BILL NUMBER:S4749

TITLE OF BILL:
An act
to amend the social services law, in relation to the collection of
prescription drug co-payments

PURPOSE:
To require patients to pay co-payments for prescription drugs at the
point-of-sale under Medicaid and Family Health Plus

SUMMARY OF PROVISIONS:
Section 1- Amends section 367 -a of the Social Services law to require
the payment of prescription drug co-payments under Medicaid. Section
2- Amends section 369-ee of the Social Services law to require the
payment of prescription drug co-payments under Family Health Plus.
Section 3- Effective date.

JUSTIFICATION:
Co-payments for prescription drugs in the State Medicaid program were
implemented in New York State in 1995. Prescription drug co-payments
were also included when the Family Health Plus program was created.
It is the current policy that Medicaid and Family Health Plus
beneficiaries cannot be denied services if they refuse to pay their
co-payments at the point-of-sale. As a result, pharmacies in the
State of New York have experienced serious financial losses through
              

the inability to collect the co-payments of $1 for generics and $3
for brand name drugs under Medicaid and $3 for generics and $6 for
brand name drugs under Family Health Plus. Survey data has found that
the statewide average of uncollectible co-payments is 50%, and the
rate is even higher in New York City with some pharmacies
experiencing uncollectible co-payments of 90%.

Unlike other providers which receive funding from bad debt and charity
pools, pharmacies cannot write off their bad debt and do not receive
state assistance to make up for these losses. Uncollectible
co-payments come directly out of the pockets of community pharmacies.
Pharmacies have also recently experienced significant reductions in
reimbursement under Medicaid and Family Health and are currently are
paid one of the lowest rates in the country. This hardship is
exacerbated by the losses
incurred through uncollectible co-payments in these programs. This
situation is inequitable and also jeopardizes access to pharmacy
services for all New Yorkers.

Recently, the pharmacy benefit under Medicaid and Family Health Plus
was changed and will now be administered by private managed care
plans for the majority of beneficiaries. However, the co-payments
remain the same as does the policy regarding pharmacy collection.
This means that pharmacies will continue to lose on average 50% of
co-payments for the prescription drugs filled for approximately four
million New Yorkers.

This inequity would be addressed through this legislation by requiring
Medicaid and Family Health Plus beneficiaries to pay their


co-payments to pharmacies at the point-of-sale when filling their
prescriptions.

LEGISLATIVE HISTORY:
New bill.

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect one hundred and eighty days after it shall
become law.