assembly Bill A9165

2021-2022 Legislative Session

Protects access to pharmacy services

download bill text pdf

Sponsored By

Current Bill Status - In Assembly Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 31, 2022 referred to health

Co-Sponsors

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A9165 (ACTIVE) - Details

See Senate Version of this Bill:
S7909
Current Committee:
Assembly Health
Law Section:
Social Services Law
Laws Affected:
Amd §364-j, Soc Serv L; amd §280-a, Pub Health L

A9165 (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.

A9165 (ACTIVE) - Bill Text download pdf

 
                     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.