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
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7197
2023-2024 Regular Sessions
IN ASSEMBLY
May 12, 2023
___________
Introduced by M. of A. DINOWITZ -- read once and referred to the Commit-
tee 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 (x) and (y) to read as follows:
3 (x) 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-three, 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 (y) 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.
LBD06891-01-3
A. 7197 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 (x) 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 6 to read as follows:
11 6. Delivery option. Notwithstanding any provision of law to the
12 contrary, no pharmacy benefit manager shall limit the option for an
13 individual receiving prescription or over-the-counter medications to
14 receive such medications from their local, non-mail order pharmacy of
15 choice via delivery including in-person delivery, United States postal
16 service or other mail or courier service. No restrictions, prohibitions
17 or prior authorization requirements shall be based on the individual's
18 choice in delivery type or distance from a pharmacy.
19 § 3. This act shall take effect immediately; provided, however, that:
20 (a) section one of this act shall take effect July 1, 2023;
21 (b) if this act shall have become a law after such effective date it
22 shall take effect immediately and shall be deemed to have been in full
23 force and effect on and after July 1, 2023;
24 (c) the amendments to subdivision 4 of section 364-j of the social
25 services law made by section one of this act shall not affect the repeal
26 of such section and shall be deemed repealed therewith; and
27 (d) section two of this act shall take effect on the thirtieth day
28 after it shall have become a law.
