Senate Bill S312

                                 BILL NUMBER:  S312

 TITLE OF BILL :  An act to amend the social services law, in relation
to the collection of prescription drug co-payments

 PURPOSE : To require patients to pay co-payments for prescription
drugs at the point-of-sale under Medicaid.

 SUMMARY OF PROVISIONS :

Section 1- Amends section 367-a of the Social Services law to require
the payment of prescription drug co-payments under Medicaid.

Section 2- Effective date.

 JUSTIFICATION : Co-payments for prescription drugs in the State
Medicaid program were implemented in New York State in 1995. It is the
current policy that Medicaid and beneficiaries cannot be denied
services if they refuse to pay their co-payments at the point-of-sale.
As a result, pharmacies in the State of New York have experienced
serious financial losses through the inability to collect the
co-payments of $1 for generics and $3 for brand name drugs under
Medicaid. Survey data has found that the statewide average of
uncollectible co-payments is 50%, and the rate is even higher in New
York City with some pharmacies experiencing uncollectible co-payments
of 90%.
              

Unlike other providers which receive funding from bad debt and charity
pools, pharmacies cannot write off their bad debt and do not receive
state assistance to make up for these losses. Uncollectible
co-payments come directly out of the pockets of community pharmacies.
Pharmacies have also recently experienced significant reductions in
reimbursement under Medicaid and are currently paid one of the lowest
rates in the country. This hardship is exacerbated by the losses
incurred through uncollectible co-payments in the program. This
situation is inequitable and also jeopardizes access to pharmacy
services for all New Yorkers.

Recently, the pharmacy benefit under Medicaid was changed and will now
be administered by private managed care plans for the majority of
beneficiaries. However, the co-payments remain the same as does the
policy regarding pharmacy collection. This means that pharmacies will
continue to lose on average 50% of co-payments for the prescription
drugs filled for approximately four million New Yorkers.

This inequity would be addressed through this legislation by requiring
Medicaid beneficiaries to pay their co-payments to pharmacies at the
point-of-sale when filling their prescriptions.

 LEGISLATIVE HISTORY : S.4749A/A.7727 of 2011-2012; S.2786 of
2013-2014

 FISCAL IMPLICATIONS : None

 EFFECTIVE DATE : This act shall take effect one hundred and eighty
days after it shall become law.