Assembly Actions -
Senate Actions - UPPERCASE
|Mar 15, 2022||
reported and committed to finance
|Jan 19, 2022||
referred to health
Senate Bill S7909
2021-2022 Legislative Session
Archive: Last Bill Status - In Senate Committee Finance Committee
- In Committee Assembly
- On Floor Calendar Assembly
- Passed Assembly
- Delivered to Governor
- Signed By Governor
2021-S7909 (ACTIVE) - Details
2021-S7909 (ACTIVE) - Summary
Requires Medicaid managed care plans to reimburse retail pharmacies in an amount equal to the fee-for-service rate; allows retail pharmacies the opportunity to participate in another provider's network under the medical assistance program; prohibits pharmacy benefit managers from limiting an individual's option to receive medications from non-mail order pharmacies.
2021-S7909 (ACTIVE) - Sponsor Memo
BILL NUMBER: S7909 SPONSOR: SKOUFIS TITLE OF BILL: An act to amend the social services law and the public health law, in relation to protecting access to pharmacy services PURPOSE: To address unfair and unsustainable practices by managed care providers and pharmacy benefit managers (PBMs) to protect patient access to essen- tial pharmacy care and services. SUMMARY OF PROVISIONS: Section one: Amends social services law to reduce the administrative fees currently paid by the State Health Department to managed care providers and PBMs under the Medicaid pharmacy benefit to be used to more appropriately pay retail pharmacies in line with the state Fee for Service pharmacy program based on pharmacy ingredient costs and dispens- ing fees determined by the State Health Department and national survey
2021-S7909 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 7909 I N S E N A T E January 19, 2022 ___________ Introduced by Sen. SKOUFIS -- read twice and ordered printed, and when printed to be committed 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.
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