S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3009
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 28, 2019
                                ___________
 
 Introduced  by  M.  of A. QUART, BRAUNSTEIN, RYAN, FAHY, LAVINE, HEVESI,
   STECK, AUBRY, PRETLOW, SEAWRIGHT, WEPRIN, RIVERA, COOK, BARCLAY, CRES-
   PO, CYMBROWITZ, ABINANTI,  PHEFFER AMATO,  GARBARINO,  SOLAGES,  RAIA,
   GALEF,  PEOPLES-STOKES,  STIRPE, OTIS, CUSICK -- Multi-Sponsored by --
   M. of A.  DILAN, PERRY -- read once and referred to the  Committee  on
   Insurance
 
 AN  ACT  to  amend  the insurance law, in relation to synchronization of
   multiple prescriptions
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The insurance law is amended by adding a new section 3224-d
 to read as follows:
   § 3224-D. PRESCRIPTION SYNCHRONIZATION.  (A) EVERY INDIVIDUAL OR GROUP
 HEALTH INSURANCE POLICY PROVIDING PRESCRIPTION DRUG COVERAGE WHEN APPLI-
 CABLE TO PERMIT SYNCHRONIZATION SHALL PERMIT AND APPLY A DAILY PRO-RATED
 COST-SHARING RATE TO PRESCRIPTIONS THAT ARE DISPENSED BY A NETWORK PHAR-
 MACY  FOR  LESS  THAN  A  THIRTY DAY SUPPLY, WHEN IT IS AGREED AMONG THE
 COVERED INDIVIDUAL, A HEALTH CARE PRACTITIONER, AND  A  PHARMACIST  THAT
 SYNCHRONIZATION OF MULTIPLE PRESCRIPTIONS FOR THE TREATMENT OF A CHRONIC
 ILLNESS  IS  IN  THE  BEST  INTEREST  OF  THE COVERED INDIVIDUAL FOR THE
 MANAGEMENT OR TREATMENT OF THAT CHRONIC ILLNESS PROVIDED THAT ALL OF THE
 FOLLOWING APPLY:
   (I) THE MEDICATIONS ARE COVERED BY THE POLICY OR PLAN.
   (II) THE MEDICATIONS ARE USED FOR TREATMENT AND MANAGEMENT OF  CHRONIC
 CONDITIONS THAT ARE SUBJECT TO REFILLS.
   (III)  THE MEDICATIONS ARE NOT A SCHEDULE II CONTROLLED SUBSTANCE OR A
 SCHEDULE III CONTROLLED SUBSTANCE CONTAINING HYDROCODONE.
   (IV) THE MEDICATIONS MEET ALL PRIOR AUTHORIZATION CRITERIA SPECIFIC TO
 MEDICATIONS AT THE TIME OF THE SYNCHRONIZATION REQUEST.
   (V) THE MEDICATIONS ARE OF A FORMULATION THAT CAN BE EFFECTIVELY SPLIT
 OVER REQUIRED SHORT FILL PERIODS TO ACHIEVE SYNCHRONIZATION.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD01416-01-9

 A. 3009                             2
 
   (VI) THE MEDICATIONS DO NOT HAVE QUANTITY LIMITS OR DOSE  OPTIMIZATION
 CRITERIA OR REQUIREMENTS THAT WOULD BE VIOLATED IN FULFILLING SYNCHRONI-
 ZATION.
   (B)   NO   INDIVIDUAL  OR  GROUP  HEALTH  INSURANCE  POLICY  PROVIDING
 PRESCRIPTION DRUG COVERAGE SHALL DENY COVERAGE FOR THE DISPENSING  OF  A
 MEDICATION FOR PARTIAL FILL WHEN IT IS FOR PURPOSES OF SYNCHRONIZING THE
 PATIENT'S  MEDICATIONS. WHEN APPLICABLE TO PERMIT SYNCHRONIZATION, EVERY
 INDIVIDUAL OR GROUP HEALTH INSURANCE POLICY MUST  ALLOW  A  PHARMACY  TO
 OVERRIDE  ANY  DENIAL  CODES  INDICATING  THAT  A  PRESCRIPTION IS BEING
 REFILLED TOO SOON FOR THE PURPOSES OF MEDICATION SYNCHRONIZATION.
   (C) DISPENSING FEES FOR PARTIALLY  FILLED  OR  REFILLED  PRESCRIPTIONS
 SHALL BE PAID IN FULL FOR EACH PRESCRIPTION DISPENSED, REGARDLESS OF ANY
 PRO-RATED COPAY FOR THE BENEFICIARY OR FEE PAID FOR ALIGNMENT SERVICES.
   (D)  NOTHING  IN  THIS  SECTION SHALL BE DEEMED TO REQUIRE HEALTH CARE
 PRACTITIONERS AND PHARMACISTS TO SYNCHRONIZE THE REFILLING  OF  MULTIPLE
 PRESCRIPTIONS FOR A COVERED INDIVIDUAL.
   (E)  THE REQUIREMENTS OF THIS PARAGRAPH SHALL APPLY ONLY ONCE FOR EACH
 PRESCRIPTION DRUG SUBJECT  TO  MEDICATION  SYNCHRONIZATION  EXCEPT  WHEN
 EITHER OF THE FOLLOWING OCCURS:
   (I)  THE  PRESCRIBER CHANGES THE DOSAGE OR FREQUENCY OF ADMINISTRATION
 OF THE PRESCRIPTION DRUG SUBJECT TO A MEDICATION SYNCHRONIZATION; OR
   (II) THE PRESCRIBER PRESCRIBES A DIFFERENT DRUG.
   § 2. The insurance law is amended by adding a new  section  4303-a  to
 read as follows:
   §  4303-A.  PRESCRIPTION SYNCHRONIZATION.   (A) EVERY HOSPITAL SERVICE
 CORPORATION AND HEALTH SERVICE CORPORATION PROVIDING  PRESCRIPTION  DRUG
 COVERAGE  WHEN  APPLICABLE  TO  PERMIT  SYNCHRONIZATION SHALL PERMIT AND
 APPLY A DAILY PRO-RATED COST-SHARING  RATE  TO  PRESCRIPTIONS  THAT  ARE
 DISPENSED  BY A NETWORK PHARMACY FOR LESS THAN A THIRTY DAY SUPPLY, WHEN
 IT IS AGREED AMONG THE COVERED INDIVIDUAL, A HEALTH  CARE  PRACTITIONER,
 AND  A PHARMACIST THAT SYNCHRONIZATION OF MULTIPLE PRESCRIPTIONS FOR THE
 TREATMENT OF A CHRONIC ILLNESS IS IN THE BEST INTEREST  OF  THE  COVERED
 INDIVIDUAL  FOR  THE  MANAGEMENT  OR  TREATMENT  OF THAT CHRONIC ILLNESS
 PROVIDED THAT ALL OF THE FOLLOWING APPLY:
   (I) THE MEDICATIONS ARE COVERED BY THE POLICY OR PLAN.
   (II) THE MEDICATIONS ARE USED FOR TREATMENT AND MANAGEMENT OF  CHRONIC
 CONDITIONS THAT ARE SUBJECT TO REFILLS.
   (III)  THE MEDICATIONS ARE NOT A SCHEDULE II CONTROLLED SUBSTANCE OR A
 SCHEDULE III CONTROLLED SUBSTANCE CONTAINING HYDROCODONE.
   (IV) THE MEDICATIONS MEET ALL PRIOR AUTHORIZATION CRITERIA SPECIFIC TO
 MEDICATIONS AT THE TIME OF THE SYNCHRONIZATION REQUEST.
   (V) THE MEDICATIONS ARE OF A FORMULATION THAT CAN BE EFFECTIVELY SPLIT
 OVER REQUIRED SHORT FILL PERIODS TO ACHIEVE SYNCHRONIZATION.
   (VI) THE MEDICATIONS DO NOT HAVE QUANTITY LIMITS OR DOSE  OPTIMIZATION
 CRITERIA OR REQUIREMENTS THAT WOULD BE VIOLATED IN FULFILLING SYNCHRONI-
 ZATION.
   (B)  NO  HOSPITAL  SERVICE  CORPORATION  OR HEALTH SERVICE CORPORATION
 PROVIDING  PRESCRIPTION  DRUG  COVERAGE  SHALL  DENY  COVERAGE  FOR  THE
 DISPENSING  OF  A MEDICATION FOR PARTIAL FILL WHEN IT IS FOR PURPOSES OF
 SYNCHRONIZING THE  PATIENT'S  MEDICATIONS.  WHEN  APPLICABLE  TO  PERMIT
 SYNCHRONIZATION,  EVERY  HOSPITAL  SERVICE CORPORATION OR HEALTH SERVICE
 CORPORATION PROVIDING PRESCRIPTION DRUG COVERAGE MUST ALLOW  A  PHARMACY
 TO  OVERRIDE  ANY  DENIAL  CODES INDICATING THAT A PRESCRIPTION IS BEING
 REFILLED TOO SOON FOR THE PURPOSES OF MEDICATION SYNCHRONIZATION.

 A. 3009                             3
 
   (C) DISPENSING FEES FOR PARTIALLY  FILLED  OR  REFILLED  PRESCRIPTIONS
 SHALL BE PAID IN FULL FOR EACH PRESCRIPTION DISPENSED, REGARDLESS OF ANY
 PRO-RATED COPAY FOR THE BENEFICIARY OR FEE PAID FOR ALIGNMENT SERVICES.
   (D)  NOTHING  IN  THIS  SECTION SHALL BE DEEMED TO REQUIRE HEALTH CARE
 PRACTITIONERS AND PHARMACISTS TO SYNCHRONIZE THE REFILLING  OF  MULTIPLE
 PRESCRIPTIONS FOR A COVERED INDIVIDUAL.
   (E)  THE REQUIREMENTS OF THIS PARAGRAPH SHALL APPLY ONLY ONCE FOR EACH
 PRESCRIPTION DRUG SUBJECT  TO  MEDICATION  SYNCHRONIZATION  EXCEPT  WHEN
 EITHER OF THE FOLLOWING OCCURS:
   (I)  THE  PRESCRIBER CHANGES THE DOSAGE OR FREQUENCY OF ADMINISTRATION
 OF THE PRESCRIPTION DRUG SUBJECT TO A MEDICATION SYNCHRONIZATION; OR
   (II) THE PRESCRIBER PRESCRIBES A DIFFERENT DRUG.
   § 3. This act shall take effect on the first  of  January,  2020,  and
 shall  apply  to  all  policies and contracts issued, renewed, modified,
 altered or amended on or after such date.