The New York State Senate

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    187
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 6, 2021
                                ___________
 
 Introduced  by  M.  of  A.  GOTTFRIED, ABINANTI, PHEFFER AMATO, SOLAGES,
   STECK, SEAWRIGHT, ASHBY, BYRNE, BUTTENSCHON, M. MILLER --  Multi-Spon-
   sored  by -- M. of A.  HEVESI -- read once and referred to the Commit-
   tee 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD00492-01-1

 A. 187                              2
 
 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.
   (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

 A. 187                              3
 
 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:
   (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.