NY State Senate Bill 2015-S7762

Senate Bill S7762

2015-2016 Legislative Session

Directs the department of health to perform bi-annual assessments of non-preferred drugs for recipients of medical assistance, and to issue annual reports to the legislature thereon

download bill text pdf

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

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 12, 2016	referred to health

2015-S7762 (ACTIVE) - Details

Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §272, Pub Health L

2015-S7762 (ACTIVE) - Summary

Directs the department of health to perform bi-annual assessments of non-preferred drugs for recipients of medical assistance, and to issue annual reports to the legislature thereon.

2015-S7762 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S7762

 TITLE OF BILL :

An act to amend the public health law, in relation to directing the
department of health to make bi-annual assessments of non-preferred
drugs for recipients of medical assistance and to submit an annual
report to the legislature thereon

 PURPOSE :

To require the Department of Health to review and assess the preferred
drug list bi-annually and to require inclusion of drugs when 35% of
prescriptions in the drug class were for a non-preferred drug

 SUMMARY OF PROVISIONS :

Section one adds a new Public Health Law § 272(15) to require the
Department of Health to make bi-annual assessments of non-preferred
drugs. A non-preferred drug shall be included as a preferred drug, at
the manufacturer's option, when at least 35% of prescriptions filled
in that drug's class in the previous two quarters were for a
non-preferred drug, provided the manufacturer agrees to required
rebates. The previously non-preferred drug shall not be disadvantaged
by prior authorizations or other requirements not imposed on other
drugs in the class. This section also requires the Department to

provide an annual report regarding drug classes, the financial impact
of preferred drug decisions and clinical evidence used in making such
decisions and criteria that permit beneficiaries to access
non-preferred drugs in a drug class.

Section two provides that the act shall take effect immediately.

 JUSTIFICATION :

Drug prices continue to be the fastest growing cost in our healthcare
system. The preferred drug program is one way the state attempts to
control costs while promoting access by entering into supplemental
rebate agreements with drug manufacturers. In certain instances the
state may enter into an exclusivity agreement with a drug manufacturer
where only that drug may be preferred within the drug class. In
exchange, the manufacturer agrees to rebate a significant portion of
the cost of the drug back to the state. Although this often allows for
the most cost effective access to treatment, there may be instances
where a non-preferred drug is being utilized at a rate higher than
expected, while providing no rebate back to the state. This bill would
allow the state, when financially advantageous, to enter into
supplemental rebate agreements for non-preferred drugs that are being
utilized at a higher rate than expected.

 LEGISLATIVE HISTORY :

New bill.

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
Immediately.

2015-S7762 (ACTIVE) - Bill Text download pdf

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

                                  7762

                            I N  S E N A T E

                              May 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  directing  the
  department  of  health  to make bi-annual assessments of non-preferred
  drugs for recipients of medical assistance and  to  submit  an  annual
  report to the legislature thereon

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

  Section 1. Section 272 of the public health law is amended by adding a
new subdivision 15 to read as follows:
  15.(A) IN MEDICAID FEE-FOR-SERVICE, THE DEPARTMENT SHALL MAKE BI-ANNU-
AL ASSESSMENTS OF NON-PREFERRED DRUGS IN THE BEST CLINICAL INTERESTS  OF
NEW  YORK  MEDICAID BENEFICIARIES. SUCH DEPARTMENT SHALL INCLUDE, AT THE
MANUFACTURER'S OPTION, A NON-PREFERRED DRUG AS A PREFERRED DRUG WHEN  AT
LEAST  THIRTY-FIVE  PERCENT OF PRESCRIPTIONS FILLED IN THAT DRUG'S CLASS
IN THE PREVIOUS TWO QUARTERS  WERE  FOR  A  NON-PREFERRED  DRUG  ON  THE
PREFERRED  DRUG  LIST, PROVIDED THAT THE MANUFACTURER OF SUCH PREVIOUSLY
NON-PREFERRED DRUG AGREES TO THE REBATE REQUIRED UNDER SECTION  1927  OF
THE  SOCIAL  SECURITY  ACT  AND  AN  ADDITIONAL SUPPLEMENTAL REBATE. THE
DEPARTMENT AND THE MANUFACTURER MAY NEGOTIATE  THE  ALTERNATIVE  SUPPLE-
MENTAL  REBATE. THE PREVIOUSLY NON-PREFERRED DRUG SHALL NOT BE DISADVAN-
TAGED, INCLUDING BUT NOT LIMITED  TO  IMPOSING  PRIOR  AUTHORIZATION  OR
UTILIZATION  MANAGEMENT  REQUIREMENTS,  RELATIVE  TO THE OTHER PREFERRED
DRUGS IN ITS CLASS OTHER THAN  WHAT  IS  REQUIRED  BY  THE  FDA-APPROVED
LABEL.
  (B)  THE  DEPARTMENT SHALL PROVIDE AN ANNUAL REPORT TO THE LEGISLATURE
THAT OUTLINES, WITH RESPECT TO ANY DRUG CLASS ON THE PREFERRED DRUG LIST
IN WHICH ONLY A SINGLE THERAPEUTIC PATHWAY, WHICH  MAY  INVOLVE  ONE  OR
MORE DRUGS PRESCRIBED IN COMBINATION FOR THE SAME PATIENT, IS PREFERRED,
THE  FINANCIAL  IMPACT  OF THE STATE'S PREFERRED DRUG LIST DECISION, THE
CLINICAL EVIDENCE THE STATE RELIED ON IN  ESTABLISHING  PREFERENCES  FOR
THE CLASS, AND THE CLINICAL CRITERIA THAT PERMIT BENEFICIARIES TO ACCESS
NON-PREFERRED DRUGS IN SUCH A CLASS.
  S 2. This act shall take effect immediately.

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

                                                           LBD15444-02-6

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