STATE OF NEW YORK ________________________________________________________________________ 2785--A 2019-2020 Regular Sessions IN ASSEMBLY January 25, 2019 ___________ Introduced by M. of A. GOTTFRIED, ABINANTI, PHEFFER AMATO, SOLAGES, JAFFEE, GARBARINO, RAIA, STECK, SEAWRIGHT, ASHBY, BYRNE -- Multi-Spon- sored by -- M. of A. HEVESI -- read once and referred to the Commit- tee on Health -- reported and referred to the Committee on Ways and Means -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee 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 EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD03580-02-9A. 2785--A 2 1 the purpose of synchronizing the patient's medications. When applicable 2 to permit synchronization, the department of health shall allow a phar- 3 macy to override any denial codes indicating that a prescription is 4 being refilled too soon for the purposes of medication synchronization. 5 (iii) To permit synchronization, the department of health shall apply 6 a prorated daily cost-sharing rate to any medication dispensed by a 7 pharmacy pursuant to this section. 8 (iv) The dispensing fee paid to a pharmacy contracted to provide 9 services pursuant to this section for a partial supply associated with a 10 medication synchronization shall be paid in full and shall not be 11 prorated. 12 (v) The requirement of this paragraph applies only once for each 13 prescription drug subject to medication synchronization except when 14 either of the following occurs: 15 (I) the prescriber changes the dosage or frequency of administration 16 of the prescription drug subject to a medication synchronization; or 17 (II) the prescriber prescribes a different drug. 18 (vi) Nothing in this paragraph shall be deemed to require health care 19 practitioners and pharmacists to synchronize the refilling of multiple 20 prescriptions for a recipient. 21 § 2. Subdivision 4 of section 364-j of the social services law is 22 amended by adding a new paragraph (w) to read as follows: 23 (w)(i) The department of health or a managed care organization 24 contracted to provide services pursuant to this section shall establish 25 a program for synchronization of medications when it is agreed among the 26 recipient, a provider and a pharmacist that synchronization of multiple 27 prescriptions for the treatment of a chronic illness is in the best 28 interest of the patient for the management or treatment of a chronic 29 illness provided that the medications: 30 (A) are covered by Medicaid services or a managed care organization 31 contracted to provide services pursuant to this chapter; 32 (B) are used for treatment and management of chronic conditions that 33 are subject to refills; 34 (C) are not a schedule II controlled substance, nor a schedule III 35 controlled substance that contains hydrocodone; 36 (D) meet all prior authorization criteria specific to the medications 37 at the time of the synchronization request; 38 (E) are of a formulation that can be effectively split over required 39 short fill periods to achieve synchronization; and 40 (F) do not have quantity limits or dose optimization criteria or 41 requirements that would be violated in fulfilling synchronization. 42 (ii) The department of health or a managed care organization 43 contracted to provide services under this section shall not deny cover- 44 age for the dispensing of a medication by a pharmacy for a partial 45 supply when it is for the purpose of synchronizing the patient's medica- 46 tions. When applicable to permit synchronization, the department of 47 health or a managed care organization contracted to provide services 48 under this title shall allow a pharmacy to override any denial codes 49 indicating that a prescription is being refilled too soon for the 50 purposes of medication synchronization. 51 (iii) To permit synchronization, the department of health or a managed 52 care organization contracted to provide services pursuant to this title 53 shall apply a prorated daily cost-sharing rate to any medication 54 dispensed by a pharmacy pursuant to this section. 55 (iv) The dispensing fee paid to a pharmacy contracted to provide 56 services pursuant to this section for a partial supply associated with aA. 2785--A 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.