Senate Bill S5199

                                BILL NUMBER:S5199

TITLE OF BILL:
An act
to amend the social services law, in relation to prescription drugs
covered by managed care programs under the medical assistance program

PURPOSE OR GENERAL IDEA OF BILL:
Provides that a Medicaid manage care providers network shall allow
pharmacies to fill prescriptions for participants at a price at
comparable to an in-network pharmacy.

SUMMARY OF PROVISIONS:
Subdivision 4 of the section 364-j of the social services law is
amended by adding a new paragraph to provide that a managed care
provider that provides coverage for prescription drugs shall permit
each participant to fill any covered prescription, at his or her
option, at any pharmacy registered with the department of education
pursuant to section sixty-eight hundred eight of the education law if
such pharmacy offers to accept a price that is comparable to that of
any mail order or non-mail order retail pharmacy in the managed care
provider network.

JUSTIFICATION:
This legislation will assist in providing appropriate access to
participants seeking to fill their prescriptions in Medicaid managed
              

care at a price comparable to that of in-network pharmacies or
network mail order pharmacies.

Access to prescriptions is critical in the state's efforts to save
Medicaid dollars both through management of a Medicaid participant's
acute and long term health issues. Importantly, the bill offers cost
protections for the state by ensuring that any prescription filled
must be at a rate comparable to that of any mail order or non-mail
order retail pharmacy in the managed care provider network.

Furthermore, the neighborhood pharmacy in these situations is forced to
bear the burden of educating the patient as to the use and potential
effects of the prescribed drug. The inability of the participant to
purchase the full prescription from the neighborhood pharmacy imposes
this burden inequitably.

Finally, many participants, especially senior citizens and persons
with disabilities, rely on their local pharmacist for the service
that they provide with respect to monitoring the regimen of drugs
that they take. This legislation provides that recent changes to the
State's Medicaid program will save money but ensure a seamless
transition for such participants.

PRIOR LEGISLATIVE HISTORY:
None

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:


Immediately, with provisions