Assembly Bill A4036A

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

    S. 2809--A                                            A. 4036--A

                       2015-2016 Regular Sessions

                      S E N A T E - A S S E M B L Y

                            January 29, 2015
                               ___________

IN SENATE -- Introduced by Sens. LANZA, BRESLIN, CARLUCCI, CROCI, DILAN,
  FUNKE,  GOLDEN,  LARKIN,  MARTINS,  RIVERA,  SAMPSON -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Insurance  -- committee discharged, bill amended, ordered reprinted as
  amended and recommitted to said committee

IN ASSEMBLY -- Introduced by M. of A.  QUART,  McDONALD,  FAHY,  LAVINE,
  HEVESI,  GOLDFEDER,  BRAUNSTEIN,  SIMANOWITZ,  RYAN,  BRINDISI, STECK,
  SKOUFIS, AUBRY, PRETLOW, SEAWRIGHT,  WEPRIN,  SCHIMEL,  RIVERA,  COOK,
  BARCLAY,  MOYA -- Multi-Sponsored by -- M. of A. CRESPO, DILAN, ROBIN-
  SON -- read once and referred to the Committee on Insurance -- commit-
  tee discharged, bill amended, ordered reprinted as amended and  recom-
  mitted to said committee

AN  ACT  to  amend  the insurance law, in relation to synchronization of
  multiple prescriptions and dispensing fee standardization

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

  Section 1. The insurance law is amended by adding a new section 3224-d
to read as follows:
  S  3224-D.  PRESCRIPTION SYNCHRONIZATION AND DISPENSING FEE STANDARDI-
ZATION. (A) EVERY INDIVIDUAL OR GROUP HEALTH INSURANCE POLICY  PROVIDING
PRESCRIPTION  DRUG  COVERAGE  SHALL  PERMIT  AND APPLY A DAILY PRO-RATED
COST-SHARING RATE TO PRESCRIPTIONS THAT ARE DISPENSED BY A NETWORK PHAR-
MACY FOR LESS THAN A THIRTY DAY SUPPLY, WHEN  IT  IS  AGREED  AMONG  THE
COVERED  INDIVIDUAL,  A  HEALTH CARE PRACTITIONER, AND A PHARMACIST THAT
SYNCHRONIZATION OF MULTIPLE PRESCRIPTIONS FOR THE TREATMENT OF A CHRONIC
ILLNESS IS IN THE BEST  INTEREST  OF  THE  COVERED  INDIVIDUAL  FOR  THE
MANAGEMENT OR TREATMENT OF THAT CHRONIC ILLNESS.
  (B)   NO   INDIVIDUAL  OR  GROUP  HEALTH  INSURANCE  POLICY  PROVIDING
PRESCRIPTION DRUG COVERAGE SHALL DENY COVERAGE FOR THE DISPENSING OF ANY
DRUG PRESCRIBED FOR THE TREATMENT OF A CHRONIC ILLNESS THAT IS  MADE  IN

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02009-03-5
              

S. 2809--A                          2                         A. 4036--A

ACCORDANCE  WITH  A  PLAN  ESTABLISHED  AMONG  THE COVERED INDIVIDUAL, A
HEALTH CARE PRACTITIONER AND A PHARMACIST TO SYNCHRONIZE  THE  REFILLING
OF  MULTIPLE PRESCRIPTIONS FOR THE COVERED INDIVIDUAL.  EVERY INDIVIDUAL
OR  GROUP  HEALTH INSURANCE POLICY MUST ALLOW A PHARMACY TO OVERRIDE ANY
DENIAL CODES INDICATING THAT A PRESCRIPTION IS BEING REFILLED  TOO  SOON
FOR THE PURPOSES OF MEDICATION SYNCHRONIZATION.
  (C)   NO   INDIVIDUAL  OR  GROUP  HEALTH  INSURANCE  POLICY  PROVIDING
PRESCRIPTION DRUG COVERAGE SHALL USE  PAYMENT  STRUCTURES  INCORPORATING
PRO-RATED  DISPENSING  FEES.    DISPENSING  FEES FOR PARTIALLY FILLED OR
REFILLED PRESCRIPTIONS SHALL BE  PAID  IN  FULL  FOR  EACH  PRESCRIPTION
DISPENSED,  REGARDLESS OF ANY PRO-RATED COPAY FOR THE BENEFICIARY OR FEE
PAID FOR ALIGNMENT SERVICES.
  (D) NOTHING IN THIS SECTION SHALL BE DEEMED  TO  REQUIRE  HEALTH  CARE
PRACTITIONERS  AND  PHARMACISTS TO SYNCHRONIZE THE REFILLING OF MULTIPLE
PRESCRIPTIONS FOR A COVERED INDIVIDUAL.
  S 2. The insurance law is amended by adding a new  section  4303-a  to
read as follows:
  S  4303-A.  PRESCRIPTION SYNCHRONIZATION AND DISPENSING FEE STANDARDI-
ZATION.   (A) EVERY HOSPITAL  SERVICE  CORPORATION  AND  HEALTH  SERVICE
CORPORATION  PROVIDING PRESCRIPTION DRUG COVERAGE SHALL PERMIT AND APPLY
A DAILY PRO-RATED COST-SHARING RATE TO PRESCRIPTIONS THAT ARE  DISPENSED
BY  A  NETWORK  PHARMACY  FOR  LESS THAN A THIRTY DAY SUPPLY, WHEN IT IS
AGREED AMONG THE COVERED INDIVIDUAL, A HEALTH CARE PRACTITIONER,  AND  A
PHARMACIST THAT SYNCHRONIZATION OF MULTIPLE PRESCRIPTIONS FOR THE TREAT-
MENT  OF  A CHRONIC ILLNESS IS IN THE BEST INTEREST OF THE COVERED INDI-
VIDUAL FOR THE MANAGEMENT OR TREATMENT OF THAT CHRONIC ILLNESS.
  (B) NO HOSPITAL SERVICE  CORPORATION  OR  HEALTH  SERVICE  CORPORATION
PROVIDING  PRESCRIPTION  DRUG  COVERAGE  SHALL  DENY  COVERAGE  FOR  THE
DISPENSING OF ANY DRUG PRESCRIBED FOR THE TREATMENT OF A CHRONIC ILLNESS
THAT IS MADE IN ACCORDANCE WITH A PLAN  ESTABLISHED  AMONG  THE  COVERED
INDIVIDUAL,  A  HEALTH CARE PRACTITIONER AND A PHARMACIST TO SYNCHRONIZE
THE REFILLING OF MULTIPLE  PRESCRIPTIONS  FOR  THE  COVERED  INDIVIDUAL.
EVERY HOSPITAL SERVICE CORPORATION OR HEALTH SERVICE CORPORATION PROVID-
ING  PRESCRIPTION  DRUG  COVERAGE  MUST ALLOW A PHARMACY TO OVERRIDE ANY
DENIAL CODES INDICATING THAT A PRESCRIPTION IS BEING REFILLED  TOO  SOON
FOR THE PURPOSES OF MEDICATION SYNCHRONIZATION.
  (C)  NO  HOSPITAL  SERVICE  CORPORATION  OR HEALTH SERVICE CORPORATION
PROVIDING PRESCRIPTION DRUG COVERAGE SHALL USE PAYMENT STRUCTURES INCOR-
PORATING PRO-RATED DISPENSING  FEES.    DISPENSING  FEES  FOR  PARTIALLY
FILLED  OR  REFILLED  PRESCRIPTIONS  SHALL  BE  PAID  IN  FULL  FOR EACH
PRESCRIPTION DISPENSED, REGARDLESS OF ANY PRO-RATED COPAY FOR THE  BENE-
FICIARY OR FEE PAID FOR ALIGNMENT SERVICES.
  (D)  NOTHING  IN  THIS  SECTION SHALL BE DEEMED TO REQUIRE HEALTH CARE
PRACTITIONERS AND PHARMACISTS TO SYNCHRONIZE THE REFILLING  OF  MULTIPLE
PRESCRIPTIONS FOR A COVERED INDIVIDUAL.
  S 3. This act shall take effect on the one hundred twentieth day after
it  shall  have  become  a  law,  and  shall  apply  to all policies and
contracts issued, renewed, modified, altered or amended on or after such
date.