Bill Text: NY A09012 | 2019-2020 | General Assembly | Introduced
Bill Title: Provides for the synchronization of multiple prescriptions for recipients of medical assistance.
Spectrum: Slight Partisan Bill (Democrat 10-4)
Status: (Introduced - Dead) 2020-01-28 - reported referred to ways and means [A09012 Detail]
Download: New_York-2019-A09012-Introduced.html
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. LBD14664-01-0A. 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.