New York State Assembly

 
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A00187 Summary:

A00187 Actions:

A00187 Committee Votes:

Committee:HEALTH   Chair:Gottfried      
DATE:01/20/2021AYE/NAY:26/0  Action: Favorable refer to committee Ways and Means        
Gottfried
Aye
Byrne
Aye
Galef
Aye
McDonough
Aye
Dinowitz
Aye
Byrnes
Aye
Cahill
Aye
Ashby
Aye
Paulin
Aye
Miller
Aye
Cymbrowitz
Aye
Salka
Aye
Gunther
Aye
Jensen
Aye
Rosenthal L 
Aye
Hevesi
Aye
Steck
Aye
Abinanti
Aye
Braunstein
Aye
Solages
Aye
Bichotte Hermel
Aye
Barron
Aye
Sayegh
Aye
Rosenthal D 
Aye
McDonald
Aye
Reyes
Aye

Committee:WAYS AND MEANS   Chair:Weinstein      
DATE:05/09/2022AYE/NAY:34/0  Action: Favorable refer to committee Rules        
Weinstein
Aye
Ra
Aye
Glick
Aye
Fitzpatrick
Aye
Nolan
Excused
Hawley
Aye
Pretlow
Aye
Montesano
Aye
Colton
Aye
Blankenbush
Aye
Cook
Aye
Norris
Aye
Cahill
Aye
Brabenec
Aye
Aubry
Aye
Palmesano
Aye
Cusick
Aye
Byrne
Aye
Benedetto
Aye
Ashby
Aye
Weprin
Aye
Ramos
Aye
Braunstein
Aye
McDonald
Aye
Rozic
Aye
Dinowitz
Aye
Joyner
Aye
Magnarelli
Aye
Zebrowski
Aye
Bronson
Aye
Dilan
Aye
Seawright
Aye
Hyndman
Aye
Walker
Aye
Bichotte Hermel
Aye

Committee:RULES   Chair:Gottfried      
DATE:05/10/2022AYE/NAY:29/0  Action: Favorable         
Heastie
Excused
Barclay
Aye
Gottfried
Aye
Hawley
Aye
Nolan
Excused
Giglio
Aye
Weinstein
Aye
Blankenbush
Aye
Pretlow
Aye
Norris
Aye
Cook
Aye
Montesano
Aye
Glick
Aye
Ra
Aye
Aubry
Aye
Brabenec
Aye
Englebright
Aye
Dinowitz
Aye
Colton
Aye
Magnarelli
Aye
Paulin
Aye
Peoples-Stokes
Aye
Benedetto
Aye
Lavine
Aye
Lupardo
Aye
Zebrowski
Aye
Thiele
Aye
Braunstein
Aye
Dickens
Aye
Davila
Aye
Hyndman
Aye

A00187 Floor Votes:

A00187 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
 submitted in accordance with Assembly Rule III, Sec 1(f)



 
BILL NUMBER: A187
 
SPONSOR: Gottfried

 
TITLE OF BILL:
 
An act to amend the social services law, in relation to synchronization
of multiple prescriptions
 
 
PURPOSE OR GENERAL IDEA OF BILL:
 
To allow pharmacists to synchronize the dispensing of multiple
prescriptions for Medicaid recipients so they may pick up multiple
prescription refills at the same time.
 
 
SUMMARY OF SPECIFIC PROVISIONS:
 
Would allow synchronized dispensing of medications when it is agreed
among the patient, his or her prescriber and the pharmacist, under
certain conditions. The bill requires fee-for-service and managed care
benefit coverage for a partial fill and would allow a pharmacy to over-
ride denial codes indicating that a prescription is being too refilled
too soon.
 
The bill would permit pro-rated cost-sharing but keep the dispensing fee
whole. A given prescription may be synchronized only once unless the
prescriber changes the doses or frequency or prescribes a different
drug.
 
 
JUSTIFICATION:
 
Medication synchronization enables a partial-fill so that later refills
are coordinated with other prescriptions a patient may have, in order to
maximize convenience and compliance, reduce waste from unnecessary fills
and ensure that patients receive only the medication they need. Normal-
ly, a partial fill is blocked during the claim submission process
because the claim is for less than a 30-day supply. Patients may be
required to pay a full months' copayment for a month's supply, even if
questions remain about the medication's effectiveness or the likelihood
of an adverse event.
 
Since 2014, Medicare Part D plans are required to facilitate pro-rated
co-payments for dispensing in less than a 30 day supply when medications
are being synchronized. To date, 18 states have enabled commercial
health plan coverage for synchronization, and two have provided Medicaid
beneficiaries access to synchronization. It is estimated that 76% of
Americans aged 60 and over use two or more medicines and 37% take five
or more.
 
Nothing in this bill requires medication synchronization. It simply
establishes a mechanism for medication synchronization for patients with
chronic illness when there is a voluntary agreed-upon plan between the
patient, the health care provider and the pharmacist
 
 
PRIOR LEGISLATIVE HISTORY:
 
2017-2018: A.7492-A - passed Assembly
2019: A.2785-A -- Vetoed
2020: A.9012 - reported to Ways and Means Committee
 
 
FISCAL IMPLICATIONS:
 
Potential Medicaid savings.
 
 
EFFECTIVE DATE:
120 days after becoming law.

A00187 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                           187
 
                               2021-2022 Regular Sessions
 
                   IN ASSEMBLY
 
                                       (Prefiled)
 
                                     January 6, 2021
                                       ___________
 
        Introduced  by  M.  of  A.  GOTTFRIED, ABINANTI, PHEFFER AMATO, SOLAGES,
          STECK, SEAWRIGHT, ASHBY, BYRNE, BUTTENSCHON, M. MILLER --  Multi-Spon-
          sored  by -- M. of A.  HEVESI -- read once and referred to the Commit-
          tee on Health

        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, nor a schedule III
    13  controlled substance that contains 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
    22  the purpose of synchronizing the patient's medications. When  applicable
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00492-01-1
        A. 187                              2
 
     1  to  permit synchronization, the department of health shall allow a phar-
     2  macy to override any denial codes  indicating  that  a  prescription  is
     3  being refilled too soon for the purposes of medication synchronization.
     4    (iii)  To permit synchronization, the department of health shall apply
     5  a prorated daily cost-sharing rate to  any  medication  dispensed  by  a
     6  pharmacy pursuant to this section.
     7    (iv)  The  dispensing  fee  paid  to  a pharmacy contracted to provide
     8  services pursuant to this section for a partial supply associated with a
     9  medication synchronization shall be  paid  in  full  and  shall  not  be
    10  prorated.
    11    (v)  The  requirement  of  this  paragraph  applies only once for each
    12  prescription drug subject  to  medication  synchronization  except  when
    13  either of the following occurs:
    14    (I)  the  prescriber changes the dosage or frequency of administration
    15  of the prescription drug subject to a medication synchronization; or
    16    (II) the prescriber prescribes a different drug.
    17    (vi) Nothing in this paragraph shall be deemed to require health  care
    18  practitioners  and  pharmacists to synchronize the refilling of multiple
    19  prescriptions for a recipient.
    20    § 2. Subdivision 4 of section 364-j of  the  social  services  law  is
    21  amended by adding a new paragraph (w) to read as follows:
    22    (w)(i)  The  department  of  health  or  a  managed  care organization
    23  contracted to provide services pursuant to this section shall  establish
    24  a program for synchronization of medications when it is agreed among the
    25  recipient,  a provider and a pharmacist that synchronization of multiple
    26  prescriptions for the treatment of a chronic  illness  is  in  the  best
    27  interest  of  the  patient  for the management or treatment of a chronic
    28  illness provided that the medications:
    29    (A) are covered by Medicaid services or a  managed  care  organization
    30  contracted to provide services pursuant to this chapter;
    31    (B)  are  used for treatment and management of chronic conditions that
    32  are subject to refills;
    33    (C) are not a schedule II controlled substance,  nor  a  schedule  III
    34  controlled substance that contains hydrocodone;
    35    (D)  meet all prior authorization criteria specific to the medications
    36  at the time of the synchronization request;
    37    (E) are of a formulation that can be effectively split  over  required
    38  short fill periods to achieve synchronization; and
    39   (F)  do  not  have  quantity  limits  or  dose optimization criteria or
    40  requirements that would be violated in fulfilling synchronization.
    41    (ii)  The  department  of  health  or  a  managed  care   organization
    42  contracted  to provide services under this section shall not deny cover-
    43  age for the dispensing of a medication  by  a  pharmacy  for  a  partial
    44  supply when it is for the purpose of synchronizing the patient's medica-
    45  tions.  When  applicable  to  permit  synchronization, the department of
    46  health or a managed care organization  contracted  to  provide  services
    47  under  this  title  shall  allow a pharmacy to override any denial codes
    48  indicating that a prescription  is  being  refilled  too  soon  for  the
    49  purposes of medication synchronization.
    50    (iii) To permit synchronization, the department of health or a managed
    51  care  organization contracted to provide services pursuant to this title
    52  shall apply  a  prorated  daily  cost-sharing  rate  to  any  medication
    53  dispensed by a pharmacy pursuant to this section.
    54    (iv)  The  dispensing  fee  paid  to  a pharmacy contracted to provide
    55  services pursuant to this section for a partial supply associated with a
        A. 187                              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.

A00187 LFIN:

 
NO LFIN

A00187 Chamber Video/Transcript: