Requires managed care providers to annually provide each participant in their programs with a written list of mail-order pharmacies with which the managed care provider has a contract for coverage of prescription drugs.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7119
SPONSOR: Bichotte Hermelyn TITLE OF BILL:
An act to amend the social services law, in relation to requiring each
managed care provider to annually provide each participant in its
program with a written list of mail-order pharmacies with which the
managed care provider has a contract for coverage of prescription drugs
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of the bill is to better ensure seamless care for patients
that utilize mail-order pharmacies.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1. Paragraph (u) of subdivision 4 of section 364-j of the
social services law, as amended by section 12 of part A of chapter 56 of
the laws of 2013, is amended to read as follows:
(u) A managed care provider that provides coverage for prescription
drugs shall permit each participant to fill any mail order covered
prescription, at his or her option, at any mail order pharmacy or non-
mail-order retail pharmacy in the managed care provider network. If the
managed care provider has designated one or more pharmacies for filling
prescriptions for a particular drug or drugs, then such prescriptions
may be filled, at the participant's option, at any other pharmacy in the
network, if the network pharmacy chosen by the participant offers to
accept a price that is comparable to that of the pharmacy designated by
the managed care provider. For the purposes of this section, "mail order
pharmacy" means a pharmacy whose primary business is to receive
prescriptions by mail, telefax or through electronic submissions, and to
dispense medication to patients through the use of the United States
mail or other common or contract carrier services, and provides any
consultation with patients electronically rather than face to face.
Every non-mail-order retail pharmacy, in the managed care provider's
network with respect to any prescription drug shall be deemed to be in
he managed care provider's network for every covered prescription drug.
Each managed care provider subject to the provisions of this paragraph
shall annually provide each participant in its program with a written
list of mail-order pharmacies with which the managed care provider has a
contract for coverage of prescription drugs.
JUSTIFICATION:
Taking one's medicine on time and consistently is critical to better
health outcomes. Managed care provider lists are often outdated. In the
case of mail-order pharmacies, not having an updated provider list can
be very detrimental to the patient. By providing a written list of mail-
order pharmacies that is covered by the managed care network, a patient
will be able to have seamless experience.
PRIOR LEGISLATIVE HISTORY:
01/03/24 referred to health
02/08/23 referred to health
2021-22:A06409; referred to health.
2019-20:A2336; referred to health
2017-18:A7834; referred to health
FISCAL IMPLICATIONS:
None
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall have become a law; and shall apply to all contracts, agreements
and leases entered into on or after such date; provided, however that
the amendments to section 364-j of the social services law made by
section one of this act shall not affect the repeal of such section and
shall be deemed repealed therewith.
