senate Bill S3963A

Relates to the amount of dispensing fees paid to pharmacies in EPIC and Medicaid

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 01 / Mar / 2013
    • REFERRED TO AGING
  • 08 / Jan / 2014
    • REFERRED TO AGING
  • 21 / Feb / 2014
    • AMEND AND RECOMMIT TO AGING
  • 21 / Feb / 2014
    • PRINT NUMBER 3963A

Summary

Relates to the amount of dispensing fees paid to pharmacies in EPIC and Medicaid; establishes the dispensing fee at eight dollars per prescription for patients in long term care facilities, intermediate care facilities for the developmentally disabled, assisted living programs and any other residential care facilities in which prescriptions are dispensed in unit-of-use packaging.

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Bill Details

Versions:
S3963
S3963A
Legislative Cycle:
2013-2014
Current Committee:
Senate Aging
Law Section:
Elder Law
Laws Affected:
Amd §250, Eld L; amd §367-a, Soc Serv L
Versions Introduced in Previous Legislative Cycles:
2011-2012: S1267A
2009-2010: S3901B
2007-2008: S8216

Sponsor Memo

BILL NUMBER:S3963A

TITLE OF BILL: An act to amend the elder law and the social services
law, in relation to dispensing fees paid to pharmacies in EPIC and
Medicaid

PURPOSE OR GENERAL IDEA OF BILL:

This bill provides for the dispensing fee paid per prescription.

SUMMARY OF SPECIFIC PROVISIONS:

Section One of the bill amends paragraph (c) of subdivision 1 of
section 250 of elder law related to the dispensing fee paid to
pharmacies for every prescription filled under EPIC program. This bill
adds a new provision related to the dispensing fee paid to pharmacies
required to dispense medications in unit-of-use packaging.

Section two of the bill amends subparagraphs (i) and (ii) of paragraph
(d) of subdivision 9 of section 367-a of the social services law, as
amended by chapter 19 of the laws of 1998 related to the dispensing
fee paid to pharmacies for every prescription filled for persons
eligible to participate in the Medicaid program. The bill adds a new
subparagraph (iii) related to the dispensing fee paid to pharmacies
required to dispense medications in unit-of-use packaging.

JUSTIFICATION:

Given the high costs of doing business in this state,
publicly-financed Prescription benefit programs such as Medicaid and
EPIC should not reimburse pharmacies at a rate lower than every other
state that has enacted deeply discounted product reimbursement
policies.

The actual cost of dispensing a prescription to a beneficiary in the
New York Medicaid program ranges between $8.79 and $14.04 according to
the survey conducted by Grant Thorton released in January, 2007. We
apply the same survey results to dispensing fees paid under EPIC.
With the high costs of living and doing business, New York's Medicaid
and EPIC programs should not reimburse pharmacies at the very lowest
level in the country. Doing so may reduce the pharmacy provider
network to unacceptable levels. Should that occur, both programs will
fail in their primary objective, to deliver medically necessary
healthcare of acceptable quality cost containment parameters.

Although the legislature has restored millions to the cuts proposed by
the executive over the course of the past decade, every state budget
has nevertheless left pharmacy providers with less reimbursement than
in the previous year. Virtually every health care provider in the
Medicaid program has faced regular decreases in reimbursement, but no
other provider category has been subject to the cumulative percentage
reductions as have the state's pharmacies.

Pharmacies that provide prescription services for residents in
long-term care facilities and other forms of residential care incur
additional expense associated with preparing "blister packs" and other
forms of unit-of-use packaging that are required by regulation. This


special packaging provides additional security against misuse or
overuse and enhances patient compliance that in turn reduces
unnecessary Medicaid spending associated with medication errors or
inappropriate use. The differential in the legislation is also based
on policies adopted by other states.

PRIOR LEGISLATIVE HISTORY:

2013 S.3963 - Referred to Aging

FISCAL IMPLICATIONS:

None. The changes proposed in this legislation are possible in the
context of the funds appropriated for spending on the pharmacy
benefit.

First of all, national trends suggest that the rate of growth in
spending for prescription drugs has slowed. The proposed 6% increase
in the cost of the benefit is likely to be much lower.

Second, the proposed spending on prescription drugs does not take into
account the additional supplemental rebates generated by preferred
drug programs. In 2006 when the PDP was first implemented, the program
generated $30.5 million.

Third, although the dispensing fees in this bill appear to be the same
for brands and generics, differences in co-payments actually provide
pharmacy with a slight higher fee for dispensing generic drugs.

EFFECTIVE DATE:

April 1, 2014, with provisions.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 3963--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              March 1, 2013
                               ___________

Introduced  by  Sen. ADDABBO -- read twice and ordered printed, and when
  printed to be committed to the Committee on Aging  --  recommitted  to
  the  Committee  on  Aging  in accordance with Senate Rule 6, sec. 8 --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted to said committee

AN  ACT  to amend the elder law and the social services law, in relation
  to dispensing fees paid to pharmacies in EPIC and Medicaid

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

  Section  1. Paragraph (c) of subdivision 1 of section 250 of the elder
law, as amended by section 18 of part T of chapter 56  of  the  laws  of
2012, is amended to read as follows:
  (c)  As  required  by  paragraphs  (a)  and (b) of this subdivision, a
dispensing fee of [four] SEVEN dollars  [fifty]  AND  TWENTY-FIVE  cents
[will apply to generic drugs and a dispensing fee of three dollars fifty
cents  will  apply  to  brand  name drugs] PER PRESCRIPTION SHALL APPLY,
PROVIDED, HOWEVER, THAT FOR PRESCRIPTION DRUGS DISPENSED FOR PATIENTS IN
LONG TERM CARE FACILITIES, INTERMEDIATE CARE FACILITIES FOR THE DEVELOP-
MENTALLY DISABLED, ASSISTED LIVING PROGRAMS, AND ANY  OTHER  RESIDENTIAL
CARE  FACILITIES  IN  WHICH  PRESCRIPTIONS  ARE DISPENSED IN UNIT-OF-USE
PACKAGING, A DISPENSING FEE OF  EIGHT  DOLLARS  PER  PRESCRIPTION  SHALL
APPLY.
  S  2.  Subparagraphs (i) and (ii) of paragraph (d) of subdivision 9 of
section 367-a of the social services law, subparagraph (i) as amended by
section 10-a of part H of chapter 59 of the laws of  2011  and  subpara-
graph  (ii) as amended by section 48 of part C of chapter 58 of the laws
of 2009, are amended and a new subparagraph (iii) is added  to  read  as
follows:
  (i)  for prescription drugs categorized as generic by the prescription
drug pricing service used by the department, [three] SEVEN  dollars  and
[fifty] TWENTY-FIVE cents per prescription; and

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09162-02-4

S. 3963--A                          2

  (ii)  for  prescription  drugs  categorized as brand-name prescription
drugs by the prescription drug pricing service used by  the  department,
[three]  SEVEN  dollars  and [fifty] TWENTY-FIVE cents per prescription,
provided, however, that for brand  name  prescription  drugs  reimbursed
pursuant  to subparagraph (ii) of paragraph (a-1) of subdivision four of
section three hundred sixty-five-a of this  title,  the  dispensing  fee
shall  be  [four]  EIGHT  dollars  and  [fifty]  TWENTY-FIVE  cents  per
prescription[.]; AND
  (III) FOR PRESCRIPTION DRUGS CATEGORIZED AS BRAND OR  GENERIC  BY  THE
PRESCRIPTION  DRUG  PRICING SERVICE USED BY THE DEPARTMENT AND DISPENSED
FOR PATIENTS IN LONG TERM CARE FACILITIES, INTERMEDIATE CARE  FACILITIES
FOR  THE  DEVELOPMENTALLY  DISABLED,  ASSISTED  LIVING PROGRAMS, AND ANY
OTHER RESIDENTIAL CARE FACILITIES IN WHICH PRESCRIPTIONS  ARE  DISPENSED
IN UNIT-OF-USE PACKAGING, EIGHT DOLLARS PER PRESCRIPTION.
  S 3. This act shall take effect April 1, 2014, provided, however, that
the  amendments to subdivision 9 of section 367-a of the social services
law made by section two of this act shall not affect the  expiration  of
such subdivision and shall be deemed to be expired therewith.

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