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.
