A09012 Summary:

BILL NOA09012
 
SAME ASSAME AS S07109
 
SPONSORGottfried (MS)
 
COSPNSRAbinanti, Pheffer Amato, Solages, Jaffee, Garbarino, Steck, Seawright, Ashby, Byrne, McDonald, Buttenschon, Miller ML
 
MLTSPNSRHevesi
 
Amd 367-a & 364-j, Soc Serv L
 
Provides for the synchronization of multiple prescriptions for recipients of medical assistance.
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A09012 Actions:

BILL NOA09012
 
01/10/2020referred to health
01/28/2020reported referred to ways and means
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A09012 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A9012
 
SPONSOR: Gottfried (MS)
  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. 2785A Vetoed   FISCAL IMPLICATIONS: Potential Medicaid savings.   EFFECTIVE DATE: 120 days after becoming law.
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A09012 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          9012
 
                   IN ASSEMBLY
 
                                    January 10, 2020
                                       ___________
 
        Introduced  by  M.  of  A.  GOTTFRIED, ABINANTI, PHEFFER AMATO, SOLAGES,
          JAFFEE, GARBARINO, STECK, SEAWRIGHT, ASHBY, BYRNE, McDONALD,  BUTTENS-
          CHON  --  Multi-Sponsored  by  --  M.  of  A.  HEVESI -- read once and
          referred to the Committee 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
    23  to  permit synchronization, the department of health shall allow a phar-
    24  macy to override any denial codes  indicating  that  a  prescription  is
    25  being refilled too soon for the purposes of medication synchronization.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14664-01-0

        A. 9012                             2
 
     1    (iii)  To permit synchronization, the department of health shall apply
     2  a prorated daily cost-sharing rate to  any  medication  dispensed  by  a
     3  pharmacy pursuant to this section.
     4    (iv)  The  dispensing  fee  paid  to  a pharmacy contracted to provide
     5  services pursuant to this section for a partial supply associated with a
     6  medication synchronization shall be  paid  in  full  and  shall  not  be
     7  prorated.
     8    (v)  The  requirement  of  this  paragraph  applies only once for each
     9  prescription drug subject  to  medication  synchronization  except  when
    10  either of the following occurs:
    11    (I)  the  prescriber changes the dosage or frequency of administration
    12  of the prescription drug subject to a medication synchronization; or
    13    (II) the prescriber prescribes a different drug.
    14    (vi) Nothing in this paragraph shall be deemed to require health  care
    15  practitioners  and  pharmacists to synchronize the refilling of multiple
    16  prescriptions for a recipient.
    17    § 2. Subdivision 4 of section 364-j of  the  social  services  law  is
    18  amended by adding a new paragraph (w) to read as follows:
    19    (w)(i)  The  department  of  health  or  a  managed  care organization
    20  contracted to provide services pursuant to this section shall  establish
    21  a program for synchronization of medications when it is agreed among the
    22  recipient,  a provider and a pharmacist that synchronization of multiple
    23  prescriptions for the treatment of a chronic  illness  is  in  the  best
    24  interest  of  the  patient  for the management or treatment of a chronic
    25  illness provided that the medications:
    26    (A) are covered by Medicaid services or a  managed  care  organization
    27  contracted to provide services pursuant to this chapter;
    28    (B)  are  used for treatment and management of chronic conditions that
    29  are subject to refills;
    30    (C) are not a schedule II controlled substance,  nor  a  schedule  III
    31  controlled substance that contains hydrocodone;
    32    (D)  meet all prior authorization criteria specific to the medications
    33  at the time of the synchronization request;
    34    (E) are of a formulation that can be effectively split  over  required
    35  short fill periods to achieve synchronization; and
    36   (F)  do  not  have  quantity  limits  or  dose optimization criteria or
    37  requirements that would be violated in fulfilling synchronization.
    38    (ii)  The  department  of  health  or  a  managed  care   organization
    39  contracted  to provide services under this section shall not deny cover-
    40  age for the dispensing of a medication  by  a  pharmacy  for  a  partial
    41  supply when it is for the purpose of synchronizing the patient's medica-
    42  tions.  When  applicable  to  permit  synchronization, the department of
    43  health or a managed care organization  contracted  to  provide  services
    44  under  this  title  shall  allow a pharmacy to override any denial codes
    45  indicating that a prescription  is  being  refilled  too  soon  for  the
    46  purposes of medication synchronization.
    47    (iii) To permit synchronization, the department of health or a managed
    48  care  organization contracted to provide services pursuant to this title
    49  shall apply  a  prorated  daily  cost-sharing  rate  to  any  medication
    50  dispensed by a pharmacy pursuant to this section.
    51    (iv)  The  dispensing  fee  paid  to  a pharmacy contracted to provide
    52  services pursuant to this section for a partial supply associated with a
    53  medication synchronization shall be  paid  in  full  and  shall  not  be
    54  prorated.

        A. 9012                             3
 
     1    (v)  The  requirement  of  this  paragraph  applies only once for each
     2  prescription drug subject  to  medication  synchronization  except  when
     3  either of the following occurs:
     4    (A)  the  prescriber changes the dosage or frequency of administration
     5  of the prescription drug subject to a medication synchronization; or
     6    (B) the prescriber prescribes a different drug.
     7    (vi) Nothing in this paragraph shall be deemed to require health  care
     8  practitioners  and  pharmacists to synchronize the refilling of multiple
     9  prescriptions for a covered individual.
    10    § 3. This act shall take effect on the one hundred twentieth day after
    11  it shall have become a law.  The amendments to subdivision 9 of  section
    12  367-a of the social services law, made by section one of this act, shall
    13  not  affect  the expiration of that subdivision, and shall expire there-
    14  with.
    15    The amendments to section 364-j of the social services  law,  made  by
    16  section  two  of  this act, shall not affect the repeal of that section,
    17  and shall be  deemed  repealed  therewith.  Effective  immediately,  the
    18  commissioner  of  health  shall  make regulations and take other actions
    19  reasonably necessary to implement this act on that date.
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