Senate Bill S8509A

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8509
 
                             I N  S E N A T E
 
                               March 8, 2022
                                ___________
 
 Introduced  by  Sen.  CLEARE -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend part FFF of chapter 56 of the laws of 2020  relating  to
   directing the department of health to remove the pharmacy benefit from
   the  managed  care benefit package and to provide the pharmacy benefit
   under the fee for service program, in relation  to  the  effectiveness
   thereof
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 1 of part FFF of chapter 56 of  the  laws  of  2020
 relating  to  directing  the department of health to remove the pharmacy
 benefit from the managed care benefit package and to provide the pharma-
 cy benefit under the fee for service program, as amended by section 1 of
 part C of chapter 57 of the laws of 2021, is amended to read as follows:
   Section 1. The Legislature hereby  finds  and  declares  that  medical
 assistance  for needy persons is a matter of public concern and a neces-
 sity in promoting the public health and welfare and  for  promoting  the
 state's  goal  of making available to everyone, regardless of race, age,
 gender, national origin  or  economic  standing,  uniform,  high-quality
 medical  care.  As  the  department of health is the single state agency
 responsible for supervising the administration of  the  state's  medical
 assistance  program  (Medicaid),  it is tasked with ensuring efficiency,
 economy, and quality of care in providing benefits to the state's  needy
 persons. To this end and with the fiscal constraints facing our state in
 mind, the department of health continues to analyze the Medicaid program
 in search of ways to ensure Medicaid spending is held to the standard of
 efficiency, economy, and quality of care. In consideration of this stan-
 dard, the department of health is hereby directed to exercise its exist-
 ing administrative authority to remove the pharmacy benefit from managed
 care  benefit package and instead provide the pharmacy benefit under the
 fee for service program, except where otherwise required by federal law,
 to ensure transparency and that the benefit is provided to  the  fullest
 extent  and  as  efficiently  as  possible;  provided, however, that the
 department of health shall not implement the transition of the  pharmacy
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD14961-01-2
 S. 8509                             2
 
 benefit  from  the  managed  care benefit package to the fee for service
 program sooner than April 1, [2023] 2021, and until it is satisfied that
 all necessary and appropriate transition planning has occurred,  in  its
 sole  discretion,  and federal approvals have been obtained and prepara-
 tions have been made. Furthermore,  to  ensure  an  orderly  transition,
 continued  access  to medications, and appropriate patient education and
 support, the department may establish uniform standards,  payment  poli-
 cies  and  reimbursement  methodologies for any sites where drugs may be
 administered or dispensed under the fee for  service  program;  provided
 that,  subject  to  the availability of federal financial participation,
 when reimbursing covered entities, as defined under section 340B of  the
 public health service act (42 U.S.C. §256b), for drugs that would other-
 wise  be  eligible  for  pricing under section 340B of the public health
 service act, the department shall examine all reasonably available meth-
 ods  for  determining  actual  acquisition  cost  and  the  professional
 dispensing  fee  and,  beginning  in  the  fiscal year starting April 1,
 [2023] 2021, review and adjust reimbursement for such drugs such that no
 sooner than April 1, [2025]  2023,  reimbursement  shall  be  determined
 based  on  a  method  that the commissioner determines that utilizes the
 actual acquisition costs and professional dispensing fee.
   § 2. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2021.