NY State Senate Bill 2021-S1588

Senate Bill S1588

2021-2022 Legislative Session

Relates to coverage for certain prescription drugs in Medicaid managed care programs; repealer

download bill text pdf

Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 05, 2022	referred to health
Jan 13, 2021	referred to health

2021-S1588 (ACTIVE) - Details

Current Committee:: Senate Health
Law Section:: Social Services Law
Laws Affected:: Amd §364-j, rpld §364-j sub 25-a, Soc Serv L
Versions Introduced in Other Legislative Sessions:: 2017-2018: S6541
2019-2020: S1794
2023-2024: S503

2021-S1588 (ACTIVE) - Summary

Provides for coverage for certain medically necessary prescription drugs in Medicaid managed care programs.

2021-S1588 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S1588

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to coverage for
certain prescription drugs; and to repeal certain provisions of such law
relating thereto

 
PURPOSE:

To clarify that "prescriber prevails" provisions under Medicaid managed
care for certain classes of drugs shall be conducted as it currently is
for fee-for-service Medicaid recipients, with exceptions.

 
SUMMARY OF PROVISIONS:

Section 1 of the bill amends Social Services Law § 364-j, subdivision 25
to obligate a Medicaid managed care plan to cover a drug benefit when,
in the prescriber's reasonable professional judgment, the prescription
is medically necessary and warranted. The exceptions are in the instance

when a drug is required by the Medicaid program to be filled with a
generic substitute and the prescriber has marked "dispense as written;"
or when the prescription is related to a use not supported by the
FDA-approved label, or official compendia or formularies. The bill also
consolidates into subdivision 25 the drug classes listed in subdivision
25-a, and repeals subdivision 25-a.

 
JUSTIFICATION:

Current New York State law allows physicians treating patients under the
Medicaid fee- for-service program to invoke prescriber prevails without
extra road- blocks. This bill will ensure that a managed-care Medicaid
patient's health care professional has the final say in determining
which drug, in certain classes, will be dispensed to the patient unless
the drug requires generic substitution, or the intended purpose is off-
label or not supported by official compendia. This bill is drafted to
respond to the veto message that was issued by the Governor in relation
to the 2015 bill S4893.

 
LEGISLATIVE HISTORY:

2015: Similar to S.4893, which was vetoed
2017-2018: S.6541 Hannon
2019-2020: S.1794A/A.2799A Gottfried

 
FISCAL IMPLICATIONS:

To be determined

 
EFFECTIVE DATE:
On the 60th day after enactment, provided that effective immediately the
Commissioner of health may make regulations necessary to implement the
act.

2021-S1588 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1588
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                             January 13, 2021
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the social services law, in  relation  to  coverage  for
   certain  prescription  drugs; and to repeal certain provisions of such
   law relating thereto

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 25 of section 364-j of the social services law,
 as  added  by section 55 of part D of chapter 56 of the laws of 2012, is
 amended to read as follows:
   25. [Effective January first, two thousand thirteen,  notwithstanding]
 NOTWITHSTANDING  any  provision  of  law  to  the contrary, managed care
 providers shall cover medically  necessary  prescription  drugs  in  the
 ANTI-DEPRESSANT,   ANTI-RETROVIRAL,  ANTIREJECTION,  SEIZURE,  EPILEPSY,
 ENDOCRINE, HEMATOLOGIC, IMMUNOLOGIC AND atypical antipsychotic therapeu-
 tic [class] CLASSES, including non-formulary drugs, upon [demonstration]
 DETERMINATION by THE PRESCRIBER UNDER THIS SUBDIVISION. IF the  prescri-
 ber,  after  consulting  with the managed care provider, DETERMINES that
 such drugs, in the prescriber's reasonable  professional  judgment,  are
 medically  necessary and warranted, THE PRESCRIBER'S DETERMINATION SHALL
 BE FINAL. HOWEVER, THE PRESCRIBER'S DETERMINATION SHALL  NOT  BE  FINAL:
 (A)  WHERE  THE  DRUG APPROVED BY THE MANAGED CARE PROVIDER IS A GENERIC
 DRUG SUBJECT TO SUBPARAGRAPH (I) OF PARAGRAPH (A-1) OF SUBDIVISION  FOUR
 OF  SECTION  THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE (MANDATORY GENERIC
 SUBSTITUTION), AND  EVEN  IF  THE  PRESCRIBER  HAS  INDICATED  THAT  THE
 PRESCRIPTION  SHALL BE DISPENSED AS WRITTEN; OR (B) IF IT IS FOR THE USE
 OF A DRUG THAT IS NOT CONSISTENT WITH FOOD AND  DRUG  ADMINISTRATION-AP-
 PROVED  LABELING  OR  SUPPORTED BY ONE OR MORE OFFICIAL COMPENDIA REFER-
 ENCES, INCLUDING, BUT NOT LIMITED TO, THE  AMERICAN  HOSPITAL  FORMULARY
 SERVICE  (AHFS),  THE  DRUGDEX  DRUG  INFORMATION  SYSTEM AND THE UNITED
 STATES PHARMACOPEIA.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD00225-01-1

 S. 1588                             2
 
   § 2. Subdivision 25-a of section 364-j of the social services  law  is
 REPEALED.
   §  3.  This  act  shall take effect on the sixtieth day after it shall
 have become a law; provided that effective immediately, the commissioner
 of health may make regulations  and  take  other  actions  necessary  to
 implement  this act on that date; and provided, further, that the amend-
 ments to 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.

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