S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4233
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 1, 2017
                                ___________
 
 Introduced by M. of A. GOTTFRIED, THIELE, RODRIGUEZ, MOSLEY, MAGNARELLI,
   LUPARDO,  CRESPO,  BLAKE, GALEF, JAFFEE, SEAWRIGHT, MONTESANO, TITONE,
   GUNTHER, LIFTON, SEPULVEDA, HOOPER, DINOWITZ, OTIS,  JENNE,  ABINANTI,
   HYNDMAN,  ORTIZ  --  Multi-Sponsored  by  --  M.  of A. CARROLL, COOK,
   CROUCH, ENGLEBRIGHT, GLICK, SIMON -- 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.
   § 2. The social services law is amended by adding a new section  365-i
 to read as follows:
   §  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:
 
              

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09321-01-7

 A. 4233                             2
 
   (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
 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.
   §  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.
   § 4. The public health law is amended by adding a new section 274-a to
 read as follows:
   §  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.
   § 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.
   §  6. Subdivisions 25 and 25-a of section 364-j of the social services
 law are REPEALED.
   § 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.