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Assembly Bill A5675

2013-2014 Legislative Session

Relates to access to specialty drugs in medicaid managed care

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2013-A5675 (ACTIVE) - Details

Law Section:
Social Services Law
Laws Affected:
Amd ยง364-j, Soc Serv L

2013-A5675 (ACTIVE) - Summary

Relates to access to specialty drugs in medicaid managed care; provides that managed care providers may not limit pharmacies for specialty drugs.

2013-A5675 (ACTIVE) - Bill Text download pdf 

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

                                  5675

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                              March 5, 2013
                               ___________

Introduced by M. of A. GOTTFRIED, CYMBROWITZ, DINOWITZ, GUNTHER, LAVINE,
  PAULIN,  ROSENTHAL,  STEVENSON,  TITONE,  BENEDETTO,  COLTON,  DUPREY,
  GALEF, JAFFEE, KELLNER, V. LOPEZ, MAISEL, McDONALD,  MONTESANO,  OTIS,
  SCARBOROUGH,  SIMANOWITZ, STECK, WEISENBERG, MILLER -- Multi-Sponsored
  by -- M. of A. ABBATE, GLICK, HIKIND, LENTOL, P. LOPEZ,  MAGEE,  McDO-
  NOUGH, RIVERA, SWEENEY, THIELE, ZEBROWSKI -- read once and referred to
  the Committee on Health

AN  ACT  to  amend  the  social  services  law, in relation to access to
  specialty drugs in medicaid managed care

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

  Section  1.  Paragraph  (u)  of  subdivision 4 of section 364-j of the
social services law, as amended by section 40 of part D of chapter 56 of
the laws of 2012, is amended to read as follows:
  (u) A managed care provider that provides  coverage  for  prescription
drugs  shall  permit  each  participant to fill any [mail order] covered
prescription, at his or her option, at any [mail order pharmacy or  non-
mail-order retail] pharmacy in the managed care provider network. HOWEV-
ER,  IF  THE MANAGED CARE PROVIDER HAS DESIGNATED ONE OR MORE PHARMACIES
FOR FILLING PRESCRIPTIONS FOR A PARTICULAR  DRUG  OR  DRUGS,  THEN  SUCH
PRESCRIPTIONS  MAY  BE FILLED, AT THE PARTICIPANT'S OPTION, AT ANY OTHER
PHARMACY IN THE NETWORK, if the [non-mail-order retail]  OTHER  pharmacy
offers  to accept a price that is comparable to that of the [mail order]
DESIGNATED pharmacy OR PHARMACIES.  Every [non-mail-order retail]  phar-
macy  in  the  managed  care  provider's  network  with  respect  to any
prescription drug shall be deemed to be in the managed  care  provider's
network  for  every  covered prescription drug[; provided, however, that
the managed care provider may limit its network of pharmacies for speci-
fied drugs, approved by the commissioner,  based  on  clinical,  profes-
sional  or  cost  criteria. Such limitation shall not be based solely on
cost].

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05408-02-3

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