S T A T E O F N E W Y O R K
________________________________________________________________________
8858
2009-2010 Regular Sessions
I N A S S E M B L Y
June 11, 2009
___________
Introduced by M. of A. GUNTHER, SAYWARD, CHRISTENSEN, REILLY, SPANO,
DUPREY, BURLING, BACALLES, KOLB, SCOZZAFAVA, RAIA, MOLINARO, CALHOUN
-- Multi-Sponsored by -- M. of A. CROUCH, EDDINGTON, McKEVITT, WEIS-
ENBERG -- read once and referred to the Committee on Aging
AN ACT to amend the elder law and the social services law, in relation
to pharmaceutical reimbursement under the EPIC program and Medicaid
for certain pharmacies
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subparagraph 1 of paragraph (b) of subdivision 1 of section
250 of the elder law, as amended by section 1 of part A of chapter 58 of
the laws of 2008, is amended and a new subparagraph 1-a is added to read
as follows:
(1) Average wholesale price discounted by sixteen and twenty-five one
hundredths percent, plus a dispensing fee as defined in paragraph (c) of
this subdivision, [or]
(1-A) AVERAGE WHOLESALE PRICE DISCOUNTED BY FOURTEEN PERCENT FOR A
SMALL PHARMACY, PLUS A DISPENSING FEE AS DEFINED IN PARAGRAPH (C) OF
THIS SUBDIVISION. FOR THE PURPOSES OF THIS SUBPARAGRAPH, A "SMALL PHAR-
MACY" SHALL MEAN A PHARMACY, APPROVED BY THE COMMISSIONER OF HEALTH,
WHICH IS DETERMINED BY THE COMMISSIONER OF HEALTH TO DISPENSE ON AVERAGE
UNDER TWO HUNDRED SCRIPTS A DAY, OR
S 2. Subparagraph (ii) of paragraph (b) of subdivision 9 of section
367-a of the social services law, as amended by section 4 of part C of
chapter 58 of the laws of 2008, is amended and a new paragraph (i) is
added to read as follows:
(ii) if the drug dispensed is a multiple source prescription drug or a
brand-name prescription drug for which no specific upper limit has been
set by such federal agency, the lower of the estimated acquisition cost
of such drug to pharmacies, or the dispensing pharmacy's usual and
customary price charged to the general public. For sole and multiple
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00965-03-9
A. 8858 2
source brand name drugs, estimated acquisition cost means the average
wholesale price of a prescription drug based upon the package size
dispensed from, as reported by the prescription drug pricing service
used by the department, less sixteen and twenty-five one hundredths
percent thereof, and updated monthly by the department; FOR A SMALL
PHARMACY, AS DEFINED IN PARAGRAPH (I) OF THIS SUBDIVISION, ACQUISITION
COSTS MEANS THE AVERAGE WHOLESALE PRICE OF A PRESCRIPTION DRUG BASED
UPON THE PACKAGE SIZE DISPENSED FROM, AS REPORTED BY THE PRESCRIPTION
DRUG PRICING SERVICE USED BY THE DEPARTMENT, LESS FOURTEEN PERCENT THER-
EOF, AND UPDATED MONTHLY BY THE DEPARTMENT; or, for a specialized HIV
pharmacy, as defined in paragraph (f) of this subdivision, acquisition
cost means the average wholesale price of a prescription drug based upon
the package size dispensed from, as reported by the prescription drug
pricing service used by the department, less twelve percent thereof, and
updated monthly by the department. For multiple source generic drugs,
estimated acquisition cost means the lower of the average wholesale
price of a prescription drug based on the package size dispensed from,
as reported by the prescription drug pricing service used by the depart-
ment, less twenty-five percent thereof, or the maximum acquisition cost,
if any, established pursuant to paragraph (e) of this subdivision; or,
for a specialized HIV pharmacy, as defined in paragraph (f) of this
subdivision, acquisition cost means the lower of the average wholesale
price of a prescription drug based on the package size dispensed from,
as reported by the prescription drug pricing service used by the depart-
ment, less twelve percent thereof, or the maximum acquisition cost, if
any, established pursuant to paragraph (e) of this subdivision.
(I) FOR PURPOSES OF THIS SECTION, A SMALL PHARMACY SHALL MEAN A PHAR-
MACY WHICH IS INDEPENDENTLY OWNED, APPROVED BY THE COMMISSIONER OF
HEALTH, AND WHICH IS DETERMINED BY THE COMMISSIONER OF HEALTH TO
DISPENSE ON AVERAGE UNDER TWO HUNDRED SCRIPTS A DAY.
S 3. This act shall take effect immediately; 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 expire therewith. Effective
immediately, the addition, amendment and/or repeal of any rule or regu-
lation necessary for the implementation of this act on its effective
date is authorized and directed to be made and completed on or before
such effective date.