S T A T E O F N E W Y O R K
________________________________________________________________________
7279
I N S E N A T E
April 12, 2016
___________
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 establishing a
Medicaid drug rebate remittance demonstration program
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
276-a to read as follows:
S 276-A. MEDICAID DRUG REBATE REMITTANCE DEMONSTRATION PROGRAM. 1. THE
DEPARTMENT SHALL ESTABLISH A MEDICAID DRUG REBATE REMITTANCE DEMON-
STRATION PROGRAM FOR THE PURPOSE OF WORKING COLLABORATIVELY WITH THIRD
PARTY VENDORS TO VALIDATE THE EXISTING MEDICAID DRUG REBATE CLAIMS AND
DETERMINE WHETHER THE DATA CONTAINS DUPLICATE CLAIMS OR CLAIMS ON WHICH
REBATES MAY ALREADY HAVE BEEN PAID ALL OR IN PART TO MEDICARE PART D
PLANS OR SOME OTHER THIRD PARTIES IN ORDER TO RECTIFY DISPUTED CLAIMS.
2. FOR THE PURPOSES OF THIS DEMONSTRATION PROGRAM, THE DEPARTMENT
SHALL PROVIDE UTILIZATION INFORMATION TYING TO INVOICES SENT TO PHARMA-
CEUTICAL MANUFACTURERS, WHICH HAVE ENTERED INTO A REBATE AGREEMENT WITH
THE DEPARTMENT OR WITH THE FEDERAL SECRETARY OF HEALTH AND HUMAN
SERVICES ON BEHALF OF THE DEPARTMENT UNDER SECTION 1927 OF THE FEDERAL
SOCIAL SECURITY ACT, AND TO THIRD PARTY DATA VENDORS, FOR THE PURPOSE OF
VALIDATING CLAIMS SUBMITTED UNDER SUCH REBATE AGREEMENT OR PROGRAM
INCLUDING BUT NOT LIMITED TO, THE PROGRAM FOR ELDERLY PHARMACEUTICAL
INSURANCE COVERAGE, AND THE MEDICAID DRUG REBATE PROGRAM IN GENERAL FOR
THE PERIOD FROM JANUARY FIRST, TWO THOUSAND FOURTEEN THROUGH JUNE THIR-
TIETH, TWO THOUSAND SEVENTEEN. SUCH UTILIZATION INFORMATION SHALL
INCLUDE, BUT NOT BE LIMITED TO: PRESCRIPTION NUMBERS, NATIONAL DRUG
CODES, NUMBER OF UNITS DISPENSED, CLAIMS PAID DATE, DATE OF SERVICE,
PRESCRIBING PHYSICIAN STATE IDENTIFICATION NUMBER, AMOUNT BILLED FOR
EACH PRESCRIPTION, AMOUNT OF REIMBURSEMENT RECEIVED FOR EACH
PRESCRIPTION (INCLUDING ANY ADJUSTMENT CODES), DISPENSING PHARMACY'S
STATE IDENTIFICATION NUMBER, DISPENSING FEE, ANY APPLICABLE THIRD-PARTY
PAYMENTS, APPLICABLE CO-PAYMENTS, REFILL CODE, INTERNAL CLAIM NUMBER OF
THE PRESCRIPTION, DAYS SUPPLY, J-CODE CLAIMS INCLUDING SINGLE SOURCE AND
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14915-01-6
S. 7279 2
MULTISOURCE PHYSICIAN ADMINISTERED DRUGS, NPI NUMBERS, MCO PLAN IDENTI-
FIER, MCO PLAN NAME, AND THE NAME, ADDRESS, CITY, STATE AND ZIP CODE OF
THE PRESCRIBING PRACTITIONER AND PHARMACY. THE PRESCRIPTION DRUG UTILI-
ZATION INFORMATION SHALL BE PROVIDED TO THE THIRD PARTY DATA VENDORS AS
SOON AS PRACTICABLE FOLLOWING ESTABLISHMENT OF THIS PROGRAM. THERE SHALL
BE NO COST TO THE DEPARTMENT FOR SERVICES PERFORMED BY THIRD PARTY DATA
VENDORS. ANY PRESCRIPTION DRUG UTILIZATION DATA PROVIDED TO THIRD PARTY
DATA VENDORS UNDER THIS DEMONSTRATION PROGRAM SHALL NOT BE SHARED WITH
OTHER PARTIES, EXCEPT PARTICIPATING DRUG MANUFACTURERS WHO HAVE ENTERED
INTO A REBATE AGREEMENT WITH THE DEPARTMENT OR WITH THE FEDERAL SECRE-
TARY OF HEALTH AND HUMAN SERVICES ON BEHALF OF THE DEPARTMENT UNDER
SECTION 1927 OF THE FEDERAL SOCIAL SECURITY ACT. UTILIZATION DATA
PROVIDED UNDER THIS SECTION SHALL BE USED FOR THE FOLLOWING PURPOSE:
REBATE VALIDATION SERVICES FOR THE BENEFIT OF DRUG COMPANIES AND
STATE/FEDERAL AGENCIES INCLUDING DRUG USE TREND REVIEW. INDIVIDUAL
PATIENT IDENTIFYING INFORMATION SHALL BE KEPT CONFIDENTIAL BY ANY PERSON
OR ENTITY TO WHOM OR TO WHICH IT IS PROVIDED UNDER THIS SECTION. THE
DISCLOSURE OF THE FOREGOING DATA BY THE DEPARTMENT SHALL BE CONSIDERED,
FOR PURPOSES OF SECTION THREE HUNDRED SIXTY-NINE OF THE SOCIAL SERVICES
LAW, TO BE DIRECTLY CONNECTED WITH THE ADMINISTRATION OF MEDICAL ASSIST-
ANCE FOR NEEDY PERSONS.
3. THE DEPARTMENT SHALL PROVIDE A REPORT ON THE RESULTS OF THE DEMON-
STRATION PROGRAM, WITH INPUT FROM STAKEHOLDERS, TO THE GOVERNOR, THE
DIRECTOR OF THE DIVISION OF BUDGET, THE STATE COMPTROLLER AND THE LEGIS-
LATURE ON OR BEFORE DECEMBER THIRTY-FIRST, TWO THOUSAND SEVENTEEN. THE
REPORT SHALL INCLUDE FINDINGS AS TO THE DEMONSTRATION PROGRAM'S CONTRIB-
UTION TO IMPROVING THE ABILITY OF THE DEPARTMENT TO VALIDATE DRUG REBATE
CLAIMS AND RECTIFY DISPUTED CLAIMS. IN THE REPORT, THE DEPARTMENT SHALL
OFFER RECOMMENDATIONS AS TO WHETHER THE DEMONSTRATION PROGRAM SHOULD BE
EXTENDED, MODIFIED, ELIMINATED OR MADE PERMANENT.
S 2. This act shall take effect immediately.
