S T A T E   O F   N E W   Y O R K
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                                   576

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 5, 2011
                               ___________

Introduced   by   M.  of  A.  GOTTFRIED,  ENGLEBRIGHT,  JACOBS,  PAULIN,
  N. RIVERA, CAHILL, PERRY, ARROYO, HEASTIE, JAFFEE  --  Multi-Sponsored
  by  --  M.  of  A.  BING,  BRENNAN,  COLTON, DESTITO, DINOWITZ, GLICK,
  GUNTHER, KELLNER, LIFTON, V. LOPEZ, LUPARDO, McENENY,  MILLMAN,  PHEF-
  FER,  SWEENEY,  TITUS,  WEISENBERG  --  read  once and referred to the
  Committee on Health

AN ACT to amend the public health law and the social  services  law,  in
  relation to medicaid payment for co-payments due under Medicare Part D

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subdivision 7 of section 273 of the public health  law,  as
amended  by  section  7  of part C of chapter 58 of the laws of 2008, is
amended to read as follows:
  7. No prior authorization under the preferred drug  program  shall  be
required when a prescriber prescribes a drug on the preferred drug list,
OR  WHEN  MEDICAL  ASSISTANCE  PAYMENT  IS  MADE, UNDER PARAGRAPH (G) OF
SUBDIVISION TWO OF SECTION THREE  HUNDRED  SIXTY-FIVE-A  OF  THE  SOCIAL
SERVICES  LAW SOLELY FOR THE CO-PAYMENT FOR PRESCRIPTIONS PROVIDED UNDER
PART D OF TITLE XVIII OF THE  FEDERAL  SOCIAL  SECURITY  ACT;  provided,
however,  that  the  commissioner  may  identify [such] a drug for which
prior authorization is required pursuant to the provisions of the  clin-
ical  drug review program established under section two hundred seventy-
four of this article.
  S 2. Subparagraph (ii) of paragraph (f) of subdivision  6  of  section
367-a  of the social services law, as amended by section 42 of part C of
chapter 58 of the laws of 2005, is amended to read as follows:
  (ii) In the year commencing April first, two  thousand  five  and  for
each  year thereafter, no recipient shall be required to pay more than a
total of two hundred dollars in co-payments, INCLUDING THOSE required by
this subdivision[, nor] AND, FOR RECIPIENTS ELIGIBLE FOR COVERAGE  UNDER

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
              

                                                           LBD02349-01-1

A. 576                              2

PART D OF TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT (REFERRED TO IN
THIS  SECTION AS "MEDICARE PART D"), THOSE CO-PAYMENTS REQUIRED BY MEDI-
CARE PART D. NOR shall reductions  in  payments  as  a  result  of  such
co-payments  exceed  two hundred dollars for any recipient.  THE COMMIS-
SIONER OF HEALTH SHALL CREATE A SYSTEM TO INCORPORATE CO-PAYMENTS BILLED
TO A RECIPIENT UNDER MEDICARE PART D TOWARDS THE RECIPIENT'S TOTAL ANNU-
AL CO-PAYMENTS UNDER MEDICAL ASSISTANCE.  AS PART OF THIS SYSTEM,  PHAR-
MACISTS SHALL RECORD ALL CO-PAYMENTS DUE UNDER MEDICARE PART D FROM SUCH
RECIPIENTS  WITH  THE  MEDICAL  ASSISTANCE  PROGRAM, THROUGH THE MEDICAL
ASSISTANCE ELECTRONIC BILLING SYSTEM.  THE COMMISSIONER OF HEALTH  SHALL
INCLUDE  THE  CO-PAYMENTS  BILLED  UNDER  MEDICARE PART D ALONG WITH THE
CO-PAYMENTS REQUIRED UNDER THIS  SUBDIVISION  IN  DETERMINING  WHEN  THE
RECIPIENT'S TOTAL ANNUAL CO-PAYMENTS HAVE REACHED TWO HUNDRED DOLLARS.
  S  3.  Paragraph  (g)  of subdivision 2 of section 365-a of the social
services law, as amended by section 1 of part F of chapter  497  of  the
laws of 2008, is amended to read as follows:
  (g)  sickroom  supplies,  eyeglasses, prosthetic appliances and dental
prosthetic appliances furnished in accordance with  the  regulations  of
the  department,  provided that the commissioner of health is authorized
to implement a preferred diabetic supply program wherein the  department
of  health will receive enhanced rebates from preferred manufacturers of
glucometers and test strips, and may subject  non-preferred  manufactur-
ers'  glucometers  and  test strips to prior authorization under section
two hundred seventy-three of the public health law; drugs provided on an
in-patient basis, those drugs contained on the list established by regu-
lation of the commissioner of health pursuant  to  subdivision  four  of
this  section, AND, FOR RECIPIENTS ELIGIBLE FOR COVERAGE UNDER PART D OF
TITLE XVIII OF THE FEDERAL SOCIAL SECURITY  ACT  (REFERRED  TO  IN  THIS
SECTION  AS  "MEDICARE  PART  D"),  PAYMENT  OF THE CO-PAYMENT FOR DRUGS
PROVIDED BY A MEDICARE PART D PLAN, AFTER THE INDIVIDUAL HAS REACHED THE
ANNUAL CAP ON CO-PAYMENTS AS DEFINED IN SUBPARAGRAPH (II)  OF  PARAGRAPH
(F)  OF  SUBDIVISION  SIX OF SECTION THREE HUNDRED SIXTY-SEVEN-A OF THIS
TITLE, and those drugs which may not be dispensed without a prescription
as required by section sixty-eight hundred ten of the education law  and
which  the  commissioner  of  health  shall determine to be reimbursable
based upon such factors as the availability of such  drugs  or  alterna-
tives at low cost if purchased by a medicaid recipient, or the essential
nature  of  such drugs as described by such commissioner in regulations,
provided, however, that such drugs, exclusive of  long-term  maintenance
drugs,  shall  be  dispensed  in quantities no greater than a thirty day
supply or one hundred doses, whichever is greater; provided further that
the commissioner of health is authorized to require prior  authorization
for  any refill of a prescription when less than seventy-five percent of
the previously dispensed amount per fill should have been used were  the
product used as normally indicated; medical assistance shall not include
any  drug provided on other than an in-patient basis for which a recipi-
ent is charged or a claim is made in the case of a prescription drug, in
excess of the maximum reimbursable amounts to be established by  depart-
ment  regulations in accordance with standards established by the secre-
tary of the United States department of health and human  services,  or,
in  the  case  of  a drug not requiring a prescription, in excess of the
maximum reimbursable amount established by the  commissioner  of  health
pursuant to paragraph (a) of subdivision four of this section;
  S  4. This act shall take effect on the first of April next succeeding
the date on which it shall have become a law;  provided,  however,  that
the  amendments to subdivision 7 of section 273 of the public health law

A. 576                              3

made by section one of this act shall not  affect  the  repeal  of  such
section  and  shall be deemed repealed therewith; and provided, further,
that the amendments to subparagraph (ii) of paragraph (f) of subdivision
6  of  section  367-a  of the social services law made by section two of
this act shall not affect the repeal of  such  paragraph  and  shall  be
deemed repealed therewith.