Senate Bill S2809A

                                BILL NUMBER:S2809

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-clay 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
pavers 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)  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.