Senate Bill S1794

                                 
BILL NUMBER: S1794

SPONSOR: FERNANDEZ
 
TITLE OF BILL:

An act to amend the public health law, in relation to requiring feder-
ally qualified health centers and rural health centers cover the cost of
all ovulation enhancing drugs dispensed

 
PURPOSE:

To ensure that the cost of ovulation enhancing drugs are included in the
calculation of the alternative payment reimbursement methodology for
federally qualified health centers and rural health clinics related to
the carveout of the pharmacy benefit from managed care to fee-for-ser-
vice.

 
SUMMARY OF PROVISIONS:

Section 1: Amends section 2807 of the Public Health Law by adding a new
paragraph to require the inclusion of ovulation enhancing drugs in the
Department of Health's calculation of alternative reimbursement method-
              

ology for entities defined under section 340B of the Public Health
Service Act (42 U.S.C, § 256b) regarding the carveout of the
prescription drug benefit from managed care to fee-for-service.

Section 2: Effective date.

 
JUSTIFICATION:

While some ovulation enhancing drugs used for fertility treatments are
currently covered by Medicaid, the more effective injectable drugs,
which provide better outcomes for patients, are currently not covered.
To bridge this gap, many health centers have been subsidizing the cost
of these drugs for their Medicaid patients so they can access the full
range of fertility treatments. However, these more effective injectable
ovulation enhancing drugs are generally covered by commercial insurance.
This imbalance of coverage has led to individuals on Medicaid not being
able to access the full spectrum of fertility treatments currently
available to patients with commercial insurance, including state employ-
ees.

With the transition of the pharmacy benefit from managed care to fee-
for-service, other funding that health centers have been utilizing to
cover the out-of-pocket costs for their Medicaid patients that seek to
access the full spectrum of infertility services, including all ovula-
tion enhancing drugs, has ended.

This bill serves to ensure that community health center 340B covered
entities continue to realize funding for these ovulation enhancing drugs
by requiring DOH to factor in the cost of these drugs when determining
the alternative payment methodologies for federally qualified health
centers as a result of the pharmacy benefit carveout from managed care.
This will help to ensure that these critical drugs are available to
their patients who otherwise would not be able to access the full range
of fertility treatments.

 
LEGISLATIVE HISTORY:

2023-2024: S9159 / A9840

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
This act shall take effect immediately.