Bill Text: NY S03509 | 2023-2024 | General Assembly | Introduced

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Bill Title: Requires Medicaid managed care plans to reimburse retail pharmacies in an amount equal to the fee-for-service rate; allows retail pharmacies the opportunity to participate in another provider's network under the medical assistance program; prohibits pharmacy benefit managers from limiting an individual's option to receive medications from non-mail order pharmacies.

Spectrum: Partisan Bill (Democrat 5-0)

Status: (Introduced) 2023-08-11 - RECOMMIT, ENACTING CLAUSE STRICKEN [S03509 Detail]

Download: New_York-2023-S03509-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          3509

                               2023-2024 Regular Sessions

                    IN SENATE

                                    January 31, 2023
                                       ___________

        Introduced  by  Sens. SKOUFIS, ADDABBO, CLEARE, KAVANAGH, THOMAS -- read
          twice and ordered printed, and when printed to  be  committed  to  the
          Committee on Health

        AN  ACT  to  amend the social services law and the public health law, in
          relation to protecting access to pharmacy services

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Subdivision 4 of section 364-j of the social services law
     2  is amended by adding two new paragraphs (x) and (y) to read as follows:
     3    (x) Notwithstanding any provision of law to the contrary,  administra-
     4  tive  fees paid to a managed care provider or a pharmacy benefit manager
     5  under the medical assistance program shall be reduced for the purpose of
     6  increasing reimbursement rates to retail pharmacies under  the  Medicaid
     7  managed  care  program.  Beginning on and after July first, two thousand
     8  twenty-three, all reimbursement paid by Medicaid managed care  plans  to
     9  retail  pharmacies  shall  include a professional dispensing fee and the
    10  drug acquisition cost for each outpatient drug dispensed at no less than
    11  the amount established under the fee-for-service program, as defined  in
    12  section three hundred sixty-seven-a of this title, regardless of whether
    13  such reimbursement is paid directly by the Medicaid managed care plan or
    14  passed  through  a  pharmacy  benefit  manager  or  other  entity.   The
    15  reimbursement provided for under this paragraph shall not apply  to  any
    16  existing reimbursement arrangements involving an eligible provider under
    17  section  340B  of the federal public health services act or a comprehen-
    18  sive HIV special needs plan under section forty-four hundred three-c  of
    19  the  public  health law under the medical assistance program. No managed
    20  care provider or pharmacy benefit manager  shall  reimburse  a  pharmacy
    21  owned  by or affiliated with such entity at a higher rate than that paid
    22  by such entity to a pharmacy it does not own or is not otherwise  affil-
    23  iated with.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD06891-01-3
        S. 3509                             2

     1    (y)  Notwithstanding  any  provision of law to the contrary, a managed
     2  care provider or pharmacy benefit  manager  acting  on  its  behalf,  as
     3  defined  in section two hundred eighty-a of the public health law, shall
     4  not deny any retail pharmacy the opportunity to participate  in  another
     5  provider's  pharmacy  network  under  the  medical assistance program at
     6  preferred participation  status,  provided  that  such  retail  pharmacy
     7  agrees  to the same reimbursement amount, as defined in paragraph (x) of
     8  this subdivision, and is able to  fill  and  dispense  prescription  and
     9  over-the-counter  medications  for those enrolled in the medical assist-
    10  ance program.
    11    § 2. Section 280-a of the public health law is amended by adding a new
    12  subdivision 6 to read as follows:
    13    6. Delivery option.  Notwithstanding  any  provision  of  law  to  the
    14  contrary,  no  pharmacy  benefit  manager  shall limit the option for an
    15  individual receiving prescription  or  over-the-counter  medications  to
    16  receive  such  medications  from their local, non-mail order pharmacy of
    17  choice via delivery including in-person delivery, United  States  postal
    18  service  or other mail or courier service. No restrictions, prohibitions
    19  or prior authorization requirements shall be based on  the  individual's
    20  choice in delivery type or distance from a pharmacy.
    21    § 3. This act shall take effect immediately; provided, however, that:
    22    (a) section one of this act shall take effect July 1, 2023;
    23    (b)  if  this act shall have become a law after such effective date it
    24  shall take effect immediately and shall be deemed to have been  in  full
    25  force and effect on and after July 1, 2023;
    26    (c)  the  amendments  to  subdivision 4 of section 364-j of the social
    27  services law made by section one of this act shall not affect the repeal
    28  of such section and shall be deemed repealed therewith; and
    29    (d) section two of this act shall take effect  on  the  thirtieth  day
    30  after it shall have become a law.