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A03009 Summary:

BILL NOA03009
 
SAME ASSAME AS S04078
 
SPONSORQuart (MS)
 
COSPNSRBraunstein, Ryan, Fahy, Lavine, Hevesi, Steck, Aubry, Pretlow, Seawright, Weprin, Rivera, Cook, Barclay, Crespo, Cymbrowitz, Abinanti, Pheffer Amato, Garbarino, Solages, Raia, Galef, Peoples-Stokes, Stirpe, Otis, Cusick
 
MLTSPNSRDilan, Perry
 
Add 3224-d & 4303-a, Ins L
 
Provides for the insurance coverage of the synchronization of multiple prescriptions.
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A03009 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          3009
 
                               2019-2020 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 28, 2019
                                       ___________
 
        Introduced  by  M.  of A. QUART, BRAUNSTEIN, RYAN, FAHY, LAVINE, HEVESI,
          STECK, AUBRY, PRETLOW, SEAWRIGHT, WEPRIN, RIVERA, COOK, BARCLAY, CRES-
          PO, CYMBROWITZ, ABINANTI,  PHEFFER AMATO,  GARBARINO,  SOLAGES,  RAIA,
          GALEF,  PEOPLES-STOKES,  STIRPE, OTIS, CUSICK -- Multi-Sponsored by --
          M. of A.  DILAN, PERRY -- read once and referred to the  Committee  on
          Insurance
 
        AN  ACT  to  amend  the insurance 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. The insurance law is amended by adding a new section 3224-d
     2  to read as follows:
     3    § 3224-d. Prescription synchronization.  (a) Every individual or group
     4  health insurance policy providing prescription drug coverage when appli-
     5  cable to permit synchronization 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 provided that all of the
    12  following apply:
    13    (i) The medications are covered by the policy or plan.
    14    (ii) The medications are used for treatment and management of  chronic
    15  conditions that are subject to refills.
    16    (iii)  The medications are not a Schedule II controlled substance or a
    17  Schedule III controlled substance containing hydrocodone.
    18    (iv) The medications meet all prior authorization criteria specific to
    19  medications at the time of the synchronization request.
    20    (v) The medications are of a formulation that can be effectively split
    21  over required short fill periods to achieve synchronization.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01416-01-9

        A. 3009                             2
 
     1    (vi) The medications do not have quantity limits or dose  optimization
     2  criteria or requirements that would be violated in fulfilling synchroni-
     3  zation.
     4    (b)   No   individual  or  group  health  insurance  policy  providing
     5  prescription drug coverage shall deny coverage for the dispensing  of  a
     6  medication for partial fill when it is for purposes of synchronizing the
     7  patient's  medications. When applicable to permit synchronization, every
     8  individual or group health insurance policy must  allow  a  pharmacy  to
     9  override  any  denial  codes  indicating  that  a  prescription is being
    10  refilled too soon for the purposes of medication synchronization.
    11    (c) Dispensing fees for partially  filled  or  refilled  prescriptions
    12  shall be paid in full for each prescription dispensed, regardless of any
    13  pro-rated copay for the beneficiary or fee paid for alignment services.
    14    (d)  Nothing  in  this  section shall be deemed to require health care
    15  practitioners and pharmacists to synchronize the refilling  of  multiple
    16  prescriptions for a covered individual.
    17    (e)  The requirements of this paragraph shall apply only once for each
    18  prescription drug subject  to  medication  synchronization  except  when
    19  either of the following occurs:
    20    (i)  The  prescriber changes the dosage or frequency of administration
    21  of the prescription drug subject to a medication synchronization; or
    22    (ii) The prescriber prescribes a different drug.
    23    § 2. The insurance law is amended by adding a new  section  4303-a  to
    24  read as follows:
    25    §  4303-a.  Prescription synchronization.   (a) Every hospital service
    26  corporation and health service corporation providing  prescription  drug
    27  coverage  when  applicable  to  permit  synchronization shall permit and
    28  apply a daily pro-rated cost-sharing  rate  to  prescriptions  that  are
    29  dispensed  by a network pharmacy for less than a thirty day supply, when
    30  it is agreed among the covered individual, a health  care  practitioner,
    31  and  a pharmacist that synchronization of multiple prescriptions for the
    32  treatment of a chronic illness is in the best interest  of  the  covered
    33  individual  for  the  management  or  treatment  of that chronic illness
    34  provided that all of the following apply:
    35    (i) The medications are covered by the policy or plan.
    36    (ii) The medications are used for treatment and management of  chronic
    37  conditions that are subject to refills.
    38    (iii)  The medications are not a Schedule II controlled substance or a
    39  Schedule III controlled substance containing hydrocodone.
    40    (iv) The medications meet all prior authorization criteria specific to
    41  medications at the time of the synchronization request.
    42    (v) The medications are of a formulation that can be effectively split
    43  over required short fill periods to achieve synchronization.
    44    (vi) The medications do not have quantity limits or dose  optimization
    45  criteria or requirements that would be violated in fulfilling synchroni-
    46  zation.
    47    (b)  No  hospital  service  corporation  or health service corporation
    48  providing  prescription  drug  coverage  shall  deny  coverage  for  the
    49  dispensing  of  a medication for partial fill when it is for purposes of
    50  synchronizing the  patient's  medications.  When  applicable  to  permit
    51  synchronization,  every  hospital  service corporation or health service
    52  corporation providing prescription drug coverage must allow  a  pharmacy
    53  to  override  any  denial  codes indicating that a prescription is being
    54  refilled too soon for the purposes of medication synchronization.

        A. 3009                             3
 
     1    (c) Dispensing fees for partially  filled  or  refilled  prescriptions
     2  shall be paid in full for each prescription dispensed, regardless of any
     3  pro-rated copay for the beneficiary or fee paid for alignment services.
     4    (d)  Nothing  in  this  section shall be deemed to require health care
     5  practitioners and pharmacists to synchronize the refilling  of  multiple
     6  prescriptions for a covered individual.
     7    (e)  The requirements of this paragraph shall apply only once for each
     8  prescription drug subject  to  medication  synchronization  except  when
     9  either of the following occurs:
    10    (i)  The  prescriber changes the dosage or frequency of administration
    11  of the prescription drug subject to a medication synchronization; or
    12    (ii) The prescriber prescribes a different drug.
    13    § 3. This act shall take effect on the first  of  January,  2020,  and
    14  shall  apply  to  all  policies and contracts issued, renewed, modified,
    15  altered or amended on or after such date.
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