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A04036 Summary:

A04036 Actions:

A04036 Committee Votes:

A04036 Floor Votes:

A04036 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
            S. 2809--A                                            A. 4036--A
 
                               2015-2016 Regular Sessions
 
                SENATE - ASSEMBLY
 
                                    January 29, 2015
                                       ___________
 
        IN SENATE -- Introduced by Sens. LANZA, BRESLIN, CARLUCCI, CROCI, DILAN,
          FUNKE,  GOLDEN,  LARKIN,  MARTINS,  RIVERA,  SAMPSON -- read twice and
          ordered printed, and when printed to be committed to the Committee  on
          Insurance  -- committee discharged, bill amended, ordered reprinted as
          amended and recommitted to said committee
 
        IN ASSEMBLY -- Introduced by M. of A.  QUART,  McDONALD,  FAHY,  LAVINE,
          HEVESI,  GOLDFEDER,  BRAUNSTEIN,  SIMANOWITZ,  RYAN,  BRINDISI, STECK,
          SKOUFIS, AUBRY, PRETLOW, SEAWRIGHT,  WEPRIN,  SCHIMEL,  RIVERA,  COOK,
          BARCLAY,  MOYA -- Multi-Sponsored by -- M. of A. CRESPO, DILAN, ROBIN-
          SON -- read once and referred to the Committee on Insurance -- commit-
          tee discharged, bill amended, ordered reprinted as amended and  recom-
          mitted to said committee
 
        AN  ACT  to  amend  the insurance law, in relation to synchronization of
          multiple prescriptions and dispensing fee standardization
 
          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 and dispensing fee standardi-
     4  zation. (a) Every individual or group health insurance policy  providing
     5  prescription  drug  coverage  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.
    12    (b)   No   individual  or  group  health  insurance  policy  providing
    13  prescription drug coverage shall deny coverage for the dispensing of any
    14  drug prescribed for the treatment of a chronic illness that is  made  in
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02009-03-5
        S. 2809--A                          2                         A. 4036--A
 
     1  accordance  with  a  plan  established  among  the covered individual, a
     2  health care practitioner and a pharmacist to synchronize  the  refilling
     3  of  multiple prescriptions for the covered individual.  Every individual
     4  or  group  health insurance policy must allow a pharmacy to override any
     5  denial codes indicating that a prescription is being refilled  too  soon
     6  for the purposes of medication synchronization.
     7    (c)   No   individual  or  group  health  insurance  policy  providing
     8  prescription drug coverage shall use  payment  structures  incorporating
     9  pro-rated  dispensing  fees.    Dispensing  fees for partially filled or
    10  refilled prescriptions shall be  paid  in  full  for  each  prescription
    11  dispensed,  regardless of any pro-rated copay for the beneficiary or fee
    12  paid for alignment services.
    13    (d) Nothing in this section shall be deemed  to  require  health  care
    14  practitioners  and  pharmacists to synchronize the refilling of multiple
    15  prescriptions for a covered individual.
    16    § 2. The insurance law is amended by adding a new  section  4303-a  to
    17  read as follows:
    18    §  4303-a.  Prescription synchronization and dispensing fee standardi-
    19  zation.   (a) Every hospital  service  corporation  and  health  service
    20  corporation  providing prescription drug coverage shall permit and apply
    21  a daily pro-rated cost-sharing rate to prescriptions that are  dispensed
    22  by  a  network  pharmacy  for  less than a thirty day supply, when it is
    23  agreed among the covered individual, a health care practitioner,  and  a
    24  pharmacist that synchronization of multiple prescriptions for the treat-
    25  ment  of  a chronic illness is in the best interest of the covered indi-
    26  vidual for the management or treatment of that chronic illness.
    27    (b) No hospital service  corporation  or  health  service  corporation
    28  providing  prescription  drug  coverage  shall  deny  coverage  for  the
    29  dispensing of any drug prescribed for the treatment of a chronic illness
    30  that is made in accordance with a plan  established  among  the  covered
    31  individual,  a  health care practitioner and a pharmacist to synchronize
    32  the refilling of multiple  prescriptions  for  the  covered  individual.
    33  Every hospital service corporation or health service corporation provid-
    34  ing  prescription  drug  coverage  must allow a pharmacy to override any
    35  denial codes indicating that a prescription is being refilled  too  soon
    36  for the purposes of medication synchronization.
    37    (c)  No  hospital  service  corporation  or health service corporation
    38  providing prescription drug coverage shall use payment structures incor-
    39  porating pro-rated dispensing  fees.    Dispensing  fees  for  partially
    40  filled  or  refilled  prescriptions  shall  be  paid  in  full  for each
    41  prescription dispensed, regardless of any pro-rated copay for the  bene-
    42  ficiary or fee paid for alignment services.
    43    (d)  Nothing  in  this  section shall be deemed to require health care
    44  practitioners and pharmacists to synchronize the refilling  of  multiple
    45  prescriptions for a covered individual.
    46    § 3. This act shall take effect on the one hundred twentieth day after
    47  it  shall  have  become  a  law,  and  shall  apply  to all policies and
    48  contracts issued, renewed, modified, altered or amended on or after such
    49  date.