NY State Senate Bill S4078

senate Bill S4078

2019-2020 Legislative Session

Provides for the insurance coverage of the synchronization of multiple prescriptions

download bill text pdf

Current Bill Status Via A3009 - Passed Senate & Assembly

Introduced
In Committee
On Floor Calendar
- Passed Senate
- Passed Assembly
Delivered to Governor
Signed/Vetoed by Governor

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Actions

view actions (9)

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 17, 2019	returned to assembly passed senate 3rd reading cal.987 substituted for s4078
Jun 17, 2019	substituted by a3009
Jun 03, 2019	advanced to third reading
May 30, 2019	2nd report cal.
May 29, 2019	1st report cal.987
Feb 27, 2019	referred to insurance

Votes

view votes

Jun 17, 2019 - floor Vote

A3009

floor

Aye

Nay

Absent

Excused

Abstained

May 29, 2019 - Insurance committee Vote

S4078

committee

Aye

Nay

Aye with Reservations

Absent

Excused

Abstained

Co-Sponsors

S4078 (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

S4078 (ACTIVE) - Summary

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

S4078 (ACTIVE) - Sponsor Memo

 
BILL NUMBER: S4078

SPONSOR: BRESLIN
 
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-
izes disrupting treatment through delayed or missed refills. The medica-
tion 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: $5196-B - Referred to Insurance
2017: S.5196-A - Referred to Insurance

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 January 1, 2020.

S4078 (ACTIVE) - Bill Text download pdf


                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  4078

                       2019-2020 Regular Sessions

                            I N  S E N A T E

                            February 27, 2019
                               ___________

Introduced  by Sens. BRESLIN, LANZA, SEPULVEDA -- read twice and ordered
  printed, and when printed to be committed to the Committee  on  Insur-
  ance

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. 4078                             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. 4078                             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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The New York State Senate

senate Bill S4078

Sponsored By

Current Bill Status Via A3009 - Passed Senate & Assembly

Your Voice

Actions

Votes

Jun 17, 2019 - floor Vote

Floor Vote: Jun 17, 2019

May 29, 2019 - Insurance committee Vote

Insurance Committee Vote: May 29, 2019

Co-Sponsors

S4078 (ACTIVE) - Details

S4078 (ACTIVE) - Summary

S4078 (ACTIVE) - Sponsor Memo

S4078 (ACTIVE) - Bill Text download pdf

Comments

senate Bill S4078

Share this bill

Sponsored By

Neil D. Breslin

Current Bill Status Via A3009 - Passed Senate & Assembly

Your Voice

Actions

Votes

Jun 17, 2019 - floor Vote

Floor Vote: Jun 17, 2019

May 29, 2019 - Insurance committee Vote

Insurance Committee Vote: May 29, 2019

Co-Sponsors

Andrew J. Lanza

Simcha Felder

Jen Metzger

Luis R. Sepúlveda

S4078 (ACTIVE) - Details

S4078 (ACTIVE) - Summary

S4078 (ACTIVE) - Sponsor Memo

S4078 (ACTIVE) - Bill Text download pdf

Comments