Senate Bill S3835

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

                                  3835

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                              April 2, 2009
                               ___________

Introduced  by  Sen.  DUANE  -- read twice and ordered printed, and when
  printed to be committed 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
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

              

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00354-01-9

S. 3835                             2

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
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.