Assembly Bill A676C

Signed By Governor
2015-2016 Legislative Session

Relates to establishing a pharmacy benefit manager contract appeals process

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Sponsored By

Archive: Last Bill Status Via S3346 - Signed by Governor

  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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Votes

Bill Amendments

co-Sponsors

multi-Sponsors

2015-A676 - Details

See Senate Version of this Bill:
S3346
Law Section:
Public Health Law
Laws Affected:
Add §280-a, Pub Health L
Versions Introduced in 2013-2014 Legislative Session:
A9264, S7025

2015-A676 - Summary

Relates to establishing a pharmacy benefit manager contract appeals process.

2015-A676 - Bill Text download pdf 

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

                                   676

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                             January 7, 2015
                               ___________

Introduced  by  M.  of  A.  ROSENTHAL,  SIMANOWITZ,  BRINDISI,  SKOUFIS,
  CYMBROWITZ, McDONALD -- Multi-Sponsored by -- M. of A. RAIA, WALTER --
  read once and referred to the Committee on Health

AN ACT to amend the public health law, in relation to  pharmacy  benefit
  managers

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

  Section 1. The public health law is amended by adding  a  new  section
280-a to read as follows:
  S  280-A.  PHARMACY  BENEFIT MANAGERS. 1. DEFINITIONS. AS USED IN THIS
SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
  (A) "PHARMACY BENEFIT  MANAGER"  MEANS  AN  ENTITY  THAT  ENTERS  INTO
CONTRACTS  WITH  PHARMACIES  ON  BEHALF  OF A HEALTH PLAN, STATE AGENCY,
INSURER, MANAGED CARE  ORGANIZATION,  OR  OTHER  THIRD  PARTY  PAYOR  TO
PROVIDE PHARMACY HEALTH BENEFIT SERVICES OR ADMINISTRATION.
  (B)  "MAXIMUM  ALLOWABLE  COST  PRICE"  MEANS  A MAXIMUM REIMBURSEMENT
AMOUNT SET BY THE PHARMACY BENEFIT MANAGER  FOR  THERAPEUTICALLY  EQUIV-
ALENT MULTIPLE SOURCE GENERIC DRUGS.
  2.  ALL  CONTRACTS BETWEEN A PHARMACY BENEFIT MANAGER AND A CONTRACTED
PHARMACY SHALL INCLUDE A REASONABLE PROCESS TO APPEAL,  INVESTIGATE  AND
RESOLVE  DISPUTES  REGARDING  MULTI-SOURCE  GENERIC  DRUG  PRICING.  THE
APPEALS PROCESS SHALL INCLUDE THE FOLLOWING PROVISIONS:
  (A) THE RIGHT TO APPEAL SHALL BE LIMITED TO SIXTY DAYS  FOLLOWING  THE
INITIAL CLAIM SUBMITTED FOR PAYMENT;
  (B)  A  TELEPHONE  NUMBER THROUGH WHICH A NETWORK PHARMACY MAY CONTACT
THE PHARMACY BENEFIT MANAGER AND SPEAK WITH AN INDIVIDUAL WHO IS RESPON-
SIBLE FOR PROCESSING APPEALS;
  (C) A PHARMACY BENEFIT MANAGER SHALL RESPOND IN WRITING TO  THE  CHAL-
LENGE WITHIN SEVEN BUSINESS DAYS AFTER RECEIPT OF THE CHALLENGE;
  (D) IF AN UPDATE TO THE MAXIMUM ALLOWABLE COST IS WARRANTED, THE PHAR-
MACY  BENEFIT  MANAGER  SHALL MAKE THE CHANGE RETROACTIVE TO THE DATE ON

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04032-01-5

co-Sponsors

multi-Sponsors

2015-A676A - Details

See Senate Version of this Bill:
S3346
Law Section:
Public Health Law
Laws Affected:
Add §280-a, Pub Health L
Versions Introduced in 2013-2014 Legislative Session:
A9264, S7025

2015-A676A - Summary

Relates to establishing a pharmacy benefit manager contract appeals process.

2015-A676A - Bill Text download pdf 

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

                                 676--A

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                             January 7, 2015
                               ___________

Introduced  by  M.  of  A.  ROSENTHAL,  SIMANOWITZ,  BRINDISI,  SKOUFIS,
  CYMBROWITZ, McDONALD -- Multi-Sponsored by -- M. of A. RAIA, WALTER --
  read once and  referred  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 pharmacy benefit
  managers

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

  Section  1.  The  public health law is amended by adding a new section
280-a to read as follows:
  S 280-A. PHARMACY BENEFIT MANAGERS. 1. DEFINITIONS. AS  USED  IN  THIS
SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
  (A)  "PHARMACY  BENEFIT  MANAGER"  MEANS AN ENTITY THAT CONTRACTS WITH
PHARMACIES OR PHARMACY CONTRACTING AGENTS ON BEHALF OF  A  HEALTH  PLAN,
STATE  AGENCY,  INSURER, MANAGED CARE ORGANIZATION, OR OTHER THIRD PARTY
PAYOR TO PROVIDE PHARMACY HEALTH BENEFIT SERVICES OR ADMINISTRATION.
  (B) "MAXIMUM ALLOWABLE  COST  PRICE"  MEANS  A  MAXIMUM  REIMBURSEMENT
AMOUNT  SET  BY  THE PHARMACY BENEFIT MANAGER FOR THERAPEUTICALLY EQUIV-
ALENT MULTIPLE SOURCE GENERIC DRUGS.
  2. A PHARMACY BENEFIT MANAGER SHALL, WITH RESPECT TO CONTRACTS BETWEEN
A PHARMACY BENEFIT MANAGER AND A PHARMACY OR, ALTERNATIVELY, A  PHARMACY
BENEFIT  MANAGER  AND A PHARMACY'S CONTRACTING AGENT, SUCH AS A PHARMACY
SERVICES ADMINISTRATIVE ORGANIZATION, INCLUDE A  REASONABLE  PROCESS  TO
APPEAL,  INVESTIGATE AND RESOLVE DISPUTES REGARDING MULTI-SOURCE GENERIC
DRUG  PRICING.  THE  APPEALS  PROCESS  SHALL   INCLUDE   THE   FOLLOWING
PROVISIONS:
  (A)  THE  RIGHT  TO  APPEAL  BY  THE  PHARMACY  AND/OR  THE PHARMACY'S
CONTRACTING AGENT SHALL BE LIMITED TO THIRTY DAYS FOLLOWING THE  INITIAL
CLAIM SUBMITTED FOR PAYMENT;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04032-03-5

co-Sponsors

multi-Sponsors

2015-A676B - Details

See Senate Version of this Bill:
S3346
Law Section:
Public Health Law
Laws Affected:
Add §280-a, Pub Health L
Versions Introduced in 2013-2014 Legislative Session:
A9264, S7025

2015-A676B - Summary

Relates to establishing a pharmacy benefit manager contract appeals process.

2015-A676B - Bill Text download pdf 

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

                                 676--B

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                             January 7, 2015
                               ___________

Introduced  by  M.  of  A.  ROSENTHAL,  SIMANOWITZ,  BRINDISI,  SKOUFIS,
  CYMBROWITZ,  McDONALD,  LUPARDO,  CUSICK,  JAFFEE,  PAULIN,  DINOWITZ,
  QUART,  BROOK-KRASNY,  WEPRIN,  TITONE, DAVILA, RUSSELL, CROUCH, GOTT-
  FRIED, BENEDETTO, FAHY, TENNEY, ABINANTI -- Multi-Sponsored by  --  M.
  of  A.  CLARK,  CURRAN,  FITZPATRICK,  LUPINACCI, MONTESANO, RA, RAIA,
  WALTER -- read once and referred to the Committee on Health -- commit-
  tee discharged, bill amended, ordered reprinted as amended and  recom-
  mitted  to  said  committee -- again reported from said committee with
  amendments, ordered reprinted  as  amended  and  recommitted  to  said
  committee

AN  ACT  to amend the public health law, in relation to pharmacy benefit
  managers

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

  Section  1.  The  public health law is amended by adding a new section
280-a to read as follows:
  S 280-A. PHARMACY BENEFIT MANAGERS. 1. DEFINITIONS. AS  USED  IN  THIS
SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
  (A)  "PHARMACY  BENEFIT  MANAGER"  MEANS AN ENTITY THAT CONTRACTS WITH
PHARMACIES OR PHARMACY CONTRACTING AGENTS ON BEHALF OF  A  HEALTH  PLAN,
STATE  AGENCY,  INSURER, MANAGED CARE ORGANIZATION, OR OTHER THIRD PARTY
PAYOR TO PROVIDE PHARMACY HEALTH BENEFIT SERVICES OR ADMINISTRATION.
  (B) "MAXIMUM ALLOWABLE  COST  PRICE"  MEANS  A  MAXIMUM  REIMBURSEMENT
AMOUNT  SET  BY  THE PHARMACY BENEFIT MANAGER FOR THERAPEUTICALLY EQUIV-
ALENT MULTIPLE SOURCE GENERIC DRUGS.
  2. A PHARMACY BENEFIT MANAGER SHALL, WITH RESPECT TO CONTRACTS BETWEEN
A PHARMACY BENEFIT MANAGER AND A PHARMACY OR, ALTERNATIVELY, A  PHARMACY
BENEFIT  MANAGER  AND A PHARMACY'S CONTRACTING AGENT, SUCH AS A PHARMACY
SERVICES ADMINISTRATIVE ORGANIZATION, INCLUDE A  REASONABLE  PROCESS  TO
APPEAL,  INVESTIGATE AND RESOLVE DISPUTES REGARDING MULTI-SOURCE GENERIC

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04032-05-5

co-Sponsors

multi-Sponsors

2015-A676C (ACTIVE) - Details

See Senate Version of this Bill:
S3346
Law Section:
Public Health Law
Laws Affected:
Add §280-a, Pub Health L
Versions Introduced in 2013-2014 Legislative Session:
A9264, S7025

2015-A676C (ACTIVE) - Summary

Relates to establishing a pharmacy benefit manager contract appeals process.

2015-A676C (ACTIVE) - Bill Text download pdf 

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

                                 676--C

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                             January 7, 2015
                               ___________

Introduced  by  M.  of  A.  ROSENTHAL,  SIMANOWITZ,  BRINDISI,  SKOUFIS,
  CYMBROWITZ,  McDONALD,  LUPARDO,  CUSICK,  JAFFEE,  PAULIN,  DINOWITZ,
  QUART,  BROOK-KRASNY,  WEPRIN,  TITONE, DAVILA, RUSSELL, CROUCH, GOTT-
  FRIED, BENEDETTO, FAHY, TENNEY,  ABINANTI,  WALTER,  LAVINE,  GUNTHER,
  McDONOUGH  --  Multi-Sponsored  by -- M.  of A. CLARK, CURRAN, FITZPA-
  TRICK, HEVESI, LUPINACCI, MONTESANO,  PALMESANO,  RA,  RAIA,  SCHIMEL,
  SIMON  -- read once and referred to the Committee on Health -- commit-
  tee discharged, bill amended, ordered reprinted as amended and  recom-
  mitted  to  said  committee -- again reported from said committee with
  amendments, ordered reprinted  as  amended  and  recommitted  to  said
  committee  -- reported and referred to the Committee on Ways and Means
  -- committee discharged, bill amended, ordered  reprinted  as  amended
  and recommitted to said committee

AN  ACT  to amend the public health law, in relation to pharmacy benefit
  managers

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

  Section  1.  The  public health law is amended by adding a new section
280-a to read as follows:
  S 280-A. PHARMACY BENEFIT MANAGERS. 1. DEFINITIONS. AS  USED  IN  THIS
SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
  (A)  "PHARMACY  BENEFIT  MANAGER"  MEANS AN ENTITY THAT CONTRACTS WITH
PHARMACIES OR PHARMACY CONTRACTING AGENTS ON BEHALF OF  A  HEALTH  PLAN,
STATE  AGENCY,  INSURER, MANAGED CARE ORGANIZATION, OR OTHER THIRD PARTY
PAYOR TO PROVIDE PHARMACY HEALTH BENEFIT SERVICES OR ADMINISTRATION.
  (B) "MAXIMUM ALLOWABLE  COST  PRICE"  MEANS  A  MAXIMUM  REIMBURSEMENT
AMOUNT  SET  BY  THE PHARMACY BENEFIT MANAGER FOR THERAPEUTICALLY EQUIV-
ALENT MULTIPLE SOURCE GENERIC DRUGS.
  2. A PHARMACY BENEFIT MANAGER SHALL, WITH RESPECT TO CONTRACTS BETWEEN
A PHARMACY BENEFIT MANAGER AND A PHARMACY OR, ALTERNATIVELY, A  PHARMACY
BENEFIT  MANAGER  AND A PHARMACY'S CONTRACTING AGENT, SUCH AS A PHARMACY

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04032-09-5

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