STATE OF NEW YORK
________________________________________________________________________
5622--A
Cal. No. 199
2017-2018 Regular Sessions
IN SENATE
April 20, 2017
___________
Introduced by Sens. HANNON, AVELLA, VALESKY -- read twice and ordered
printed, and when printed to be committed to the Committee on Health
-- recommitted to the Committee on Health in accordance with Senate
Rule 6, sec. 8 -- reported favorably from said committee, ordered to
first and second report, ordered to a third reading, amended and
ordered reprinted, retaining its place in the order of third reading
AN ACT to amend the social services law, in relation to synchronization
of multiple prescriptions
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 9 of section 367-a of the social services law
2 is amended by adding a new paragraph (i) to read as follows:
3 (i)(i) The department of health shall establish a program for synchro-
4 nization of medications when it is agreed among the recipient, a provid-
5 er and a pharmacist that synchronization of multiple prescriptions for
6 the treatment of a chronic illness is in the best interest of the
7 patient for the management or treatment of a chronic illness provided
8 that the medications:
9 (A) are covered by the department of health pursuant to this title;
10 (B) are used for treatment and management of chronic conditions that
11 are subject to refills;
12 (C) are not a schedule II controlled substance or a schedule III
13 controlled substance containing hydrocodone;
14 (D) meet all prior authorization criteria specific to the medications
15 at the time of the synchronization request;
16 (E) are of a formulation that can be effectively split over required
17 short fill periods to achieve synchronization; and
18 (F) do not have quantity limits or dose optimization criteria or
19 requirements that would be violated in fulfilling synchronization.
20 (ii) The department of health shall not deny coverage for the dispens-
21 ing of a medication by a pharmacy for a partial supply when it is for
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11066-03-8
S. 5622--A 2
1 the purpose of synchronizing the patient's medications. When applicable
2 to permit synchronization, the department of health shall allow a phar-
3 macy to override any denial codes indicating that a prescription is
4 being refilled too soon for the purposes of medication synchronization.
5 (iii) To permit synchronization, the department of health shall apply
6 a prorated daily cost-sharing rate to any medication dispensed by a
7 pharmacy pursuant to this section.
8 (iv) The dispensing fee paid to a pharmacy contracted to provide
9 services pursuant to this section for a partial supply associated with a
10 medication synchronization shall be paid in full and shall not be
11 prorated.
12 (v) The requirement of this paragraph applies only once for each
13 prescription drug subject to medication synchronization except when
14 either of the following occurs:
15 (I) the prescriber changes the dosage or frequency of administration
16 of the prescription drug subject to a medication synchronization; or
17 (II) the prescriber prescribes a different drug.
18 (vi) Nothing in this paragraph shall be deemed to require health care
19 practitioners and pharmacists to synchronize the refilling of multiple
20 prescriptions for a recipient.
21 § 2. Subdivision 4 of section 364-j of the social services law is
22 amended by adding a new paragraph (w) to read as follows:
23 (w)(i) The department of health or a managed care organization
24 contracted to provide services pursuant to this section shall establish
25 a program for synchronization of medications when it is agreed among the
26 recipient, a provider and a pharmacist that synchronization of multiple
27 prescriptions for the treatment of a chronic illness is in the best
28 interest of the patient for the management or treatment of a chronic
29 illness provided that the medications:
30 (A) are covered by Medicaid services or a managed care organization
31 contracted to provide services pursuant to this chapter;
32 (B) are used for treatment and management of chronic conditions that
33 are subject to refills;
34 (C) are not a schedule II controlled substance or a schedule III
35 controlled substance containing hydrocodone;
36 (D) meet all prior authorization criteria specific to the medications
37 at the time of the synchronization request;
38 (E) are of a formulation that can be effectively split over required
39 short fill periods to achieve synchronization; and
40 (F) do not have quantity limits or dose optimization criteria or
41 requirements that would be violated in fulfilling synchronization.
42 (ii) The department of health or a managed care organization
43 contracted to provide services under this section shall not deny cover-
44 age for the dispensing of a medication by a pharmacy for a partial
45 supply when it is for the purpose of synchronizing the patient's medica-
46 tions. When applicable to permit synchronization, the department of
47 health or a managed care organization contracted to provide services
48 under this title shall allow a pharmacy to override any denial codes
49 indicating that a prescription is being refilled too soon for the
50 purposes of medication synchronization.
51 (iii) To permit synchronization, the department of health or a managed
52 care organization contracted to provide services pursuant to this title
53 shall apply a prorated daily cost-sharing rate to any medication
54 dispensed by a pharmacy pursuant to this section.
55 (iv) The dispensing fee paid to a pharmacy contracted to provide
56 services pursuant to this section for a partial supply associated with a
S. 5622--A 3
1 medication synchronization shall be paid in full and shall not be
2 prorated.
3 (v) The requirement of this paragraph applies only once for each
4 prescription drug subject to medication synchronization except when
5 either of the following occurs:
6 (A) the prescriber changes the dosage or frequency of administration
7 of the prescription drug subject to a medication synchronization; or
8 (B) the prescriber prescribes a different drug.
9 (vi) Nothing in this paragraph shall be deemed to require health care
10 practitioners and pharmacists to synchronize the refilling of multiple
11 prescriptions for a covered individual.
12 § 3. This act shall take effect on the one hundred twentieth day after
13 it shall have become a law. The amendments to subdivision 9 of section
14 367-a of the social services law, made by section one of this act, shall
15 not affect the expiration of that subdivision, and shall expire there-
16 with.
17 The amendments to section 364-j of the social services law, made by
18 section two of this act, shall not affect the repeal of that section,
19 and shall be deemed repealed therewith. Effective immediately, the
20 commissioner of health shall make regulations and take other actions
21 reasonably necessary to implement this act on that date.
