NY State Senate Bill 2017-S6541

Senate Bill S6541

2017-2018 Legislative Session

Relates to coverage for certain prescription drugs in Medicaid managed care programs; repealer

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Archive: Last Bill Status - In Senate Committee Health Committee

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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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2018	referred to health
Jun 01, 2017	referred to health

co-Sponsors

2017-S6541 (ACTIVE) - Details

See Assembly Version of this Bill:: A4007
Current Committee:: Senate Health
Law Section:: Social Services Law
Laws Affected:: Amd §364-j, rpld sub 25-a, Soc Serv L
Versions Introduced in Other Legislative Sessions:: 2019-2020: S1794, A2799
2021-2022: S1588
2023-2024: S503

2017-S6541 (ACTIVE) - Summary

Provides for coverage for certain medically necessary prescription drugs in Medicaid managed care programs.

2017-S6541 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S6541

 TITLE OF BILL :  An act to amend the social services law, in relation
to coverage for certain prescription drugs; and to repeal certain
provisions of such law relating thereto

 PURPOSE: :

To clarify that "prescriber prevails" provisions under Medicaid
managed care for certain classes of drugs shall be conducted as it
currently is for fee-for-service Medicaid recipients, with exceptions.

 SUMMARY OF PROVISIONS: :

Section 1 of the bill Amends Social Services Law § 364-j, subdivision
25 to obligate a Medicaid managed care plan to cover a drug benefit
when, in the prescriber's reasonable professional judgment, the
prescription is medically necessary and warranted. The exceptions are
in the instance when a drug is required by the Medicaid program to be
filled with a generic substitute and the prescriber has marked
"dispense as written;" or when the prescription is related to a use
not supported by the FDA-approved label, or official compendia or
formularies. The bill also consolidates into subdivision 25 the drug
classes listed in subdivision 25-a, and repeals subdivision 25-a.

 JUSTIFICATION: :

Current law allows physicians treating patients under the Medicaid
fee-for-service program to invoke prescriber prevails without extra
roadblocks. This bill will ensure that a managed-care Medicaid
patient's health care professional has the final say in determining
which drug, in certain classes, will be dispensed to the patient
unless the drug requires generic substitution, or the intended purpose
is off-label or not supported by official compendia. This bill is
drafted to respond to the veto message that was issued by the Governor
in relation to the 2015 bill.

 LEGISLATIVE HISTORY: :

Similar to S 4893 of 2015 which was vetoed

 FISCAL IMPLICATIONS: :

To be determined

 EFFECTIVE DATE: :

On the 60th day after enactment, provided that effective immediately
the Commissioner of health may make regulations necessary to implement
the act.

2017-S6541 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6541
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               June 1, 2017
                                ___________
 
 Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the social services law, in  relation  to  coverage  for
   certain  prescription  drugs; and to repeal certain provisions of such
   law relating thereto

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 25 of section 364-j of the social services law,
 as  added  by section 55 of part D of chapter 56 of the laws of 2012, is
 amended to read as follows:
   25. [Effective January first, two thousand thirteen,  notwithstanding]
 NOTWITHSTANDING  any  provision  of  law  to  the contrary, managed care
 providers shall cover medically  necessary  prescription  drugs  in  the
 ANTI-DEPRESSANT,   ANTI-RETROVIRAL,  ANTIREJECTION,  SEIZURE,  EPILEPSY,
 ENDOCRINE, HEMATOLOGIC, IMMUNOLOGIC AND atypical antipsychotic therapeu-
 tic [class] CLASSES, including non-formulary drugs, upon [demonstration]
 DETERMINATION by THE PRESCRIBER UNDER THIS SUBDIVISION. IF the  prescri-
 ber,  after  consulting  with the managed care provider, DETERMINES that
 such drugs, in the prescriber's reasonable  professional  judgment,  are
 medically  necessary and warranted, THE PRESCRIBER'S DETERMINATION SHALL
 BE FINAL. HOWEVER, THE PRESCRIBER'S DETERMINATION SHALL  NOT  BE  FINAL:
 (A)  WHERE  THE  DRUG APPROVED BY THE MANAGED CARE PROVIDER IS A GENERIC
 DRUG SUBJECT TO SUBPARAGRAPH (I) OF PARAGRAPH (A-1) OF SUBDIVISION  FOUR
 OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS ARTICLE (MANDATORY GENERIC
 SUBSTITUTION),  AND  THE  PRESCRIBER HAS INDICATED THAT THE PRESCRIPTION
 SHALL BE DISPENSED AS WRITTEN; OR (B) IF IT IS FOR THE  USE  OF  A  DRUG
 THAT IS NOT CONSISTENT WITH FOOD AND DRUG ADMINISTRATION-APPROVED LABEL-
 ING  OR  SUPPORTED BY ONE OR MORE OFFICIAL COMPENDIA REFERENCES, INCLUD-
 ING, BUT NOT LIMITED TO, THE AMERICAN HOSPITAL FORMULARY SERVICE (AHFS),
 THE DRUGDEX DRUG INFORMATION SYSTEM AND THE UNITED STATES PHARMACOPEIA.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07092-02-7

 S. 6541                             2
 
   § 2. Subdivision 25-a of section 364-j of the social services  law  is
 REPEALED.
   §  3.  This  act  shall take effect on the sixtieth day after it shall
 have become a law; provided that effective immediately, the commissioner
 of health may make regulations  and  take  other  actions  necessary  to
 implement  this act on that date; and provided, further, that the amend-
 ments to section 364-j of the social services law made by section one of
 this act shall not affect the repeal of such section and shall be deemed
 repealed therewith.

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Senate Bill S6541

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