NY State Senate Bill 2019-S416

Archive: Last Bill Status - Stricken

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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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Feb 05, 2019	recommit, enacting clause stricken
Jan 09, 2019	referred to insurance

2019-S416 (ACTIVE) - Details

See Assembly Version of this Bill:: A3009
Law Section:: Insurance Law
Laws Affected:: Add §§3224-d & 4303-a, Ins L
Versions Introduced in Other Legislative Sessions:: 2013-2014: S6763, A8975
2015-2016: S2809, A4036
2017-2018: S5196, A4306

2019-S416 (ACTIVE) - Summary

Provides for the insurance coverage of the synchronization of multiple prescriptions.

2019-S416 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S416

SPONSOR: LANZA
 
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 practition-
ers 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 medi-
cation 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 mini-
mizes confusion over when a prescription is due to be refilled and mini-
mizes disrupting treatment through delayed or missed refills. The medi-
cation 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 effec-
tiveness 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 benefici-
aries 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 phar-
macists. 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:
2018: S.5196-B - Referred to Insurance/ A.4306-B - Passed Assembly
2017: S.5196-A - Referred to Insurance
2016: S.2809A - Referred to Insurance /A.4036-A - Passed Assembly
2015: S.2809A - 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 January 1, 2019.

2019-S416 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    416
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 9, 2019
                                ___________
 
 Introduced  by  Sen.  LANZA  -- read twice and ordered printed, and when
   printed to be committed 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.
   (VI)  THE MEDICATIONS DO NOT HAVE QUANTITY LIMITS OR DOSE OPTIMIZATION
 CRITERIA OR REQUIREMENTS THAT WOULD BE VIOLATED IN FULFILLING SYNCHRONI-
 ZATION.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD01416-01-9

 S. 416                              2
 
   (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.
   (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.

 S. 416                              3
 
   (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.

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Senate Bill S416

Sponsored By

Archive: Last Bill Status - Stricken

2019-S416 (ACTIVE) - Details

2019-S416 (ACTIVE) - Summary

2019-S416 (ACTIVE) - Sponsor Memo

2019-S416 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S416

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Sponsored By

Andrew J. Lanza

Archive: Last Bill Status - Stricken

2019-S416 (ACTIVE) - Details

2019-S416 (ACTIVE) - Summary

2019-S416 (ACTIVE) - Sponsor Memo

2019-S416 (ACTIVE) - Bill Text download pdf

Comments