Bill Text: NY S03466 | 2023-2024 | General Assembly | Introduced

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Bill Title: Provides that prescription drugs eligible for reimbursement shall be provided and paid for under the preferred drug program and the clinical drug review program; restores pharmacy benefits under Medicaid managed care.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-01-03 - REFERRED TO HEALTH [S03466 Detail]

Download: New_York-2023-S03466-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          3466

                               2023-2024 Regular Sessions

                    IN SENATE

                                    January 31, 2023
                                       ___________

        Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
          printed to be committed to the Committee on Health

        AN ACT to amend the social services law,  in  relation  to  prescription
          drugs  eligible for Medicaid coverage; to amend the public health law,
          in relation to prior authorization under the preferred  drug  program;
          to  repeal certain provisions of part FFF of chapter 56 of the laws of
          2020 directing the department of health to remove the pharmacy benefit
          from the managed care benefit  package,  relating  to  restoring  such
          benefits; and to repeal certain provisions of the social services law,
          relating  to  coverage  for  certain prescription drugs under Medicaid
          managed care programs

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

     1    Section 1. Legislative findings. This legislature finds that the costs
     2  of  many prescription drugs in the market have been escalating unreason-
     3  ably. The preferred drug program and the clinical  drug  review  program
     4  under  the  public  health law provide effective mechanisms for assuring
     5  access to quality, effective and safe drugs to  patients  at  reasonable
     6  cost.  Providing  prescription  drugs  to  Medicaid  managed health care
     7  provider participants through these programs will maximize the  Medicaid
     8  program's  ability  to  negotiate  more  substantial  rebates  with drug
     9  manufacturers (effectively, lower  prices),  while  protecting  Medicaid
    10  managed care provider participants.
    11    § 2. Sections 1 and 1-a of part FFF of chapter 56 of the laws of 2020,
    12  relating to prescription drugs under the Medicaid program, are REPEALED.
    13    §  3. The social services law is amended by adding a new section 365-i
    14  to read as follows:
    15    § 365-i. Prescription drugs in Medicaid. 1. The definitions  of  terms
    16  in  section  two hundred seventy of the public health law shall apply to
    17  this section.   As used in this  section,  unless  the  context  clearly
    18  requires otherwise, "managed care provider" means a managed care provid-
    19  er  under  section  three  hundred  sixty-four-j  of  this article, or a
    20  managed long term care plan under section forty-four hundred three-f  of
    21  the public health law.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD06159-01-3
        S. 3466                             2

     1    2.  Prescription  drugs  eligible for reimbursement under this article
     2  shall be provided and paid for under the preferred drug program and  the
     3  clinical  drug  review  program  under title one of article two-A of the
     4  public health law, except as otherwise provided in subdivision three  of
     5  this section.
     6    3.  This subdivision applies where the eligible individual is enrolled
     7  in a managed care provider and a prescription for the eligible  individ-
     8  ual  is made under section 340B of the federal Public Health Service Act
     9  (the "340B program"). The managed care provider shall pay for the  drugs
    10  under  the  340B  program. However, the prescription shall be subject to
    11  section two hundred seventy-three (preferred drug program prior authori-
    12  zation) and section  two  hundred  seventy-four  (clinical  drug  review
    13  program) of the public health law.
    14    4.  The  managed  care  provider  shall  account  to and reimburse the
    15  department for the net cost to the  department  for  prescription  drugs
    16  provided  to  eligible individuals who receive medical services from the
    17  managed care provider.  Capitation payments by the  department  to  such
    18  managed  care provider shall include a component for reimbursements paid
    19  under this subdivision.
    20    § 4. Paragraph (b) of subdivision 3  of  section  273  of  the  public
    21  health  law,  as added by section 10 of part C of chapter 58 of the laws
    22  of 2005, is amended to read as follows:
    23    (b) In the event that the patient does not meet the criteria in  para-
    24  graph  (a)  of  this  subdivision, the prescriber may provide additional
    25  information to the program to justify the use  of  a  prescription  drug
    26  that  is  not  on  the  preferred drug list. The program shall provide a
    27  reasonable opportunity for a prescriber to reasonably present his or her
    28  justification of prior authorization. If, after  consultation  with  the
    29  program, the prescriber, in his or her reasonable professional judgment,
    30  determines  that  the  use  of  a  prescription  drug that is not on the
    31  preferred drug list is warranted, the prescriber's  determination  shall
    32  be  final.   However, the prescriber's determination shall not be final:
    33  (i) where the preferred drug is a generic drug subject  to  subparagraph
    34  (i)  of  paragraph  (a-1)  of  subdivision four of section three hundred
    35  sixty-five-a of the  social  services  law  (mandatory  generic  substi-
    36  tution),  and even if the prescriber has indicated that the prescription
    37  shall be dispensed as written; or (ii) if it is for the use  of  a  drug
    38  that is not consistent with food and drug administration-approved label-
    39  ing  or  supported by one or more official Compendia references, includ-
    40  ing, but not limited to, the American Hospital Formulary Service (AHFS),
    41  the DRUGDEX Drug Information System and the United States Pharmacopeia.
    42    § 5. Subdivisions 25, 25-a, 26 and 26-b, and paragraph (u) of subdivi-
    43  sion 4 of section 364-j of the social services law are REPEALED.
    44    § 6. Severability. If any provision of this act, or any application of
    45  any provision of this act, is held to be invalid, or to  violate  or  be
    46  inconsistent  with  any federal law or regulation, that shall not affect
    47  the validity or effectiveness of any other provision of this act, or  of
    48  any  other  application of any provision of this act, which can be given
    49  effect without that provision or  application;  and  to  that  end,  the
    50  provisions and applications of this act are severable.
    51    §  7. This act shall take effect immediately, except that sections one
    52  through five of this act shall take effect on the one hundred  eightieth
    53  day  after  they  shall  have become a law.   Effective immediately, the
    54  commissioner of health shall make regulations  and  take  other  actions
    55  reasonably necessary to implement this act when it takes effect.