BILL NUMBER: S2520A

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend part FFF of chapter 56 of the laws of 2020, amending the
public health law relating to extending and enhancing the Medicaid drug
cap and to reduce unnecessary pharmacy benefit manager costs to the
Medicaid program, in relation to temporarily exempting covered entities
under the federal 340B program and comprehensive HIV special needs plans

 
PURPOSE OR GENERAL IDEA OF BILL:

To delay for 3 years the transition from managed care to fee-for-service
for Medicaid pharmacy benefits under the federal 340B program and
Comprehensive HIV special needs plans.

 
SUMMARY OF SPECIFIC PROVISIONS:

Chap. 56, Part FFF of the 2020-21 enacted budget transfers the Medicaid
prescription drug benefit from Medicaid managed care to fee-for-service
              

Medicaid by April 1, 2021. This bill adds a new § 1-b to postpone this
carve-out until April 2024 for prescriptions under the federal 340B
program and Medicaid HIV special needs plans.

 
JUSTIFICATION:

The federal 340B prescription drug program was created to lower drug
prices for government funded health clinics "to enable these entities to
stretch scarce Federal resources as far as possible, reaching more
eligible patients and providing more comprehensive services." The
savings are used by 340B providers (especially community health centers)
to provide health care services to needy patients. See: H.R.  Rep. No.
102-384(11), at 12 (1992).

Medicaid HIV special needs plans provide enhanced care coordination
encompassing all aspect of HIV therapeutics, including prescription drug
regimen and adjustment, which is the key factor in survival with HIV.
They are concerned that carving out the prescription drug benefit will
undermine their ability to do enhanced care coordination.

Carving out the Medicaid drug benefit and putting it under the fee-for-
service Preferred Drug Program will have fiscal and patient care bene-
fits. However, the abrupt transition will endanger 340B providers and
HIV SNPs. Delaying implementation for these two programs will enable
them, the Health Department and the Legislature to consider ways to
avoid or minimize the negative impact.

 
PRIOR LEGISLATIVE HISTORY:

2019-2020: S8948/A10960 Gottfried

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
Immediately.