Bill Text: NY S04078 | 2019-2020 | General Assembly | Introduced

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Bill Title: Provides for the insurance coverage of the synchronization of multiple prescriptions.

Spectrum: Moderate Partisan Bill (Democrat 4-1)

Status: (Passed) 2019-12-20 - signed chap.691 [S04078 Detail]

Download: New_York-2019-S04078-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          4078
                               2019-2020 Regular Sessions
                    IN SENATE
                                    February 27, 2019
                                       ___________
        Introduced  by Sens. BRESLIN, LANZA, SEPULVEDA -- read twice and ordered
          printed, and when printed to be committed to the Committee  on  Insur-
          ance
        AN  ACT  to  amend  the insurance 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. The insurance law is amended by adding a new section 3224-d
     2  to read as follows:
     3    § 3224-d. Prescription synchronization.  (a) Every individual or group
     4  health insurance policy providing prescription drug coverage when appli-
     5  cable to permit synchronization shall permit and apply a daily pro-rated
     6  cost-sharing rate to prescriptions that are dispensed by a network phar-
     7  macy  for  less  than  a  thirty day supply, when it is agreed among the
     8  covered individual, a health care practitioner, and  a  pharmacist  that
     9  synchronization of multiple prescriptions for the treatment of a chronic
    10  illness  is  in  the  best  interest  of  the covered individual for the
    11  management or treatment of that chronic illness provided that all of the
    12  following apply:
    13    (i) The medications are covered by the policy or plan.
    14    (ii) The medications are used for treatment and management of  chronic
    15  conditions that are subject to refills.
    16    (iii)  The medications are not a Schedule II controlled substance or a
    17  Schedule III controlled substance containing hydrocodone.
    18    (iv) The medications meet all prior authorization criteria specific to
    19  medications at the time of the synchronization request.
    20    (v) The medications are of a formulation that can be effectively split
    21  over required short fill periods to achieve synchronization.
    22    (vi) The medications do not have quantity limits or dose  optimization
    23  criteria or requirements that would be violated in fulfilling synchroni-
    24  zation.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01416-01-9
        S. 4078                             2
     1    (b)   No   individual  or  group  health  insurance  policy  providing
     2  prescription drug coverage shall deny coverage for the dispensing  of  a
     3  medication for partial fill when it is for purposes of synchronizing the
     4  patient's  medications. When applicable to permit synchronization, every
     5  individual  or  group  health  insurance policy must allow a pharmacy to
     6  override any denial  codes  indicating  that  a  prescription  is  being
     7  refilled too soon for the purposes of medication synchronization.
     8    (c)  Dispensing  fees  for  partially filled or refilled prescriptions
     9  shall be paid in full for each prescription dispensed, regardless of any
    10  pro-rated copay for the beneficiary or fee paid for alignment services.
    11    (d) Nothing in this section shall be deemed  to  require  health  care
    12  practitioners  and  pharmacists to synchronize the refilling of multiple
    13  prescriptions for a covered individual.
    14    (e) The requirements of this paragraph shall apply only once for  each
    15  prescription  drug  subject  to  medication  synchronization except when
    16  either of the following occurs:
    17    (i) The prescriber changes the dosage or frequency  of  administration
    18  of the prescription drug subject to a medication synchronization; or
    19    (ii) The prescriber prescribes a different drug.
    20    §  2.  The  insurance law is amended by adding a new section 4303-a to
    21  read as follows:
    22    § 4303-a. Prescription synchronization.   (a) Every  hospital  service
    23  corporation  and  health service corporation providing prescription drug
    24  coverage when applicable to  permit  synchronization  shall  permit  and
    25  apply  a  daily  pro-rated  cost-sharing  rate to prescriptions that are
    26  dispensed by a network pharmacy for less than a thirty day supply,  when
    27  it  is  agreed among the covered individual, a health care practitioner,
    28  and a pharmacist that synchronization of multiple prescriptions for  the
    29  treatment  of  a  chronic illness is in the best interest of the covered
    30  individual for the management  or  treatment  of  that  chronic  illness
    31  provided that all of the following apply:
    32    (i) The medications are covered by the policy or plan.
    33    (ii)  The medications are used for treatment and management of chronic
    34  conditions that are subject to refills.
    35    (iii) The medications are not a Schedule II controlled substance or  a
    36  Schedule III controlled substance containing hydrocodone.
    37    (iv) The medications meet all prior authorization criteria specific to
    38  medications at the time of the synchronization request.
    39    (v) The medications are of a formulation that can be effectively split
    40  over required short fill periods to achieve synchronization.
    41    (vi)  The medications do not have quantity limits or dose optimization
    42  criteria or requirements that would be violated in fulfilling synchroni-
    43  zation.
    44    (b) No hospital service  corporation  or  health  service  corporation
    45  providing  prescription  drug  coverage  shall  deny  coverage  for  the
    46  dispensing of a medication for partial fill when it is for  purposes  of
    47  synchronizing  the  patient's  medications.  When  applicable  to permit
    48  synchronization, every hospital service corporation  or  health  service
    49  corporation  providing  prescription drug coverage must allow a pharmacy
    50  to override any denial codes indicating that  a  prescription  is  being
    51  refilled too soon for the purposes of medication synchronization.
    52    (c)  Dispensing  fees  for  partially filled or refilled prescriptions
    53  shall be paid in full for each prescription dispensed, regardless of any
    54  pro-rated copay for the beneficiary or fee paid for alignment services.
        S. 4078                             3
     1    (d) Nothing in this section shall be deemed  to  require  health  care
     2  practitioners  and  pharmacists to synchronize the refilling of multiple
     3  prescriptions for a covered individual.
     4    (e)  The requirements of this paragraph shall apply only once for each
     5  prescription drug subject  to  medication  synchronization  except  when
     6  either of the following occurs:
     7    (i)  The  prescriber changes the dosage or frequency of administration
     8  of the prescription drug subject to a medication synchronization; or
     9    (ii) The prescriber prescribes a different drug.
    10    § 3. This act shall take effect on the first  of  January,  2020,  and
    11  shall  apply  to  all  policies and contracts issued, renewed, modified,
    12  altered or amended on or after such date.