Relates to excepting situations where a physician or other licensed health care provider is authorized to dispense certain medications and is practicing medicine in the oncology setting and is dispensing oncology drugs or drugs related to an approved course of treatment used to manage symptoms related to cancer or cancer therapies.
STATE OF NEW YORK
________________________________________________________________________
7817--A
2025-2026 Regular Sessions
IN ASSEMBLY
April 11, 2025
___________
Introduced by M. of A. PAULIN -- 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 part FFF of chapter 56 of the laws of 2020 relating to
directing the department of health to remove the pharmacy benefit from
the managed care benefit package and to provide the pharmacy benefit
under the fee for service program, in relation to pharmacy benefits
where a physician is authorized to dispense certain medications and
practices medicine in the oncology setting
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 1 of part FFF of chapter 56 of the laws of 2020
2 relating to directing the department of health to remove the pharmacy
3 benefit from the managed care benefit package and to provide the pharma-
4 cy benefit under the fee for service program, as amended by section 1 of
5 part C of chapter 57 of the laws of 2021, is amended to read as follows:
6 Section 1. The Legislature hereby finds and declares that medical
7 assistance for needy persons is a matter of public concern and a neces-
8 sity in promoting the public health and welfare and for promoting the
9 state's goal of making available to everyone, regardless of race, age,
10 gender, national origin or economic standing, uniform, high-quality
11 medical care. As the department of health is the single state agency
12 responsible for supervising the administration of the state's medical
13 assistance program (Medicaid), it is tasked with ensuring efficiency,
14 economy, and quality of care in providing benefits to the state's needy
15 persons. To this end and with the fiscal constraints facing our state in
16 mind, the department of health continues to analyze the Medicaid program
17 in search of ways to ensure Medicaid spending is held to the standard of
18 efficiency, economy, and quality of care. In consideration of this stan-
19 dard, the department of health is hereby directed to exercise its exist-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11144-02-6
A. 7817--A 2
1 ing administrative authority to remove the pharmacy benefit from managed
2 care benefit package and instead provide the pharmacy benefit under the
3 fee for service program, except where otherwise required by federal law
4 or where a physician or other licensed health care provider is author-
5 ized to dispense medications in accordance with section 6807 of the
6 education law and is practicing medicine in an oncology setting and is
7 dispensing oncology drugs or drugs related to an approved course of
8 treatment used to manage symptoms related to cancer or cancer therapies,
9 to ensure transparency and that the benefit is provided to the fullest
10 extent and as efficiently as possible; provided, however, that the
11 department of health shall not implement the transition of the pharmacy
12 benefit from the managed care benefit package to the fee for service
13 program sooner than April 1, 2023, and until it is satisfied that all
14 necessary and appropriate transition planning has occurred, in its sole
15 discretion, and federal approvals have been obtained and preparations
16 have been made. Furthermore, to ensure an orderly transition, continued
17 access to medications, and appropriate patient education and support,
18 the department may establish uniform standards, payment policies and
19 reimbursement methodologies for any sites where drugs may be adminis-
20 tered or dispensed under the fee for service program; provided that,
21 subject to the availability of federal financial participation, when
22 reimbursing covered entities, as defined under section 340B of the
23 public health service act (42 U.S.C. §256b), for drugs that would other-
24 wise be eligible for pricing under section 340B of the public health
25 service act, the department shall examine all reasonably available meth-
26 ods for determining actual acquisition cost and the professional
27 dispensing fee and, beginning in the fiscal year starting April 1, 2023,
28 review and adjust reimbursement for such drugs such that no sooner than
29 April 1, 2025, reimbursement shall be determined based on a method that
30 the commissioner determines that utilizes the actual acquisition costs
31 and professional dispensing fee.
32 § 2. This act shall take effect immediately.
