Bill Text: NY S07025 | 2013-2014 | General Assembly | Amended

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Bill Title: Relates to establishing a pharmacy benefit manager contract appeals process.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2014-06-16 - PRINT NUMBER 7025A [S07025 Detail]

Download: New_York-2013-S07025-Amended.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                        7025--A
                                   I N  S E N A T E
                                    April 16, 2014
                                      ___________
       Introduced  by  Sens.  HANNON, ADDABBO, AVELLA, MAZIARZ, VALESKY -- read
         twice and ordered printed, and when printed to  be  committed  to  the
         Committee  on  Health  --  committee discharged, bill amended, ordered
         reprinted as amended and recommitted to said committee
       AN ACT to amend the public health law, in relation to  pharmacy  benefit
         managers
         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section 1. The public health law is amended by adding  a  new  section
    2  280-a to read as follows:
    3    S  280-A.  PHARMACY  BENEFIT MANAGERS. 1. DEFINITIONS. AS USED IN THIS
    4  SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
    5    (A) "PHARMACY BENEFIT  MANAGER"  MEANS  AN  ENTITY  THAT  ENTERS  INTO
    6  CONTRACTS  WITH  PHARMACIES  ON  BEHALF  OF A HEALTH PLAN, STATE AGENCY,
    7  INSURER, MANAGED CARE  ORGANIZATION,  OR  OTHER  THIRD  PARTY  PAYOR  TO
    8  PROVIDE PHARMACY HEALTH BENEFIT SERVICES OR ADMINISTRATION.
    9    (B)  "MAXIMUM  ALLOWABLE  COST  PRICE"  MEANS  A MAXIMUM REIMBURSEMENT
   10  AMOUNT SET BY THE PHARMACY BENEFIT MANAGER  FOR  THERAPEUTICALLY  EQUIV-
   11  ALENT MULTIPLE SOURCE GENERIC DRUGS.
   12    2.  ALL  CONTRACTS BETWEEN A PHARMACY BENEFIT MANAGER AND A CONTRACTED
   13  PHARMACY SHALL INCLUDE A REASONABLE PROCESS TO APPEAL,  INVESTIGATE  AND
   14  RESOLVE  DISPUTES  REGARDING  MULTI-SOURCE  GENERIC  DRUG  PRICING.  THE
   15  APPEALS PROCESS SHALL INCLUDE THE FOLLOWING PROVISIONS:
   16    (A) THE RIGHT TO APPEAL SHALL BE LIMITED TO SIXTY DAYS  FOLLOWING  THE
   17  INITIAL CLAIM SUBMITTED FOR PAYMENT;
   18    (B)  A  TELEPHONE  NUMBER THROUGH WHICH A NETWORK PHARMACY MAY CONTACT
   19  THE PHARMACY BENEFIT MANAGER AND SPEAK WITH AN INDIVIDUAL WHO IS RESPON-
   20  SIBLE FOR PROCESSING APPEALS;
   21    (C) A PHARMACY BENEFIT MANAGER SHALL RESPOND IN WRITING TO  THE  CHAL-
   22  LENGE WITHIN SEVEN BUSINESS DAYS AFTER RECEIPT OF THE CHALLENGE;
   23    (D) IF AN UPDATE TO THE MAXIMUM ALLOWABLE COST IS WARRANTED, THE PHAR-
   24  MACY  BENEFIT  MANAGER  SHALL MAKE THE CHANGE RETROACTIVE TO THE DATE ON
   25  WHICH THE CLAIM FOR PAYMENT WAS  ADJUDICATED  BY  THE  PHARMACY  BENEFIT
   26  MANAGER.   THE PHARMACY BENEFIT MANAGER SHALL MAKE THE ADJUSTMENT EFFEC-
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD14526-05-4
       S. 7025--A                          2
    1  TIVE FOR ALL SIMILARLY SITUATED PHARMACY PROVIDERS IN THE STATE  IN  THE
    2  NETWORK; AND
    3    (E) IF AN APPEAL IS DENIED, THE PHARMACY BENEFIT MANAGER SHALL PROVIDE
    4  IN WRITING THE REASON FOR THE DENIAL AND IDENTIFY THE NATIONAL DRUG CODE
    5  AT  A PRICE AT OR BELOW THE MAXIMUM ALLOWABLE COST OR BENCHMARK PRICE AS
    6  DETERMINED BY THE PHARMACY BENEFIT MANAGER.
    7    S 2. This act shall take effect on the ninetieth day  after  it  shall
    8  become  a  law  and shall apply to any contract between a pharmacy and a
    9  pharmacy benefit manager issued or renewed after such effective date.