Senate Bill S5773

                                 BILL NUMBER:  S5773

 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;
S.312 of 2015-2016

 FISCAL IMPLICATIONS :

None

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