Senate Bill S6763

                                BILL NUMBER:S6763

TITLE OF BILL:  An act to amend the insurance law, in relation to
synchronization of multiple prescriptions and dispensing fee
standardization

PURPOSE: Provides for the insurance coverage of the synchronization of
multiple prescriptions and dispensing fee standardization.
Specifically, this bill would amend the insurance law by adding
Article 32, governing for-profit commercial health insurance policies,
and Article 43, governing nonprofit health insurance policies. The
bill would provide coverage for a pharmaceutical claim for less than a
30-day supply for patients enrolling in medication synchronization
programs.

SUMMARY OF PROVISIONS:

Sections 1 and 2 add the following provisions:

(a) provides that a pro-rated cost-sharing rate shall be permitted and
applied to prescriptions that are dispensed for less than a 30-day
supply for the purpose of synchronizing the covered individual's
chronic medication.

(b) provides that drug coverage shall not be denied for a partial fill
for any drug prescribed for the treatment of a chronic illness made in
              

accordance with a medication synchronization plan among the insured, a
health care practitioner and a pharmacist.

(c) ensures that the dispensing fee stays whole for the pharmacist for
a partial fill.

(d) specifies that nothing in his bill requires health care
practitioners and pharmacists to synchronize the filling of
prescriptions.

Section 3 is the effective date.

JUSTIFICATION:  This bill would eliminate barriers to the
implementation of medication synchronization, a service that has been
shown to improve rates of medication adherence and thus, lower overall
healthcare expenditures.

Medication synchronization is a pharmacy service that improves patient
adherence to prescribed medications by coordinating the refill dates
for all of a patient's chronic prescription medications so these can
be picked up on the same date each month. It is estimated that 76
percent of Americans aged 60 and over use two or more medicines and 37
percent take five or more medicines. Patient and caregiver lives are
simplified by eliminating multiple trips to the pharmacy each month.
It also minimizes confusion over when a prescription is due to be
refilled, and minimizes disrupting treatment through delayed or missed
refills.  The Medication Synchronization model improves adherence and
provides a more coordinated level of care; resulting in healthier
patients, and more effective delivery of care which can reduce overall
costs to payers and the health care system.


Despite the benefits of synchronization, patients and pharmacies still
face several challenges when trying to synchronize all of a patient's
prescriptions. A "short fill" or partial fill is often needed to align
the patient's medications to a single refill date. Currently, many
payers do not have payment policies in place to provide coverage for a
claim for less than a 30-day supply. Therefore, patients are required
to pay a full month's copayment or coinsurance for a month's supply of
medications, even if questions remain as to the effectiveness or
adverse impacts of that medication on that patient.

The Centers for Medicare & Medicaid Services (CMS), the largest payer
for health care in the nation, is implementing several policy changes
that will help remove current barriers to the medication
synchronization process, reduce waste from unnecessary fills, and
ensure that beneficiaries are only receiving the medications they
need. Beginning January 1, 2014, Medicare Part D sponsors will be
required to apply a daily cost-sharing rate to most prescriptions that
are dispensed for less than a 30-day supply. This provides a common
sense approach when patient is just starting out on new therapy and
may not require a full month's supply, or is attempting to synchronize
their refills. State-level legislation would help remove existing
operational and payment barriers presented by other payers and
facilitate an even greater uptake of medication synchronization
programs and other methods that promote adherence and appropriate
medication use.

This bill is voluntary for patients, health care practitioners and
pharmacists. Nothing in this bill requires health care practitioners
and pharmacists to synchronize the filling of prescriptions. It simply
establishes a mechanism for medication synchronization for patients
with chronic illness when there is a voluntary agreed upon plan
between the patient, the health care provider and the pharmacist.

This legislation would:

* Eliminate barriers to the implementation of medication
synchronization, a service that has been shown to improve rates of
medication adherence and thus, lower overall health care expenditures.

* Benefit the patient, particularly when they are initially prescribed
a new medication that has significant side effects, is frequently
poorly tolerated, may pose drug-drug interactions with their current
regimen, and when less than a month's supply of the prescription is
clinically appropriate.

* Improve the ongoing issue of medication waste when medications are
changed during a mid-30 day supply.

* Provide a patient with the ability to synchronize their
prescriptions in consultation with their pharmacists without having to
pay a full month's cost-sharing when less than a month's supply of
medication(s) is dispensed during the synchronization process until
all medications are on the same thirty or more days refill schedule.

* Protect a pharmacist from being compensated a pro-rated a dispensing
fee when a partial fill is provided. A dispensing fee does not relate
to the amount of medication dispensed. It is the fee associated with


operating costs, overhead, packaging and other costs of operating a
pharmacy

LEGISLATIVE HISTORY: New bill.

FISCAL IMPLICATIONS:  None.

EFFECTIVE DATE: This act shall take effect on the 120th day after
becoming law.