Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|
---|---|
Jun 16, 2014 |
print number 7025a |
Jun 16, 2014 |
amend and recommit to health |
Apr 16, 2014 |
referred to health |
Senate Bill S7025A
2013-2014 Legislative Session
Sponsored By
(R, C, IP) Senate District
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
Actions
Bill Amendments
co-Sponsors
(D) 15th Senate District
(D) Senate District
(R) Senate District
(D, IP) Senate District
2013-S7025 - Details
- See Assembly Version of this Bill:
- A9264
- Current Committee:
- Senate Health
- Law Section:
- Public Health Law
- Laws Affected:
- Add §280-a, Pub Health L
- Versions Introduced in 2015-2016 Legislative Session:
-
S3346, A676
2013-S7025 - Sponsor Memo
BILL NUMBER:S7025 TITLE OF BILL: An act to amend the public health law, in relation to pharmacy benefit managers PURPOSE: To provide transparency and clarity between pharmacy benefit managers and pharmacies with regard to how the maximum allowable cost pricing is determined and updated. SUMMARY OF PROVISIONS: Section one adds a new section 280-a to the Public Health Law. Section two sets forth the effective date. JUSTIFICATION: Pharmacy benefit managers (PBMs) are health providers or entities that manage prescription drug program services for healthcare benefit providers. Services include the procurement of prescription drugs to be dispensed to patients or the administration or management of prescription drug benefits. The Maximum Allowable Cost list or commonly referred to as the 'MAC"
2013-S7025 - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 7025 I N S E N A T E April 16, 2014 ___________ Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the public health law, in relation to pharmacy benefit managers THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The public health law is amended by adding a new section 280-a to read as follows: S 280-A. PHARMACY BENEFIT MANAGERS. 1. DEFINITIONS. AS USED IN THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS: (A) "PHARMACY BENEFIT MANAGER" MEANS AN ENTITY THAT ENTERS INTO CONTRACTS WITH PHARMACIES ON BEHALF OF A HEALTH PLAN, STATE AGENCY, INSURER, MANAGED CARE ORGANIZATION, OR OTHER THIRD PARTY PAYOR TO PROVIDE PHARMACY HEALTH BENEFIT SERVICES OR ADMINISTRATION. (B) "MAXIMUM ALLOWABLE COST PRICE" MEANS A MAXIMUM REIMBURSEMENT AMOUNT FOR A GROUP OF THERAPEUTICALLY EQUIVALENT MULTIPLE SOURCE GENERIC DRUGS. 2. A PHARMACY BENEFIT MANAGER MAY NOT PLACE A PRESCRIPTION DRUG ON A MAXIMUM ALLOWABLE COST PRICE LIST UNLESS: (A) THE DRUG HAS AT LEAST THREE NATIONALLY AVAILABLE, THERAPEUTICALLY EQUIVALENT MULTIPLE SOURCE DRUGS WITH A SIGNIFICANT COST DIFFERENCE; (B) THE DRUG IS LISTED AS THERAPEUTICALLY EQUIVALENT AND PHARMACEUTI- CALLY EQUIVALENT OR "A" RATED IN THE UNITED STATES FOOD AND DRUG ADMIN- ISTRATION'S MOST RECENT VERSION OF THE "ORANGE BOOK"; (C) THE DRUG IS AVAILABLE FOR PURCHASE WITHOUT LIMITATIONS BY ALL PHARMACIES IN THE STATE FROM NATIONAL OR REGIONAL WHOLESALERS OPERATING IN NEW YORK AND IS NOT OBSOLETE OR TEMPORARILY UNAVAILABLE; AND (D) THE DRUG IS AVAILABLE FOR PURCHASE AT OR BELOW THE MAXIMUM ALLOW- ABLE COST WITHOUT LIMITATIONS TO PHARMACIES OPERATING IN NEW YORK. 3. A PHARMACY BENEFIT MANAGER SHALL MAKE AVAILABLE TO EACH NETWORK PHARMACY AT THE BEGINNING OF THE TERM OF THE CONTRACT, THE SOURCES UTILIZED TO DETERMINE THE MAXIMUM ALLOWABLE COST PRICING. 4. A PHARMACY BENEFIT MANAGER SHALL UPDATE THE MAXIMUM ALLOWABLE COST ON A TIMELY BASIS, BUT IN NO EVENT LONGER THAN SEVEN CALENDAR DAYS FROM EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
co-Sponsors
(D) 15th Senate District
(D) Senate District
(R) Senate District
(R, C, IP) Senate District
2013-S7025A (ACTIVE) - Details
- See Assembly Version of this Bill:
- A9264
- Current Committee:
- Senate Health
- Law Section:
- Public Health Law
- Laws Affected:
- Add §280-a, Pub Health L
- Versions Introduced in 2015-2016 Legislative Session:
-
S3346, A676
2013-S7025A (ACTIVE) - Sponsor Memo
BILL NUMBER:S7025A TITLE OF BILL: An act to amend the public health law, in relation to pharmacy benefit managers PURPOSE: Requires contracts between pharmacy benefit managers and pharmacies to include a reasonable appeals process. SUMMARY OF PROVISIONS: Section one adds a new section 280-a to the Public Health Law. Section two sets forth the effective date. JUSTIFICATION: Pharmacy benefit managers (PBMs) are health providers or entities that manage prescription drug program services for healthcare benefit providers. Services include the procurement of prescription drugs to be dispensed to patients or the administration or management of prescription drug benefits. The Maximum Allowable Cost (MAC) list, is an industry generated price index that lists the maximum amount that a prescription plan will reimburse for generic drugs or multi-source brand names. Since there is no standardization in place or clear methodology on how PBMs generate the MAC list, PBMs have unfettered control to charge their clients prices that may not reflect market demand. This bill would
2013-S7025A (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 7025--A I N S E N A T E April 16, 2014 ___________ Introduced by Sens. HANNON, ADDABBO, AVELLA, MAZIARZ, VALESKY -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to pharmacy benefit managers THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The public health law is amended by adding a new section 280-a to read as follows: S 280-A. PHARMACY BENEFIT MANAGERS. 1. DEFINITIONS. AS USED IN THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS: (A) "PHARMACY BENEFIT MANAGER" MEANS AN ENTITY THAT ENTERS INTO CONTRACTS WITH PHARMACIES ON BEHALF OF A HEALTH PLAN, STATE AGENCY, INSURER, MANAGED CARE ORGANIZATION, OR OTHER THIRD PARTY PAYOR TO PROVIDE PHARMACY HEALTH BENEFIT SERVICES OR ADMINISTRATION. (B) "MAXIMUM ALLOWABLE COST PRICE" MEANS A MAXIMUM REIMBURSEMENT AMOUNT SET BY THE PHARMACY BENEFIT MANAGER FOR THERAPEUTICALLY EQUIV- ALENT MULTIPLE SOURCE GENERIC DRUGS. 2. ALL CONTRACTS BETWEEN A PHARMACY BENEFIT MANAGER AND A CONTRACTED PHARMACY SHALL INCLUDE A REASONABLE PROCESS TO APPEAL, INVESTIGATE AND RESOLVE DISPUTES REGARDING MULTI-SOURCE GENERIC DRUG PRICING. THE APPEALS PROCESS SHALL INCLUDE THE FOLLOWING PROVISIONS: (A) THE RIGHT TO APPEAL SHALL BE LIMITED TO SIXTY DAYS FOLLOWING THE INITIAL CLAIM SUBMITTED FOR PAYMENT; (B) A TELEPHONE NUMBER THROUGH WHICH A NETWORK PHARMACY MAY CONTACT THE PHARMACY BENEFIT MANAGER AND SPEAK WITH AN INDIVIDUAL WHO IS RESPON- SIBLE FOR PROCESSING APPEALS; (C) A PHARMACY BENEFIT MANAGER SHALL RESPOND IN WRITING TO THE CHAL- LENGE WITHIN SEVEN BUSINESS DAYS AFTER RECEIPT OF THE CHALLENGE; (D) IF AN UPDATE TO THE MAXIMUM ALLOWABLE COST IS WARRANTED, THE PHAR- MACY BENEFIT MANAGER SHALL MAKE THE CHANGE RETROACTIVE TO THE DATE ON WHICH THE CLAIM FOR PAYMENT WAS ADJUDICATED BY THE PHARMACY BENEFIT MANAGER. THE PHARMACY BENEFIT MANAGER SHALL MAKE THE ADJUSTMENT EFFEC- EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
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