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S06603 Summary:

BILL NOS06603
 
SAME ASSAME AS A07598
 
SPONSORSKOUFIS
 
COSPNSRADDABBO, AKSHAR, COMRIE, GOUNARDES, HARCKHAM, HINCHEY, KAVANAGH, MARTUCCI, MAYER, O'MARA, REICHLIN-MELNICK, RIVERA
 
MLTSPNSR
 
Amd §364-j, Soc Serv L; amd §280-a, Pub Health L
 
Requires Medicaid managed care plans to reimburse retail pharmacies in an amount equal to the fee-for-service rate; allows retail pharmacies the opportunity to participate in another provider's network under the medical assistance program; prohibits pharmacy benefit managers from limiting an individual's option to receive medications from non-mail order pharmacies.
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S06603 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          6603
 
                               2021-2022 Regular Sessions
 
                    IN SENATE
 
                                      May 10, 2021
                                       ___________
 
        Introduced  by  Sen. SKOUFIS -- read twice and ordered printed, and when
          printed to be committed to the Committee on Health
 
        AN ACT to amend the social services law and the public  health  law,  in
          relation to protecting access to pharmacy services
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Subdivision 4 of section 364-j of the social  services  law
     2  is amended by adding two new paragraphs (w) and (x) to read as follows:
     3    (w)  Notwithstanding any provision of law to the contrary, administra-
     4  tive fees paid to a managed care provider or a pharmacy benefit  manager
     5  under the medical assistance program shall be reduced for the purpose of
     6  increasing  reimbursement  rates to retail pharmacies under the Medicaid
     7  managed care program. Beginning on and after July  first,  two  thousand
     8  twenty-one,  all  reimbursement  paid  by Medicaid managed care plans to
     9  retail pharmacies shall include a professional dispensing  fee  and  the
    10  drug acquisition cost for each outpatient drug dispensed at no less than
    11  the  amount established under the fee-for-service program, as defined in
    12  section three hundred sixty-seven-a of this title, regardless of whether
    13  such reimbursement is paid directly by the Medicaid managed care plan or
    14  passed through  a  pharmacy  benefit  manager  or  other  entity.    The
    15  reimbursement  provided  for under this paragraph shall not apply to any
    16  existing reimbursement arrangements involving an eligible provider under
    17  section 340B of the federal public health services act or  a  comprehen-
    18  sive  HIV special needs plan under section forty-four hundred three-c of
    19  the public health law under the medical assistance program.  No  managed
    20  care  provider  or  pharmacy  benefit manager shall reimburse a pharmacy
    21  owned by or affiliated with such entity at a higher rate than that  paid
    22  by  such entity to a pharmacy it does not own or is not otherwise affil-
    23  iated with.
    24    (x) Notwithstanding any provision of law to the  contrary,  a  managed
    25  care  provider  or  pharmacy  benefit  manager  acting on its behalf, as
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11345-01-1

        S. 6603                             2
 
     1  defined in section two hundred eighty-a of the public health law,  shall
     2  not  deny  any retail pharmacy the opportunity to participate in another
     3  provider's pharmacy network under  the  medical  assistance  program  at
     4  preferred  participation  status,  provided  that  such  retail pharmacy
     5  agrees to the same reimbursement amount, as defined in paragraph (w)  of
     6  this  subdivision,  and  is  able  to fill and dispense prescription and
     7  over-the-counter medications for those enrolled in the  medical  assist-
     8  ance program.
     9    § 2. Section 280-a of the public health law is amended by adding a new
    10  subdivision 5 to read as follows:
    11    5.  Notwithstanding  any provision of law to the contrary, no pharmacy
    12  benefit manager shall limit  the  option  for  an  individual  receiving
    13  prescription or over-the-counter medications to receive such medications
    14  from their local, non-mail order pharmacy of choice via delivery includ-
    15  ing  in-person  delivery,  United States postal service or other mail or
    16  courier service. No restrictions, prohibitions  or  prior  authorization
    17  requirements  shall be based on the individual's choice in delivery type
    18  or distance from a pharmacy.
    19    § 3. This act shall take effect on the thirtieth day  after  it  shall
    20  have become a law; provided, however, that the amendments to subdivision
    21  4  of  section  364-j  of the social services law made by section one of
    22  this act shall take effect July 1, 2021; provided further that  if  this
    23  act  shall  have become a law after such date it shall take effect imme-
    24  diately and shall be deemed to have been in full force and effect on and
    25  after July 1, 2021; provided further that the amendments to  subdivision
    26  4  of  section  364-j  of the social services law made by section one of
    27  this act shall not affect the repeal of such section and shall be deemed
    28  repealed therewith.
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