NY State Senate Bill S6603

Archive: Last Bill Status - Vetoed by Governor

Introduced
In Committee
On Floor Calendar
- Passed Senate
- Passed Assembly
Delivered to Governor
Vetoed by Governor

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Actions

view actions (13)

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Dec 29, 2021	vetoed memo.85
Dec 17, 2021	delivered to governor
Jun 10, 2021	returned to senate passed assembly ordered to third reading rules cal.773 substituted for a7598 referred to ways and means delivered to assembly passed senate ordered to third reading cal.1749 committee discharged and committed to rules
May 19, 2021	reported and committed to finance
May 10, 2021	referred to health

Votes

view votes

Jun 10, 2021 - floor Vote

S6603

floor

Aye

Nay

Absent

Excused

Abstained

Jun 10, 2021 - Rules committee Vote

S6603

committee

Aye

Nay

Aye with Reservations

Absent

Excused

Abstained

May 19, 2021 - Health committee Vote

S6603

committee

Aye

Nay

Aye with Reservations

Absent

Excused

Abstained

Co-Sponsors

view additional co-sponsors

S6603 (ACTIVE) - Details

See Assembly Version of this Bill:: A7598
Law Section:: Social Services Law
Laws Affected:: Amd §364-j, Soc Serv L; amd §280-a, Pub Health L

S6603 (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.

S6603 (ACTIVE) - Sponsor Memo

 
BILL NUMBER: S6603

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 OR GENERAL IDEA OF BILL:

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 SPECIFIC 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
data by the federal Centers for Medicaid and Medicare Services. This
section also requires managed care providers and PBMs to allow any will-
ing pharmacy provider into their Medicaid pharmacy networks to ensure
access for patients. These provisions will not impact 340B entities or
HIV Special Needs Plans.

Section two: Amends public health law to prevent PBMs, health plans and
other insurers from limiting patient choice in how they choose to
receive their needed medications from local pharmacies.

Section three: effective date.

 
JUSTIFICATION:

The SFY 2022 Final State Budget delayed the planned carve out of the
pharmacy benefit from Medicaid Managed Care to Fee for Service two years
to April 1, 2023. This delay allows managed care plans and their PBMs to
continue to make significant profits off this program at the expense of
taxpayers, community pharmacies and patient care.

Even prior to this delay, community pharmacies, independent and chain,
have been struggling to remain open in areas with a high number of indi-
viduals enrolled in Medicaid due to the unfair and unsustainable, often
below cost, reimbursement paid to pharmacies by managed care providers
and PBMs as well as their restrictive networks and other self-serving
requirements which make it difficult for pharmacies to continue to serve
patients in their communities. Many pharmacies have closed and this will
continue unless immediate relief is provided now to address this untena-
ble situation for community pharmacies on behalf of those they serve.

This legislation would provide critical reforms and protections, shift-
ing the excessive administrative fees that managed care providers and
PBMs currently enjoy, to provide adequate payment to community pharma-
cies. Also, this bill would prevent restrictive networks enabling
patients enrolled in Medicaid to have the choice of and access to their
local pharmacies, and to have the option under any insurance plan to
receive medications via in-person or mail delivery from their local
pharmacies if they choose, rather than having to use out-of-state mail
order pharmacies dictated by PBMs to do so.

This bill ensures that limited Medicaid dollars are invested in patient
care, local communities and local businesses rather than further lining
PBM and health plan pockets.

 
PRIOR LEGISLATIVE HISTORY:

None

 
FISCAL IMPLICATIONS:

None, The bill requires a transfer of Medicaid funds from one entity to
another under Medicaid Managed Care without need for additional revenue
or appropriations

 
EFFECTIVE DATE:
This act shall take effect on the thirtieth days after it shall become a
law; provided, however, that the amendments to subdivision 18 4 of
section 364-j of the social services law made by section one of 19 this
act shall take effect July 1, 2021; provided further that if this 20 act
shall have become a law after such date it shall take effect immediately
and shall be deemed to have been in full force and effect on and further
that the amendments to subdivision 23 social services law made by
section one of 24 this act shall not affect the repeal of such section
and shall be deemed 25 repealed therewith.

S6603 (ACTIVE) - Bill Text download pdf

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6603
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                               May 10, 2021
                                ___________
 
 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-ONE,  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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD11345-01-1

 S. 6603                             2
 
 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
 PREFERRED  PARTICIPATION  STATUS,  PROVIDED  THAT  SUCH  RETAIL PHARMACY
 AGREES TO THE SAME REIMBURSEMENT AMOUNT, AS DEFINED IN PARAGRAPH (W)  OF
 THIS  SUBDIVISION,  AND  IS  ABLE  TO FILL AND DISPENSE PRESCRIPTION AND
 OVER-THE-COUNTER MEDICATIONS FOR THOSE ENROLLED IN THE  MEDICAL  ASSIST-
 ANCE PROGRAM.
   § 2. Section 280-a of the public health law is amended by adding a new
 subdivision 5 to read as follows:
   5.  NOTWITHSTANDING  ANY PROVISION OF LAW TO THE CONTRARY, NO PHARMACY
 BENEFIT MANAGER SHALL LIMIT  THE  OPTION  FOR  AN  INDIVIDUAL  RECEIVING
 PRESCRIPTION OR OVER-THE-COUNTER MEDICATIONS TO RECEIVE SUCH MEDICATIONS
 FROM THEIR LOCAL, NON-MAIL ORDER PHARMACY OF CHOICE VIA DELIVERY INCLUD-
 ING  IN-PERSON  DELIVERY,  UNITED STATES POSTAL SERVICE OR OTHER MAIL OR
 COURIER SERVICE. NO RESTRICTIONS, PROHIBITIONS  OR  PRIOR  AUTHORIZATION
 REQUIREMENTS  SHALL BE BASED ON THE INDIVIDUAL'S CHOICE IN DELIVERY TYPE
 OR DISTANCE FROM A PHARMACY.
   § 3. This act shall take effect on the thirtieth day  after  it  shall
 have become a law; provided, however, that the amendments to subdivision
 4  of  section  364-j  of the social services law made by section one of
 this act shall take effect July 1, 2021; provided further that  if  this
 act  shall  have become a law after such date it shall take effect imme-
 diately and shall be deemed to have been in full force and effect on and
 after July 1, 2021; provided further that the amendments to  subdivision
 4  of  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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The New York State Senate

senate Bill S6603

Sponsored By

Archive: Last Bill Status - Vetoed by Governor

Your Voice

Actions

Votes

Jun 10, 2021 - floor Vote

Floor Vote: Jun 10, 2021

Jun 10, 2021 - Rules committee Vote

Rules Committee Vote: Jun 10, 2021

May 19, 2021 - Health committee Vote

Health Committee Vote: May 19, 2021

Co-Sponsors

S6603 (ACTIVE) - Details

S6603 (ACTIVE) - Summary

S6603 (ACTIVE) - Sponsor Memo

S6603 (ACTIVE) - Bill Text download pdf

Comments

senate Bill S6603

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Sponsored By

Archive: Last Bill Status - Vetoed by Governor

Your Voice

Actions

Votes

Jun 10, 2021 - floor Vote

Floor Vote: Jun 10, 2021

Jun 10, 2021 - Rules committee Vote

Rules Committee Vote: Jun 10, 2021

May 19, 2021 - Health committee Vote

Health Committee Vote: May 19, 2021

Co-Sponsors

S6603 (ACTIVE) - Details

S6603 (ACTIVE) - Summary

S6603 (ACTIVE) - Sponsor Memo

S6603 (ACTIVE) - Bill Text download pdf

Comments