NY State Senate Bill 2009-S6937

Senate Bill S6937

2009-2010 Legislative Session

Directs the department of health to evaluate and report on Medicaid prescription drug reimbursement to retail pharmacies

download bill text pdf

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

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Feb 26, 2010	referred to health

2009-S6937 (ACTIVE) - Details

See Assembly Version of this Bill:: A8782
Current Committee:: Senate Health
Law Section:: Health
Versions Introduced in 2011-2012 Legislative Session:: A4534

2009-S6937 (ACTIVE) - Summary

Directs the department of health to evaluate and report on Medicaid prescription drug reimbursement to retail pharmacies; creates a workgroup to conduct study and report findings to the legislature concerning the effect of reimbursement methodology on costs.

2009-S6937 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S6937

 TITLE OF BILL :
An act to direct the department of health to evaluate and report on
Medicaid prescription drug reimbursement to retail pharmacies


 PURPOSE OR GENERAL IDEA OF BILL :
This bill directs the Department of Health to evaluate and report on
Medicaid prescription drug reimbursement to retail pharmacies.

 SUMMARY OF SPECIFIC PROVISIONS :
Section one of the bill creates a workgroup within the Department of
Health to assist the Commissioner of Health in studying Medicaid
prescription drug reimbursement to retail pharmacies. Section two
outlines the different factors to be considered in the study. Section
three requires the Commissioner of Health to issue a report to the
Governor and the Legislature. section four sets forth the effective
date.

 JUSTIFICATION :
It has become important for the legislature to have access to factual
information on which to base policy and budget decisions with regard
to payments to pharmacies. This legislation requires the Health
Department, working with representatives of organized pharmacy and
other stakeholders, to gather information and prepare a report to

inform about the adequacy of present reimbursement in terms of actual
costs both for medications and professional services.

Compounding the pharmacy reimbursement matter further is the use of
the term 'Average Wholesale Price' (AWP) that, combined with a
discount, forms the payment formula for brand drugs. For generics, New
York State law allows the Department of Health to calculate 'State
Maximum Allowable Cost' (SMAC). Pharmacies report that SMAC pricing is
not based on any known methodology and it brings payment levels
unrealistically low. Access to generics is an important key to our
cost-containment strategies, and we should have confidence that our
reimbursement policy is set appropriately.

As enumerated in this legislation, pharmacy overhead costs cover a
wide range of elements that must be considered as part of a fair and
reasonable payment standard. For consumers, the professional service
components may represent the real value of having a local pharmacy
with an accessible pharmacist, who has filled the prescription,
checked for drug interactions and can provide important information
about how to take the medicine prescribed for them. In this time of
limited resources, it becomes more important that our Medicaid and
EPIC beneficiaries derive the maximum therapeutic benefit from the
medicines they are prescribed so that they can remain at home living
independently as long as possible. Local pharmacies represent
healthcare outreach into communities and a valuable cost-containment
strategy.

 PRIOR LEGISLATIVE HISTORY :
2009: A.8782 - Passed Assembly.

 FISCAL IMPLICATIONS :
To be determined.

 EFFECTIVE DATE :
Immediately.

2009-S6937 (ACTIVE) - Bill Text download pdf

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

                                  6937

                            I N  S E N A T E

                            February 26, 2010
                               ___________

Introduced  by  Sen. VALESKY -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT to direct the department of health  to  evaluate  and  report  on
  Medicaid prescription drug reimbursement to retail pharmacies

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

  Section 1. The commissioner of health shall establish in  the  depart-
ment  of health a Medicaid pharmacy reimbursement workgroup (referred to
in this act as the "workgroup") for the purpose of assisting the commis-
sioner of health in studying Medicaid prescription drug reimbursement to
retail pharmacies. The workgroup shall consist  of  16  members,  to  be
appointed  as  follows:  4 members shall be appointed by the governor, 3
members shall be appointed by the speaker of  the  assembly,  3  members
shall  be  appointed  by the temporary president of the senate, 1 member
shall be appointed by the minority leader of the senate,  and  1  member
shall be appointed by the minority leader of the assembly. The chairs of
the assembly and senate fiscal and health committees, or their designees
shall  serve  as ex-officio members. The work group shall include: (a) 3
representatives of organizations of chain and independent retail pharma-
cies, 3 prescription drug manufacturers and wholesalers, 2 advocates for
Medicaid recipients, and other stakeholders; (b) 2 appropriate officials
of the department of health; and (c) 2 academic  or  other  professional
experts on prescription drug reimbursement.
  S 2. 1. The workgroup's study shall include but need not be limited to
an analysis of:
  (a)  how  the current reimbursement methodology relates to pharmacies'
actual costs for wholesale purchasing of drugs and  dispensing  Medicaid
prescriptions,  including  but  not limited to inventory acquisition and
management, payroll costs,  employee  benefits,  professional  liability
insurance,  licenses and other fees, professional services such as coor-
dination of benefits, patient counseling and prescription verifications,
facility costs including rent, mortgage interest, insurance, real estate
taxes, utilities, maintenance, permits and delivery  expenses,  contain-
ers, labels and supplies, specialized packaging, transaction fees, tele-

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

                                                           LBD11995-07-0

S. 6937                             2

phone, data management, computer systems and support, bad debt including
uncollected co-pays, and payment lag times;
  (b)  the  comparative  merits  of  reimbursement methodologies used in
other states or allowed by the Federal government;
  (c) the effect of New York's current and possible alternative  method-
ologies on the financial viability of pharmacies, access to prescription
drugs  for  Medicaid recipients, controlling wholesale prices, and costs
to the Medicaid system;
  (d) the actual cost to New York of the  pharmacy  benefit  considering
the  total  amount paid to pharmacies after federal participation, minus
the total amount collected by New York in  rebates  from  pharmaceutical
manufacturers,  and  separately identifying product costs and dispensing
fees.
  2. The department of health and other  state  agencies  shall  provide
assistance to the workgroup in conducting its work. Members of the work-
group  shall receive no compensation for their service as members of the
workgroup but may receive reimbursement for their reasonable and  neces-
sary  expenses  incurred  in  connection with their participation in the
workgroup. A public official or employee may serve as a  member  of  the
workgroup.
  S  3.  The  commissioner of health shall report his or her preliminary
findings and recommendations  relating  to  Medicaid  prescription  drug
reimbursement  to  retail pharmacies to the governor and the legislature
no later than January first after this act shall have become a  law  and
may provide further findings and recommendations thereafter.
  S 4. This act shall take effect immediately.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.