Bill Text: NY S05043 | 2011-2012 | General Assembly | Amended
Bill Title: Establishes a Medicaid drug rebate remittance demonstration program to authorize the department of health to work collaboratively with third party vendors to validate existing Medicaid drug rebate claims and the data contains duplicate claims or claims on which rebates may have already been paid all or in part to Medicare Part D plans or some other third parties in order to rectify disputed claims.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Engrossed - Dead) 2012-01-04 - REFERRED TO HEALTH [S05043 Detail]
Download: New_York-2011-S05043-Amended.html
S T A T E O F N E W Y O R K
________________________________________________________________________
5043--A
2011-2012 Regular Sessions
I N S E N A T E
May 3, 2011
___________
Introduced by Sen. HANNON -- 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 establishing a
medicaid drug rebate remittance demonstration program
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
2 276-b to read as follows:
3 S 276-B. MEDICAID DRUG REBATE REMITTANCE DEMONSTRATION PROGRAM. 1.
4 THE DEPARTMENT SHALL ESTABLISH A MEDICAID DRUG REBATE REMITTANCE DEMON-
5 STRATION PROGRAM FOR THE PURPOSE OF WORKING COLLABORATIVELY WITH THIRD
6 PARTY VENDORS TO VALIDATE THE EXISTING MEDICAID DRUG REBATE CLAIMS AND
7 DETERMINE WHETHER THE DATA CONTAINS DUPLICATE CLAIMS OR CLAIMS ON WHICH
8 REBATES MAY ALREADY HAVE BEEN PAID ALL OR IN PART TO MEDICARE PART D
9 PLANS OR SOME OTHER THIRD PARTIES IN ORDER TO RECTIFY DISPUTED CLAIMS.
10 2. FOR THE PURPOSES OF THIS DEMONSTRATION PROGRAM, THE DEPARTMENT
11 SHALL PROVIDE UTILIZATION INFORMATION TYING TO INVOICES SENT TO PHARMA-
12 CEUTICAL MANUFACTURERS, WHICH HAVE ENTERED INTO A REBATE AGREEMENT WITH
13 THE DEPARTMENT OR WITH THE FEDERAL SECRETARY OF HEALTH AND HUMAN
14 SERVICES ON BEHALF OF THE DEPARTMENT UNDER SECTION 1927 OF THE FEDERAL
15 SOCIAL SECURITY ACT, AND TO THIRD PARTY DATA VENDORS, FOR THE PURPOSE OF
16 VALIDATING CLAIMS SUBMITTED UNDER SUCH REBATE AGREEMENT OR PROGRAM
17 INCLUDING BUT NOT LIMITED TO, THE PROGRAM FOR ELDERLY PHARMACEUTICAL
18 INSURANCE COVERAGE, AND THE MEDICAID DRUG REBATE PROGRAM IN GENERAL FOR
19 THE PERIOD FROM JANUARY FIRST, TWO THOUSAND NINE THROUGH JUNE THIRTIETH,
20 TWO THOUSAND TWELVE. SUCH UTILIZATION INFORMATION SHALL INCLUDE, BUT NOT
21 BE LIMITED TO: PRESCRIPTION NUMBERS, NATIONAL DRUG CODES, NUMBER OF
22 UNITS DISPENSED, CLAIMS PAID DATE, DATE OF SERVICE, PRESCRIBING PHYSI-
23 CIAN STATE IDENTIFICATION NUMBER, AMOUNT BILLED FOR EACH PRESCRIPTION,
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11186-02-1
S. 5043--A 2
1 AMOUNT OF REIMBURSEMENT RECEIVED FOR EACH PRESCRIPTION (INCLUDING ANY
2 ADJUSTMENT CODES), DISPENSING PHARMACY'S STATE IDENTIFICATION NUMBER,
3 DISPENSING FEE, ANY APPLICABLE THIRD-PARTY PAYMENTS, APPLICABLE CO-PAY-
4 MENTS, REFILL CODE, INTERNAL CLAIM NUMBER OF THE SCRIPT, DAYS SUPPLY,
5 J-CODE CLAIMS INCLUDING SINGLE SOURCE AND MULTISOURCE PHYSICIAN ADMINIS-
6 TERED DRUGS, NPI NUMBERS, MCO PLAN IDENTIFIER, MCO PLAN NAME, AND THE
7 NAME, ADDRESS, CITY, STATE AND ZIP CODE OF THE PRESCRIBING PRACTITIONER
8 AND PHARMACY. THE PRESCRIPTION DRUG UTILIZATION INFORMATION SHALL BE
9 PROVIDED TO THE THIRD PARTY DATA VENDORS AS SOON AS PRACTICABLE FOLLOW-
10 ING ESTABLISHMENT OF THIS PROGRAM. THERE SHALL BE NO COST TO THE DEPART-
11 MENT FOR SERVICES PERFORMED BY THIRD PARTY DATA VENDORS. ANY
12 PRESCRIPTION DRUG UTILIZATION DATA PROVIDED TO THIRD PARTY DATA VENDORS
13 UNDER THIS DEMONSTRATION PROGRAM SHALL NOT BE SHARED WITH OTHER PARTIES,
14 EXCEPT PARTICIPATING DRUG MANUFACTURERS WHO HAVE ENTERED INTO A REBATE
15 AGREEMENT WITH THE DEPARTMENT OR WITH THE FEDERAL SECRETARY OF HEALTH
16 AND HUMAN SERVICES ON BEHALF OF THE DEPARTMENT UNDER SECTION 1927 OF THE
17 FEDERAL SOCIAL SECURITY ACT. UTILIZATION DATA PROVIDED UNDER THIS
18 SECTION SHALL BE USED FOR THE FOLLOWING PURPOSE: REBATE VALIDATION
19 SERVICES FOR THE BENEFIT OF DRUG COMPANIES AND STATE/FEDERAL AGENCIES
20 INCLUDING DRUG USE TREND REVIEW. INDIVIDUAL PATIENT IDENTIFYING INFORMA-
21 TION SHALL BE KEPT CONFIDENTIAL BY ANY PERSON OR ENTITY TO WHOM OR TO
22 WHICH IT IS PROVIDED UNDER THIS SECTION. THE DISCLOSURE OF THE FOREGOING
23 DATA BY THE DEPARTMENT SHALL BE CONSIDERED, FOR PURPOSES OF SECTION
24 THREE HUNDRED SIXTY-NINE OF THE SOCIAL SERVICES LAW, TO BE DIRECTLY
25 CONNECTED WITH THE ADMINISTRATION OF MEDICAL ASSISTANCE FOR NEEDY
26 PERSONS.
27 3. THE DEPARTMENT SHALL PROVIDE A REPORT ON THE RESULTS OF THE DEMON-
28 STRATION PROGRAM, WITH INPUT FROM STAKEHOLDERS, TO THE GOVERNOR, THE
29 DIRECTOR OF THE DIVISION OF BUDGET, THE STATE COMPTROLLER AND THE LEGIS-
30 LATURE ON OR BEFORE DECEMBER THIRTY-FIRST, TWO THOUSAND TWELVE. THE
31 REPORT SHALL INCLUDE FINDINGS AS TO THE DEMONSTRATION PROGRAM'S CONTRIB-
32 UTION TO IMPROVING THE ABILITY OF THE DEPARTMENT TO VALIDATE DRUG REBATE
33 CLAIMS AND RECTIFY DISPUTED CLAIMS. IN THE REPORT, THE DEPARTMENT SHALL
34 OFFER RECOMMENDATIONS AS TO WHETHER THE DEMONSTRATION PROGRAM SHOULD BE
35 EXTENDED, MODIFIED, ELIMINATED OR MADE PERMANENT.
36 S 2. This act shall take effect immediately, provided, however, that
37 the amendments to article 2-A of the public health law made by section
38 one of this act shall survive the repeal of such article as provided in
39 section 79 of part C of chapter 58 of the laws of 2005, as amended.
