S T A T E O F N E W Y O R K
________________________________________________________________________
9012
I N A S S E M B L Y
January 10, 2020
___________
Introduced by M. of A. GOTTFRIED, ABINANTI, PHEFFER AMATO, SOLAGES,
JAFFEE, GARBARINO, STECK, SEAWRIGHT, ASHBY, BYRNE, McDONALD, BUTTENS-
CHON -- Multi-Sponsored by -- M. of A. HEVESI -- read once and
referred to the Committee on Health
AN ACT to amend the social services 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. Subdivision 9 of section 367-a of the social services law
is amended by adding a new paragraph (i) to read as follows:
(I)(I) THE DEPARTMENT OF HEALTH SHALL ESTABLISH A PROGRAM FOR SYNCHRO-
NIZATION OF MEDICATIONS WHEN IT IS AGREED AMONG THE RECIPIENT, A PROVID-
ER AND A PHARMACIST THAT SYNCHRONIZATION OF MULTIPLE PRESCRIPTIONS FOR
THE TREATMENT OF A CHRONIC ILLNESS IS IN THE BEST INTEREST OF THE
PATIENT FOR THE MANAGEMENT OR TREATMENT OF A CHRONIC ILLNESS PROVIDED
THAT THE MEDICATIONS:
(A) ARE COVERED BY THE DEPARTMENT OF HEALTH PURSUANT TO THIS TITLE;
(B) ARE USED FOR TREATMENT AND MANAGEMENT OF CHRONIC CONDITIONS THAT
ARE SUBJECT TO REFILLS;
(C) ARE NOT A SCHEDULE II CONTROLLED SUBSTANCE, NOR A SCHEDULE III
CONTROLLED SUBSTANCE THAT CONTAINS HYDROCODONE;
(D) MEET ALL PRIOR AUTHORIZATION CRITERIA SPECIFIC TO THE MEDICATIONS
AT THE TIME OF THE SYNCHRONIZATION REQUEST;
(E) ARE OF A FORMULATION THAT CAN BE EFFECTIVELY SPLIT OVER REQUIRED
SHORT FILL PERIODS TO ACHIEVE SYNCHRONIZATION; AND
(F) DO NOT HAVE QUANTITY LIMITS OR DOSE OPTIMIZATION CRITERIA OR
REQUIREMENTS THAT WOULD BE VIOLATED IN FULFILLING SYNCHRONIZATION.
(II) THE DEPARTMENT OF HEALTH SHALL NOT DENY COVERAGE FOR THE DISPENS-
ING OF A MEDICATION BY A PHARMACY FOR A PARTIAL SUPPLY WHEN IT IS FOR
THE PURPOSE OF SYNCHRONIZING THE PATIENT'S MEDICATIONS. WHEN APPLICABLE
TO PERMIT SYNCHRONIZATION, THE DEPARTMENT OF HEALTH SHALL ALLOW A PHAR-
MACY TO OVERRIDE ANY DENIAL CODES INDICATING THAT A PRESCRIPTION IS
BEING REFILLED TOO SOON FOR THE PURPOSES OF MEDICATION SYNCHRONIZATION.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14664-01-0
A. 9012 2
(III) TO PERMIT SYNCHRONIZATION, THE DEPARTMENT OF HEALTH SHALL APPLY
A PRORATED DAILY COST-SHARING RATE TO ANY MEDICATION DISPENSED BY A
PHARMACY PURSUANT TO THIS SECTION.
(IV) THE DISPENSING FEE PAID TO A PHARMACY CONTRACTED TO PROVIDE
SERVICES PURSUANT TO THIS SECTION FOR A PARTIAL SUPPLY ASSOCIATED WITH A
MEDICATION SYNCHRONIZATION SHALL BE PAID IN FULL AND SHALL NOT BE
PRORATED.
(V) THE REQUIREMENT OF THIS PARAGRAPH APPLIES 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.
(VI) NOTHING IN THIS PARAGRAPH SHALL BE DEEMED TO REQUIRE HEALTH CARE
PRACTITIONERS AND PHARMACISTS TO SYNCHRONIZE THE REFILLING OF MULTIPLE
PRESCRIPTIONS FOR A RECIPIENT.
§ 2. Subdivision 4 of section 364-j of the social services law is
amended by adding a new paragraph (w) to read as follows:
(W)(I) THE DEPARTMENT OF HEALTH OR A MANAGED CARE ORGANIZATION
CONTRACTED TO PROVIDE SERVICES PURSUANT TO THIS SECTION SHALL ESTABLISH
A PROGRAM FOR SYNCHRONIZATION OF MEDICATIONS WHEN IT IS AGREED AMONG THE
RECIPIENT, A PROVIDER AND A PHARMACIST THAT SYNCHRONIZATION OF MULTIPLE
PRESCRIPTIONS FOR THE TREATMENT OF A CHRONIC ILLNESS IS IN THE BEST
INTEREST OF THE PATIENT FOR THE MANAGEMENT OR TREATMENT OF A CHRONIC
ILLNESS PROVIDED THAT THE MEDICATIONS:
(A) ARE COVERED BY MEDICAID SERVICES OR A MANAGED CARE ORGANIZATION
CONTRACTED TO PROVIDE SERVICES PURSUANT TO THIS CHAPTER;
(B) ARE USED FOR TREATMENT AND MANAGEMENT OF CHRONIC CONDITIONS THAT
ARE SUBJECT TO REFILLS;
(C) ARE NOT A SCHEDULE II CONTROLLED SUBSTANCE, NOR A SCHEDULE III
CONTROLLED SUBSTANCE THAT CONTAINS HYDROCODONE;
(D) MEET ALL PRIOR AUTHORIZATION CRITERIA SPECIFIC TO THE MEDICATIONS
AT THE TIME OF THE SYNCHRONIZATION REQUEST;
(E) ARE OF A FORMULATION THAT CAN BE EFFECTIVELY SPLIT OVER REQUIRED
SHORT FILL PERIODS TO ACHIEVE SYNCHRONIZATION; AND
(F) DO NOT HAVE QUANTITY LIMITS OR DOSE OPTIMIZATION CRITERIA OR
REQUIREMENTS THAT WOULD BE VIOLATED IN FULFILLING SYNCHRONIZATION.
(II) THE DEPARTMENT OF HEALTH OR A MANAGED CARE ORGANIZATION
CONTRACTED TO PROVIDE SERVICES UNDER THIS SECTION SHALL NOT DENY COVER-
AGE FOR THE DISPENSING OF A MEDICATION BY A PHARMACY FOR A PARTIAL
SUPPLY WHEN IT IS FOR THE PURPOSE OF SYNCHRONIZING THE PATIENT'S MEDICA-
TIONS. WHEN APPLICABLE TO PERMIT SYNCHRONIZATION, THE DEPARTMENT OF
HEALTH OR A MANAGED CARE ORGANIZATION CONTRACTED TO PROVIDE SERVICES
UNDER THIS TITLE SHALL ALLOW A PHARMACY TO OVERRIDE ANY DENIAL CODES
INDICATING THAT A PRESCRIPTION IS BEING REFILLED TOO SOON FOR THE
PURPOSES OF MEDICATION SYNCHRONIZATION.
(III) TO PERMIT SYNCHRONIZATION, THE DEPARTMENT OF HEALTH OR A MANAGED
CARE ORGANIZATION CONTRACTED TO PROVIDE SERVICES PURSUANT TO THIS TITLE
SHALL APPLY A PRORATED DAILY COST-SHARING RATE TO ANY MEDICATION
DISPENSED BY A PHARMACY PURSUANT TO THIS SECTION.
(IV) THE DISPENSING FEE PAID TO A PHARMACY CONTRACTED TO PROVIDE
SERVICES PURSUANT TO THIS SECTION FOR A PARTIAL SUPPLY ASSOCIATED WITH A
MEDICATION SYNCHRONIZATION SHALL BE PAID IN FULL AND SHALL NOT BE
PRORATED.
A. 9012 3
(V) THE REQUIREMENT OF THIS PARAGRAPH APPLIES ONLY ONCE FOR EACH
PRESCRIPTION DRUG SUBJECT TO MEDICATION SYNCHRONIZATION EXCEPT WHEN
EITHER OF THE FOLLOWING OCCURS:
(A) THE PRESCRIBER CHANGES THE DOSAGE OR FREQUENCY OF ADMINISTRATION
OF THE PRESCRIPTION DRUG SUBJECT TO A MEDICATION SYNCHRONIZATION; OR
(B) THE PRESCRIBER PRESCRIBES A DIFFERENT DRUG.
(VI) NOTHING IN THIS PARAGRAPH SHALL BE DEEMED TO REQUIRE HEALTH CARE
PRACTITIONERS AND PHARMACISTS TO SYNCHRONIZE THE REFILLING OF MULTIPLE
PRESCRIPTIONS FOR A COVERED INDIVIDUAL.
§ 3. This act shall take effect on the one hundred twentieth day after
it shall have become a law. The amendments to subdivision 9 of section
367-a of the social services law, made by section one of this act, shall
not affect the expiration of that subdivision, and shall expire there-
with.
The amendments to section 364-j of the social services law, made by
section two of this act, shall not affect the repeal of that section,
and shall be deemed repealed therewith. Effective immediately, the
commissioner of health shall make regulations and take other actions
reasonably necessary to implement this act on that date.