Bill Text: NY A09165 | 2021-2022 | 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 19-0)

Status: (Introduced - Dead) 2022-01-31 - referred to health [A09165 Detail]

Download: New_York-2021-A09165-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          9165

                   IN ASSEMBLY

                                    January 31, 2022
                                       ___________

        Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred 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 (w) and (x) to read as follows:
     3    (w)  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-two,  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.
    24    (x) Notwithstanding any provision of law to the  contrary,  a  managed
    25  care  provider  or  pharmacy  benefit  manager  acting on its behalf, as
    26  defined in section two hundred eighty-a of the public health law,  shall
    27  not  deny  any retail pharmacy the opportunity to participate in another
    28  provider's pharmacy network under  the  medical  assistance  program  at

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11345-02-2
        A. 9165                             2

     1  preferred  participation  status,  provided  that  such  retail pharmacy
     2  agrees to the same reimbursement amount, as defined in paragraph (w)  of
     3  this  subdivision,  and  is  able  to fill and dispense prescription and
     4  over-the-counter  medications  for those enrolled in the medical assist-
     5  ance program.
     6    § 2. Section 280-a of the public health law is amended by adding a new
     7  subdivision 6 to read as follows:
     8    6. Delivery option.  Notwithstanding  any  provision  of  law  to  the
     9  contrary,  no  pharmacy  benefit  manager  shall limit the option for an
    10  individual receiving prescription  or  over-the-counter  medications  to
    11  receive  such  medications  from their local, non-mail order pharmacy of
    12  choice via delivery including in-person delivery, United  States  postal
    13  service  or other mail or courier service. No restrictions, prohibitions
    14  or prior authorization requirements shall be based on  the  individual's
    15  choice in delivery type or distance from a pharmacy.
    16    §  3.  This  act shall take effect on the thirtieth day after it shall
    17  have become a law; provided, however, that:
    18    (a) the amendments to subdivision 4 of section  364-j  of  the  social
    19  services  law  made by section one of this act shall take effect July 1,
    20  2022;
    21    (b) if this act shall have become a law after such effective  date  it
    22  shall  take  effect immediately and shall be deemed to have been in full
    23  force and effect on and after July 1, 2022;
    24    (c) the amendments to subdivision 4 of section  364-j  of  the  social
    25  services law made by section one of this act shall not affect the repeal
    26  of such section and shall be deemed repealed therewith; and
    27    (d)  if chapter 828 of the laws of 2021 shall not have taken effect on
    28  or before such effective date then section two of this  act  shall  take
    29  effect  on  the  same date and in the same manner as such chapter of the
    30  laws of 2021 takes effect.