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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, McDonald, Griffin
 
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 Actions:

BILL NOA03009
 
01/28/2019referred to insurance
06/05/2019reported referred to rules
06/11/2019reported
06/11/2019rules report cal.108
06/11/2019ordered to third reading rules cal.108
06/13/2019passed assembly
06/13/2019delivered to senate
06/13/2019REFERRED TO RULES
06/17/2019SUBSTITUTED FOR S4078
06/17/20193RD READING CAL.987
06/17/2019PASSED SENATE
06/17/2019RETURNED TO ASSEMBLY
12/10/2019delivered to governor
12/20/2019signed chap.691
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A03009 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A3009
 
SPONSOR: Quart (MS)
  TITLE OF BILL: An act to amend the insurance law, in relation to synchronization of multiple prescriptions   PURPOSE OR GENERAL IDEA OF BILL: Provides for the insurance coverage of the synchronization of multiple prescriptions and dispensing fee standardization. Specifically, this bill would amend the insurance law by adding Article 32, governing for- profit commercial health insurance policies, and Article 43, governing nonprofit health insurance policies. The bill would provide coverage for a pharmaceutical claim for less than a 30 day supply for patients enrolling in medication synchronization programs.   SUMMARY OF SPECIFIC PROVISIONS: Sections 1 and 2 add the following provisions: (a) Provides that a pro-rated cost-sharing rate shall be permitted and applied to prescriptions that are dispensed for less than a 30 day supply for the purpose of synchronizing the covered individual's chronic medication. (b) Provides that drug coverage shall not be denied for a partial fill for any drug prescribed for the treatment of a chronic illness made in accordance with a medication synchronization plan among the insured, a health care practitioner and a pharmacist. (c) Ensures that the dispensing fee stays whole for the pharmacist for a partial fill. (d) Specifies that nothing in this bill requires health care practition- ers and pharmacists to synchronize the filling of prescriptions. (e) Specifies that the aforementioned provisions shall apply only once for each prescription drug subject to medication synchronization except when a prescriber changes the dosage or frequency of administration of the prescription drug subject to medication synchronization or the pres- criber prescribes a different drug. Section 3 sets forth the effective date.   JUSTIFICATION: This bill would eliminate barriers to the implementation of medication synchronization, a service that has been shown to improve rates of medi- cation adherence and thus, lower overall health care expenditures. Medication synchronization is a pharmacy service that improves patient adherence to prescribed medications by coordinating the refill dates for all of a patient's chronic prescription medications so these can be picked up on the same date each month. It is estimated that 76 percent of Americans over the age of 60 use two or more medicines and 37 percent take five or more medicines. Patient and caregiver lives are simplified by eliminating multiple trips to the pharmacy each month. It also mini- mizes confusion over when a prescription is due to be refilled and mini- mizes disrupting treatment through delayed or missed refills. The medi- cation synchronization model improves adherence and provides a more coordinated level of care, resulting in healthier patients and more effective delivery of care, reducing overall costs to payers and the health care system. Despite the benefits of synchronization, patients and pharmacies still face several challenges when trying to synchronize all of a patient's prescriptions. A "short fill" or partial fill is often needed to align the patient's medications to a single refill date. Currently, many payers do not have payment policies in place to provide coverage for a claim for less than a 30 day supply. Therefore, patients are required to pay a full month's copayment or coinsurance for a month's supply of medications, even if questions remain as to the effectiveness or adverse impacts of that medication on that patient. The Centers for Medicare and Medicaid Services (CMS), the largest payer for health care in the nation, is implementing several policy changes that will help remove current barriers to the medication synchronization process, reduce waste from unnecessary fills, and ensure that benefici- aries are only receiving the medications they need. Beginning January 1, 2014, Medicare Part D sponsors will be required to apply a daily cost- sharing rate to most prescriptions that are dispensed for less than a 30 day supply. This provides a common sense approach when a patient is just starting out on a new therapy and may not require a full month's supply, or is attempting to synchronize their refills. State-level legislation would help remove existing operational and payment barriers presented by other payers and facilitate an even greater uptake of medication synchronization programs and other methods that promote adherence and appropriate medication use. This bill is voluntary for patients, health care practitioners and phar- macists. Nothing in this bill requires health care practitioners and pharmacists to synchronize the filling of prescriptions. 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. This legislation would: *Eliminate barriers to the implementation of medication synchronization, a service that has been shown to improve rates of medication adherence and thus, lower overall health care expenditures. *Benefit the patient, particularly when they are initially prescribed a new medication that has significant side effects, is frequently poorly tolerated, may pose drug-drug interactions with their current regimen, and when less than a month's supply of the prescription is clinically appropriate. *Improve the ongoing issue of medication waste when medications are changed during a mid-30 day supply. * Provide a patient with the ability to synchronize their prescriptions in consultation with their pharmacists without having to pay a full month's cost-sharing when less than a month's supply of medication(s) is dispensed during the synchronization process until all medications are on the same thirty or more days refill schedule. *Protect a pharmacist from being compensated a pro-rated dispensing fee when a partial fill is provided. A dispensing fee does not relate to the amount of medication dispensed. It is the fee associated with operating costs, overhead, packaging and other costs of operating a pharmacy.   PRIOR LEGISLATIVE HISTORY: 2017-2018: A.4306 Passed Assembly 2015-16: A.4036 Passed Assembly 2014: A.8975 Referred to Insurance   FISCAL IMPLICATIONS: None   EFFECTIVE DATE: This act shall take effect on the 120th day after becoming law.
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