is being
12 refilled too soon for the purposes of medication synchronization.
13 (c) Dispensing fees for partially filled or refilled prescriptions
14 shall be paid in full for each prescription dispensed, regardless of any
15 pro-rated copay for the beneficiary or fee paid for alignment services.
16 (d) Nothing in this section shall be deemed to require health care
17 practitioners and pharmacists to synchronize the refilling of multiple
18 prescriptions for a covered individual.
19 (e) The requirements of this paragraph shall apply only once for each
20 prescription drug subject to medication synchronization except when
21 either of the following occurs:
22 (i) The prescriber changes the dosage or frequency of administration
23 of the prescription drug subject to a medication synchronization; or
24 (ii) The prescriber prescribes a different drug.
25 § 2. The insurance law is amended by adding a new section 4303-a to
26 read as follows:
27 § 4303-a. Prescription synchronization. (a) Every hospital service
28 corporation and health service corporation providing prescription drug
29 coverage when applicable to permit synchronization shall permit and
30 apply a daily pro-rated cost-sharing rate to prescriptions that are
31 dispensed by a network pharmacy for less than a thirty day supply, when
32 it is agreed among the covered individual, a health care practitioner,
33 and a pharmacist that synchronization of multiple prescriptions for the
34 treatment of a chronic illness is in the best interest of the covered
35 individual for the management or treatment of that chronic illness
36 provided that all of the following apply:
37 (i) The medications are covered by the policy or plan.
38 (ii) The medications are used for treatment and management of chronic
39 conditions that are subject to refills.
40 (iii) The medications are not a Schedule II controlled substance or a
41 Schedule III controlled substance containing hydrocodone.
42 (iv) The medications meet all prior authorization criteria specific to
43 medications at the time of the synchronization request.
44 (v) The medications are of a formulation that can be effectively split
45 over required short fill periods to achieve synchronization.
46 (vi) The medications do not have quantity limits or dose optimization
47 criteria or requirements that would be violated in fulfilling synchroni-
48 zation.
49 (b) No hospital service corporation or health service corporation
50 providing prescription drug coverage shall deny coverage for the
51 dispensing of a medication for partial fill when it is for purposes of
52 synchronizing the patient's medications. When applicable to permit
53 synchronization, every hospital service corporation or health service
54 corporation providing prescription drug coverage must allow a pharmacy
55 to override any denial codes indicating that a prescription is being
56 refilled too soon for the purposes of medication synchronization.
S. 5196--B 3
1 (c) Dispensing fees for partially filled or refilled prescriptions
2 shall be paid in full for each prescription dispensed, regardless of any
3 pro-rated copay for the beneficiary or fee paid for alignment services.
4 (d) Nothing in this section shall be deemed to require health care
5 practitioners and pharmacists to synchronize the refilling of multiple
6 prescriptions for a covered individual.
7 (e) The requirements of this paragraph shall apply only once for each
8 prescription drug subject to medication synchronization except when
9 either of the following occurs:
10 (i) The prescriber changes the dosage or frequency of administration
11 of the prescription drug subject to a medication synchronization; or
12 (ii) The prescriber prescribes a different drug.
13 § 3. This act shall take effect on the first of January, 2019, and
14 shall apply to all policies and contracts issued, renewed, modified,
15 altered or amended on or after such date.
