BILL NUMBER:  S5196

 TITLE OF BILL :  An act to amend the insurance law, in relation to
synchronization of multiple prescriptions and dispensing fee
standardization

 PURPOSE OR GENERAL IDEA OF BILL :

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 day supply for patients
enrolling in medication synchronization programs.

 SUMMARY OF SPECIFIC 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 this bill requires health care
practitioners and pharmacists to synchronize the filling of
prescriptions.

Section 3 sets 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 health care 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 over the age of 60 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, reducing
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
payers 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 and 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 a patient is just starting out on a 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)
is 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 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.

 PRIOR LEGISLATIVE HISTORY :

2016: S.2809-A - Referred to Insurance / A.4036-A - Passed Assembly.
2015: S.2809-A - Referred to Insurance / A.4036-A - Passed Assembly.
2014: S.6763 - Referred to Insurance / A.8975 - Referred to Insurance.

 FISCAL IMPLICATIONS :

None

 EFFECTIVE DATE :
This act shall take effect on the 120th day after becoming law.

                                 BILL NUMBER:  S5196A

 TITLE OF BILL :

An act to amend the insurance law, in relation to synchronization of
multiple prescriptions

 PURPOSE OR GENERAL IDEA OF BILL :

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 day supply for
patients enrolling in medication synchronization programs.

 SUMMARY OF SPECIFIC 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 this bill requires health care
practitioners and pharmacists to synchronize the filling of
prescriptions.

Section 3 sets 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 health care 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 over the age of 60 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, reducing
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
payers 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 and 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 a patient is just starting out on a 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)
is 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 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.

 PRIOR LEGISLATIVE HISTORY :

2016: S.2809A - Referred to Insurance/A.4036A - Passed Assembly.
2015: S.2809A - Referred to Insurance/A.4036A - Passed Assembly.
2014: S.6763 - Referred to Insurance/A.8975 - Referred to Insurance.

 FISCAL IMPLICATIONS :

None

 EFFECTIVE DATE :
This act shall take effect on the 120th day after becoming law.