S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  9271

                          I N  A S S E M B L Y

                            February 10, 2016
                               ___________

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  extending the preferred drug program to medicaid managed
  care providers and offering the program to other health plans; and  to
  repeal certain provisions of the social services law relating thereto

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Legislative findings. This legislature finds that the costs
of many prescription drugs in the market have been escalating  unreason-
ably.  The  preferred  drug program and the clinical drug review program
under the public health law provide effective  mechanisms  for  assuring
access  to  quality,  effective and safe drugs to patients at reasonable
cost. Providing prescription  drugs  to  Medicaid  managed  health  care
provider  participants through these programs will maximize the Medicaid
program's ability  to  negotiate  more  substantial  rebates  with  drug
manufacturers  (effectively,  lower  prices),  while protecting Medicaid
managed care provider participants. Offering non-Medicaid  health  plans
the  opportunity  to  use these programs will help lower costs for those
health plans and those who pay their premiums, while protecting individ-
uals covered by those plans, and will also further increase the  negoti-
ating power of the programs.
  S  2. The social services law is amended by adding a new section 365-i
to read as follows:
  S 365-I. PRESCRIPTION DRUGS IN MEDICAID MANAGED  CARE  PROGRAMS.    1.
DEFINITIONS. (A) THE DEFINITIONS OF TERMS IN SECTION TWO HUNDRED SEVENTY
OF THE PUBLIC HEALTH LAW SHALL APPLY TO THIS SECTION.
  (B)  AS  USED  IN  THIS  SECTION,  UNLESS THE CONTEXT CLEARLY REQUIRES
OTHERWISE:
  (I) "MANAGED CARE  PROVIDER"  MEANS  A  MANAGED  CARE  PROVIDER  UNDER
SECTION  THREE HUNDRED SIXTY-FOUR-J OF THIS ARTICLE, A MANAGED LONG TERM
CARE PLAN UNDER SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC  HEALTH
LAW,  OR ANY OTHER ENTITY THAT PROVIDES OR ARRANGES FOR THE PROVISION OF
MEDICAL ASSISTANCE SERVICES AND SUPPLIES  TO  PARTICIPANTS  DIRECTLY  OR

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
              

                                                           LBD13967-02-6

A. 9271                             2

INDIRECTLY (INCLUDING BY REFERRAL), INCLUDING CASE MANAGEMENT, INCLUDING
THE MANAGED CARE PROVIDER'S AUTHORIZED AGENTS.
  (II)  "PARTICIPANT" MEANS A MEDICAL ASSISTANCE RECIPIENT WHO RECEIVES,
IS REQUIRED TO RECEIVE OR ELECTS TO RECEIVE HIS OR HER  MEDICAL  ASSIST-
ANCE SERVICES FROM A MANAGED CARE PROVIDER.
  2.  PROVIDING  AND PAYMENT FOR PRESCRIPTION DRUGS FOR MEDICAID MANAGED
CARE PROVIDER PARTICIPANTS. PRESCRIPTION DRUGS ELIGIBLE  FOR  REIMBURSE-
MENT  UNDER THIS ARTICLE PRESCRIBED IN RELATION TO A SERVICE PROVIDED BY
A MANAGED CARE PROVIDER  SHALL  BE  PROVIDED  AND  PAID  FOR  UNDER  THE
PREFERRED  DRUG PROGRAM AND THE CLINICAL DRUG REVIEW PROGRAM UNDER TITLE
ONE OF ARTICLE TWO-A OF THE PUBLIC HEALTH LAW. THE MANAGED CARE PROVIDER
SHALL ACCOUNT TO AND REIMBURSE THE DEPARTMENT FOR THE NET  COST  TO  THE
DEPARTMENT  FOR  PRESCRIPTION DRUGS PROVIDED TO THE MANAGED CARE PROVID-
ER'S PARTICIPANTS. PAYMENT FOR PRESCRIPTION DRUGS SHALL BE  INCLUDED  IN
THE  CAPITATION  PAYMENTS  TO  THE MANAGED CARE PROVIDER FOR SERVICES OR
SUPPLIES PROVIDED TO A MANAGED CARE PROVIDER'S PARTICIPANTS.
  S 3. Section 270 of the public health law is amended by adding  a  new
subdivision 15 to read as follows:
  15.  "THIRD-PARTY  HEALTH  CARE  PAYER"  HAS ITS ORDINARY MEANINGS AND
INCLUDES AN ENTITY SUCH AS A  FISCAL  ADMINISTRATOR,  OR  ADMINISTRATIVE
SERVICES   PROVIDER   THAT  PARTICIPATES  IN  THE  ADMINISTRATION  OF  A
THIRD-PARTY HEALTH CARE PAYER SYSTEM.
  S 4. The public health law is amended by adding a new section 274-a to
read as follows:
  S 274-A. USE OF  PREFERRED  DRUG  PROGRAM  AND  CLINICAL  DRUG  REVIEW
PROGRAM.  THE  COMMISSIONER  SHALL  CONTRACT WITH ANY THIRD-PARTY HEALTH
CARE PAYER THAT SO CHOOSES, TO USE THE PREFERRED DRUG  PROGRAM  AND  THE
CLINICAL  DRUG  REVIEW PROGRAM TO PROVIDE AND PAY FOR PRESCRIPTION DRUGS
FOR THE THIRD-PARTY HEALTH CARE PAYER'S  ENROLLEES.  TO  CONTRACT  UNDER
THIS  SECTION,  THE THIRD-PARTY HEALTH CARE PAYER SHALL PROVIDE COVERAGE
FOR PRESCRIPTION DRUGS AUTHORIZED  UNDER  THIS  TITLE.  THE  THIRD-PARTY
HEALTH  CARE PAYER SHALL ACCOUNT TO AND REIMBURSE THE DEPARTMENT FOR THE
NET COST TO THE  DEPARTMENT  FOR  PRESCRIPTION  DRUGS  PROVIDED  TO  THE
THIRD-PARTY  HEALTH  CARE  PAYER'S ENROLLEES. THE CONTRACT SHALL INCLUDE
TERMS REQUIRED BY THE COMMISSIONER.
  S 5. Section 272 of the public health law is amended by adding  a  new
subdivision 12 to read as follows:
  12.  NO PRIOR AUTHORIZATION SHALL BE REQUIRED UNDER THE PREFERRED DRUG
PROGRAM FOR: (A) ATYPICAL  ANTI-PSYCHOTICS;  (B)  ANTI-DEPRESSANTS;  (C)
ANTI-RETROVIRALS  USED  IN THE TREATMENT OF HIV/AIDS; (D) ANTI-REJECTION
DRUGS USED IN  THE  TREATMENT  OF  ORGAN  AND  TISSUE  TRANSPLANTS;  (E)
SEIZURE,  EPILEPSY,  ENDOCRINE,  HEMATOLOGIC AND IMMUNOLOGIC THERAPEUTIC
CLASSES; AND (F) ANY OTHER THERAPEUTIC CLASS FOR THE TREATMENT OF MENTAL
ILLNESS OR HIV/AIDS, RECOMMENDED BY THE COMMITTEE AND  APPROVED  BY  THE
COMMISSIONER UNDER THIS TITLE.
  S  6. Subdivisions 25 and 25-a of section 364-j of the social services
law are REPEALED.
  S 7. This act shall take effect on the one hundred eightieth day after
it shall have become a law; provided, however, that the commissioner  of
health  is immediately authorized and directed to take actions necessary
to implement this act when it takes effect.