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.
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.
