The New York State Senate

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9165
 
                           I N  A S S E M B L Y
 
                             January 31, 2022
                                ___________
 
 Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
   Committee on Health
 
 AN ACT to amend the social services law and the public  health  law,  in
   relation to protecting access to pharmacy services
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Subdivision 4 of section 364-j of the social  services  law
 is amended by adding two new paragraphs (w) and (x) to read as follows:
   (W)  NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, ADMINISTRA-
 TIVE FEES PAID TO A MANAGED CARE PROVIDER OR A PHARMACY BENEFIT  MANAGER
 UNDER THE MEDICAL ASSISTANCE PROGRAM SHALL BE REDUCED FOR THE PURPOSE OF
 INCREASING  REIMBURSEMENT  RATES TO RETAIL PHARMACIES UNDER THE MEDICAID
 MANAGED CARE PROGRAM. BEGINNING ON AND AFTER JULY  FIRST,  TWO  THOUSAND
 TWENTY-TWO,  ALL  REIMBURSEMENT  PAID  BY MEDICAID MANAGED CARE PLANS TO
 RETAIL PHARMACIES SHALL INCLUDE A PROFESSIONAL DISPENSING  FEE  AND  THE
 DRUG ACQUISITION COST FOR EACH OUTPATIENT DRUG DISPENSED AT NO LESS THAN
 THE  AMOUNT ESTABLISHED UNDER THE FEE-FOR-SERVICE PROGRAM, AS DEFINED IN
 SECTION THREE HUNDRED SIXTY-SEVEN-A OF THIS TITLE, REGARDLESS OF WHETHER
 SUCH REIMBURSEMENT IS PAID DIRECTLY BY THE MEDICAID MANAGED CARE PLAN OR
 PASSED THROUGH  A  PHARMACY  BENEFIT  MANAGER  OR  OTHER  ENTITY.    THE
 REIMBURSEMENT  PROVIDED  FOR UNDER THIS PARAGRAPH SHALL NOT APPLY TO ANY
 EXISTING REIMBURSEMENT ARRANGEMENTS INVOLVING AN ELIGIBLE PROVIDER UNDER
 SECTION 340B OF THE FEDERAL PUBLIC HEALTH SERVICES ACT OR  A  COMPREHEN-
 SIVE  HIV SPECIAL NEEDS PLAN UNDER SECTION FORTY-FOUR HUNDRED THREE-C OF
 THE PUBLIC HEALTH LAW UNDER THE MEDICAL ASSISTANCE PROGRAM.  NO  MANAGED
 CARE  PROVIDER  OR  PHARMACY  BENEFIT MANAGER SHALL REIMBURSE A PHARMACY
 OWNED BY OR AFFILIATED WITH SUCH ENTITY AT A HIGHER RATE THAN THAT  PAID
 BY  SUCH ENTITY TO A PHARMACY IT DOES NOT OWN OR IS NOT OTHERWISE AFFIL-
 IATED WITH.
   (X) NOTWITHSTANDING ANY PROVISION OF LAW TO THE  CONTRARY,  A  MANAGED
 CARE  PROVIDER  OR  PHARMACY  BENEFIT  MANAGER  ACTING ON ITS BEHALF, AS
 DEFINED IN SECTION TWO HUNDRED EIGHTY-A OF THE PUBLIC HEALTH LAW,  SHALL
 NOT  DENY  ANY RETAIL PHARMACY THE OPPORTUNITY TO PARTICIPATE IN ANOTHER
 PROVIDER'S PHARMACY NETWORK UNDER  THE  MEDICAL  ASSISTANCE  PROGRAM  AT
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD11345-02-2
 A. 9165                             2
 
 PREFERRED  PARTICIPATION  STATUS,  PROVIDED  THAT  SUCH  RETAIL PHARMACY
 AGREES TO THE SAME REIMBURSEMENT AMOUNT, AS DEFINED IN PARAGRAPH (W)  OF
 THIS  SUBDIVISION,  AND  IS  ABLE  TO FILL AND DISPENSE PRESCRIPTION AND
 OVER-THE-COUNTER  MEDICATIONS  FOR THOSE ENROLLED IN THE MEDICAL ASSIST-
 ANCE PROGRAM.
   § 2. Section 280-a of the public health law is amended by adding a new
 subdivision 6 to read as follows:
   6. DELIVERY OPTION.  NOTWITHSTANDING  ANY  PROVISION  OF  LAW  TO  THE
 CONTRARY,  NO  PHARMACY  BENEFIT  MANAGER  SHALL LIMIT THE OPTION FOR AN
 INDIVIDUAL RECEIVING PRESCRIPTION  OR  OVER-THE-COUNTER  MEDICATIONS  TO
 RECEIVE  SUCH  MEDICATIONS  FROM THEIR LOCAL, NON-MAIL ORDER PHARMACY OF
 CHOICE VIA DELIVERY INCLUDING IN-PERSON DELIVERY, UNITED  STATES  POSTAL
 SERVICE  OR OTHER MAIL OR COURIER SERVICE. NO RESTRICTIONS, PROHIBITIONS
 OR PRIOR AUTHORIZATION REQUIREMENTS SHALL BE BASED ON  THE  INDIVIDUAL'S
 CHOICE IN DELIVERY TYPE OR DISTANCE FROM A PHARMACY.
   §  3.  This  act shall take effect on the thirtieth day after it shall
 have become a law; provided, however, that:
   (a) the amendments to subdivision 4 of section  364-j  of  the  social
 services  law  made by section one of this act shall take effect July 1,
 2022;
   (b) if this act shall have become a law after such effective  date  it
 shall  take  effect immediately and shall be deemed to have been in full
 force and effect on and after July 1, 2022;
   (c) the amendments to subdivision 4 of section  364-j  of  the  social
 services law made by section one of this act shall not affect the repeal
 of such section and shall be deemed repealed therewith; and
   (d)  if chapter 828 of the laws of 2021 shall not have taken effect on
 or before such effective date then section two of this  act  shall  take
 effect  on  the  same date and in the same manner as such chapter of the
 laws of 2021 takes effect.