NY State Senate Bill 2017-S5622A

Senate Bill S5622A

2017-2018 Legislative Session

Provides for the synchronization of multiple prescriptions for recipients of medical assistance

download bill text pdf

Archive: Last Bill Status - In Senate Committee Rules 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

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 20, 2018	committed to rules
May 30, 2018	amended on third reading 5622a
Jan 23, 2018	advanced to third reading
Jan 22, 2018	2nd report cal.
Jan 17, 2018	1st report cal.199
Jan 03, 2018	referred to health
Apr 20, 2017	referred to health

Votes

- Jan 17, 2018 - Health Committee Vote
  S5622A
  
  14
  
  Aye
  
  0
  
  Nay
  
  3
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: Jan 17, 2018
      
      aye (14)
      
      Felder
      
      Golden
      
      Hannon
      
      Hoylman-Sigal
      
      Jacobs
      
      Larkin
      
      Little
      
      Montgomery
      
      Persaud
      
      Ritchie
      
      Rivera
      
      Stavisky
      
      Tedisco
      
      Valesky
      
      aye wr (3)
      
      Kaminsky
      
      Murphy
      
      Seward

Bill Amendments

Original

A (Active)

co-Sponsors

2017-S5622 - Details

See Assembly Version of this Bill:: A7492
Current Committee:: Senate Rules
Law Section:: Social Services Law
Laws Affected:: Amd §§367-a & 364-j, Soc Serv L
Versions Introduced in 2019-2020 Legislative Session:: S3118, A2785

2017-S5622 - Summary

Provides for the synchronization of multiple prescriptions for recipients of medical assistance.

2017-S5622 - Sponsor Memo

                                 BILL NUMBER:  S5622

 TITLE OF BILL :

An act to amend the social services law, in relation to
synchronization of multiple prescriptions

 PURPOSE :

This bill provides for the synchronization of multiple prescriptions
for Medicaid recipients so that a beneficiary can pick up prescription
refills on the same day of each month.

 SUMMARY OF PROVISIONS :

Sections 1 and 2 amend Social Services law § 367-a(9) and § 364-j(4)
respectively to provide for the creation of a voluntary program for
medication synchronization of medications when it is agreed among the
member, a provider, and a pharmacists that synchronization of multiple
prescriptions for the treatment of a chronic illness is in the best
interest of the patient given certain conditions. Drug coverage shall
not be denied for a partial fill for any drug prescribed when it is
for the purposes of synchronization. To permit synchronization, an
individual or plan would allow a pharmacy to override any denial codes
indicating that a prescription is being refilled too soon, for the
purposes of medication synchronization.

Amendments also ensure a pro-rated cost-sharing rate shall be
permitted and applied to prescriptions that are dispensed for less
than a 30 day supply for the purpose of synchronizing the covered
individual's medications, and that the dispensing fee stays whole for
the pharmacist for a partial fill.

Section 3 sets the effective date.

 JUSTIFICATION :

This bill would eliminate barriers to the implementation of medication
synchronization, a service that has been shown to improve the rates of
medication adherence and lower overall healthcare costs.

Medication synchronization refers to a voluntary program initiated by
a pharmacist in coordination with a physician and a beneficiary in
which the medication refills are coordinated so that every
prescription refill is due on the same day each month. The coordinated
timing of refills creates an opportunity for a meaningful dialogue
between a pharmacist and a patient about the goals of the medication
therapy, as well as problems with compliance and the strategies to
overcome or manage them.

It is estimated that 76% of Americans aged 60 and over use two or more
medicines and 37% take five or more. In fact, medication
synchronization was first studied in a clinical trial that
specifically addressed medication non adherence in the elderly. The
Federal Study of Adherence to Medications in the Elderly (FAME) was
conducted between June 2004 and August 2006. It involved 200 patients
65 years and older. FAME represents one of the few randomized
controlled studies to demonstrate improvement in both adherence and
health outcomes through a pharmacy program that used reminder
packaging in the form of blister packs. After six months of
pharmacists' intervention, medication adherence increased to 96.9%
from the baseline of 61.25% at the start of the study.

The Centers for Medicare and Medicaid Services (CMS), the largest
payer for healthcare in the nation, implemented medication
synchronization as policy for Medicare Part D plans effective January
1, 2014. The Federal Register/Vol/77/April 12, 2012, estimates $1.8
billion in net savings (over 6 years) in Part D. Part D plans are
required to establish a daily cost-sharing rate to facilitate
pro-rated co-payments for prescriptions written for 30-day supplies,
which the pharmacist is dispensing in a smaller days' supply because
medications are being synchronized. One goal is to reduce waste from
unnecessary fills and ensure that beneficiaries receive only the
medication they need.

To date, 18 states have removed statutory and/or regulatory barriers
to medication synchronization through proactive legislation in
commercial plans. Importantly, legislation passed in Kentucky in 2015
and Ohio in 2016 gave Medicaid beneficiaries access to medication
synchronization.

Nothing in this bill requires medication synchronization. It simply
establishes a mechanism for medication synchronization for patients
with chronic illness when there is a voluntary agreed-upon plan
between the patient, the health care provider and the pharmacist.

 LEGISLATIVE HISTORY :

New Bill

 FISCAL IMPLICATIONS :

None

 EFFECTIVE DATE :
This act shall take effect on the 120th day after becoming law.

2017-S5622 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5622
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                              April 20, 2017
                                ___________
 
 Introduced  by  Sen.  HANNON -- 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  synchronization
   of multiple prescriptions
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Subdivision 9 of section 367-a of the social  services  law
 is amended by adding a new paragraph (i) to read as follows:
   (I)(I) THE DEPARTMENT OF HEALTH SHALL ESTABLISH A PROGRAM FOR SYNCHRO-
 NIZATION OF MEDICATIONS WHEN IT IS AGREED AMONG THE RECIPIENT, A PROVID-
 ER  AND  A PHARMACIST THAT SYNCHRONIZATION OF MULTIPLE PRESCRIPTIONS FOR
 THE TREATMENT OF A CHRONIC ILLNESS  IS  IN  THE  BEST  INTEREST  OF  THE
 PATIENT  FOR  THE  MANAGEMENT OR TREATMENT OF A CHRONIC ILLNESS PROVIDED
 THAT THE MEDICATIONS:
   (A) ARE COVERED BY THE DEPARTMENT OF HEALTH PURSUANT TO THIS TITLE;
   (B) ARE USED FOR TREATMENT AND MANAGEMENT OF CHRONIC  CONDITIONS  THAT
 ARE SUBJECT TO REFILLS;
   (C)  ARE  NOT  A  SCHEDULE  II  CONTROLLED SUBSTANCE OR A SCHEDULE III
 CONTROLLED SUBSTANCE CONTAINING HYDROCODONE;
   (D) MEET ALL PRIOR AUTHORIZATION CRITERIA SPECIFIC TO THE  MEDICATIONS
 AT THE TIME OF THE SYNCHRONIZATION REQUEST;
   (E)  ARE  OF A FORMULATION THAT CAN BE EFFECTIVELY SPLIT OVER REQUIRED
 SHORT FILL PERIODS TO ACHIEVE SYNCHRONIZATION; AND
   (F) DO NOT HAVE QUANTITY  LIMITS  OR  DOSE  OPTIMIZATION  CRITERIA  OR
 REQUIREMENTS THAT WOULD BE VIOLATED IN FULFILLING SYNCHRONIZATION.
   (II) THE DEPARTMENT OF HEALTH SHALL NOT DENY COVERAGE FOR THE DISPENS-
 ING  OF  A MEDICATION BY A NETWORK PHARMACY FOR A PARTIAL SUPPLY WHEN IT
 IS FOR THE PURPOSE OF  SYNCHRONIZING  THE  PATIENT'S  MEDICATIONS.  WHEN
 APPLICABLE  TO  PERMIT  SYNCHRONIZATION,  THE DEPARTMENT OF HEALTH SHALL
 ALLOW A  PHARMACY  TO  OVERRIDE  ANY  DENIAL  CODES  INDICATING  THAT  A
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11066-01-7

 S. 5622                             2
 
 PRESCRIPTION  IS  BEING REFILLED TOO SOON FOR THE PURPOSES OF MEDICATION
 SYNCHRONIZATION.
   (III)  TO PERMIT SYNCHRONIZATION, THE DEPARTMENT OF HEALTH SHALL APPLY
 A PRORATED DAILY COST-SHARING RATE TO  ANY  MEDICATION  DISPENSED  BY  A
 NETWORK PHARMACY PURSUANT TO THIS SECTION.
   (IV)  THE  DISPENSING  FEE  PAID  TO  A NETWORK PHARMACY CONTRACTED TO
 PROVIDE SERVICES PURSUANT TO THIS SECTION FOR A PARTIAL  SUPPLY  ASSOCI-
 ATED  WITH  A MEDICATION SYNCHRONIZATION SHALL BE PAID IN FULL AND SHALL
 NOT BE PRORATED.
   (V) THE REQUIREMENT OF THIS  PARAGRAPH  APPLIES  ONLY  ONCE  FOR  EACH
 PRESCRIPTION  DRUG  SUBJECT  TO  MEDICATION  SYNCHRONIZATION EXCEPT WHEN
 EITHER OF THE FOLLOWING OCCURS:
   (I) THE PRESCRIBER CHANGES THE DOSAGE OR FREQUENCY  OF  ADMINISTRATION
 OF THE PRESCRIPTION DRUG SUBJECT TO A MEDICATION SYNCHRONIZATION; OR
   (II) THE PRESCRIBER PRESCRIBES A DIFFERENT DRUG.
   (VI)  NOTHING IN THIS PARAGRAPH SHALL BE DEEMED TO REQUIRE HEALTH CARE
 PRACTITIONERS AND PHARMACISTS TO SYNCHRONIZE THE REFILLING  OF  MULTIPLE
 PRESCRIPTIONS FOR A RECIPIENT.
   §  2.  Subdivision  4  of  section 364-j of the social services law is
 amended by adding a new paragraph (w) to read as follows:
   (W)(I) THE  DEPARTMENT  OF  HEALTH  OR  A  MANAGED  CARE  ORGANIZATION
 CONTRACTED  TO PROVIDE SERVICES PURSUANT TO THIS SECTION SHALL ESTABLISH
 A PROGRAM FOR SYNCHRONIZATION OF MEDICATIONS WHEN IT IS AGREED AMONG THE
 RECIPIENT, A PROVIDER AND A PHARMACIST THAT SYNCHRONIZATION OF  MULTIPLE
 PRESCRIPTIONS  FOR  THE  TREATMENT  OF  A CHRONIC ILLNESS IS IN THE BEST
 INTEREST OF THE PATIENT FOR THE MANAGEMENT OR  TREATMENT  OF  A  CHRONIC
 ILLNESS PROVIDED THAT THE MEDICATIONS:
   (A)  ARE  COVERED  BY MEDICAID SERVICES OR A MANAGED CARE ORGANIZATION
 CONTRACTED TO PROVIDE SERVICES PURSUANT TO THIS CHAPTER;
   (B) ARE USED FOR TREATMENT AND MANAGEMENT OF CHRONIC  CONDITIONS  THAT
 ARE SUBJECT TO REFILLS;
   (C)  ARE  NOT  A  SCHEDULE  II  CONTROLLED SUBSTANCE OR A SCHEDULE III
 CONTROLLED SUBSTANCE CONTAINING HYDROCODONE;
   (D) MEET ALL PRIOR AUTHORIZATION CRITERIA SPECIFIC TO THE  MEDICATIONS
 AT THE TIME OF THE SYNCHRONIZATION REQUEST;
   (E)  ARE  OF A FORMULATION THAT CAN BE EFFECTIVELY SPLIT OVER REQUIRED
 SHORT FILL PERIODS TO ACHIEVE SYNCHRONIZATION; AND
  (F) DO NOT HAVE  QUANTITY  LIMITS  OR  DOSE  OPTIMIZATION  CRITERIA  OR
 REQUIREMENTS THAT WOULD BE VIOLATED IN FULFILLING SYNCHRONIZATION.
   (II)   THE  DEPARTMENT  OF  HEALTH  OR  A  MANAGED  CARE  ORGANIZATION
 CONTRACTED TO PROVIDE SERVICES UNDER THIS SECTION SHALL NOT DENY  COVER-
 AGE  FOR  THE  DISPENSING  OF  A  MEDICATION BY A NETWORK PHARMACY FOR A
 PARTIAL SUPPLY WHEN IT IS FOR THE PURPOSE OF SYNCHRONIZING THE PATIENT'S
 MEDICATIONS. WHEN APPLICABLE TO PERMIT SYNCHRONIZATION,  THE  DEPARTMENT
 OF  HEALTH OR A MANAGED CARE ORGANIZATION CONTRACTED TO PROVIDE SERVICES
 UNDER THIS TITLE SHALL ALLOW A PHARMACY TO  OVERRIDE  ANY  DENIAL  CODES
 INDICATING  THAT  A  PRESCRIPTION  IS  BEING  REFILLED  TOO SOON FOR THE
 PURPOSES OF MEDICATION SYNCHRONIZATION.
   (III) TO PERMIT SYNCHRONIZATION, THE DEPARTMENT OF HEALTH OR A MANAGED
 CARE ORGANIZATION CONTRACTED TO PROVIDE SERVICES PURSUANT TO THIS  TITLE
 SHALL  APPLY  A  PRORATED  DAILY  COST-SHARING  RATE  TO  ANY MEDICATION
 DISPENSED BY A NETWORK PHARMACY PURSUANT TO THIS SECTION.
   (IV) THE DISPENSING FEE PAID  TO  A  NETWORK  PHARMACY  CONTRACTED  TO
 PROVIDE  SERVICES  PURSUANT TO THIS SECTION FOR A PARTIAL SUPPLY ASSOCI-
 ATED WITH A MEDICATION SYNCHRONIZATION SHALL BE PAID IN FULL  AND  SHALL
 NOT BE PRORATED.

 S. 5622                             3
 
   (V)  THE  REQUIREMENT  OF  THIS  PARAGRAPH  APPLIES ONLY ONCE FOR EACH
 PRESCRIPTION DRUG SUBJECT  TO  MEDICATION  SYNCHRONIZATION  EXCEPT  WHEN
 EITHER OF THE FOLLOWING OCCURS:
   (A)  THE  PRESCRIBER CHANGES THE DOSAGE OR FREQUENCY OF ADMINISTRATION
 OF THE PRESCRIPTION DRUG SUBJECT TO A MEDICATION SYNCHRONIZATION; OR
   (B) THE PRESCRIBER PRESCRIBES A DIFFERENT DRUG.
   (VI) NOTHING IN THIS PARAGRAPH SHALL BE DEEMED TO REQUIRE HEALTH  CARE
 PRACTITIONERS  AND  PHARMACISTS TO SYNCHRONIZE THE REFILLING OF MULTIPLE
 PRESCRIPTIONS FOR A COVERED INDIVIDUAL.
   § 3. This act shall take effect on the one hundred twentieth day after
 it shall have become a law, and shall apply to  policies  and  contracts
 issued,  renewed,  modified,  altered  or amended on or after such date;
 provided that:
   (a) the amendments to subdivision 9 of section  367-a  of  the  social
 services  law,  made  by  section  one of this act, shall not affect the
 expiration of such subdivision, and shall expire therewith; and
   (b) the amendments to section 364-j of the social services  law,  made
 by section two of this act, shall not affect the repeal of such section,
 and shall be deemed repealed therewith.

co-Sponsors

2017-S5622A (ACTIVE) - Details

See Assembly Version of this Bill:: A7492
Current Committee:: Senate Rules
Law Section:: Social Services Law
Laws Affected:: Amd §§367-a & 364-j, Soc Serv L
Versions Introduced in 2019-2020 Legislative Session:: S3118, A2785

2017-S5622A (ACTIVE) - Summary

Provides for the synchronization of multiple prescriptions for recipients of medical assistance.

2017-S5622A (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S5622A

SPONSOR: HANNON
 
TITLE OF BILL:  An act to amend the social services law, in relation
to synchronization of multiple prescriptions

 
PURPOSE:

This bill provides for the synchronization of multiple prescriptions for
Medicaid recipients so that a beneficiary can pick up prescription
refills on the same day of each month.

 
SUMMARY OF PROVISIONS:

Sections 1 and 2 amend Social Services law § 367-a(9) and § 364-j(4)
respectively to provide for the creation of a voluntary program for
medication synchronization of medications when it is agreed among the
member, a provider, and a pharmacists that synchronization of multiple
prescriptions for the treatment of a chronic illness is in the best
interest of the patient given certain conditions. Drug coverage shall
not be denied for a partial fill for any drug prescribed when it is for

the purposes of synchronization. To permit synchronization, an individ-
ual or plan would allow a pharmacy to override any denial codes indicat-
ing that a prescription is being refilled too soon, for the purposes of
medication synchronization.

Amendments also ensure a pro-rated cost-sharing rate shall be permitted
and applied to prescriptions that are dispensed for less than a 30 day
supply for the purpose of synchronizing the covered individual's medica-
tions, and that the dispensing fee stays whole for the pharmacist for a
partial fill.

Section 3 sets the effective date.

 
JUSTIFICATION:

This bill would eliminate barriers to the implementation of medication
synchronization, a service that has been shown to improve the rates of
medication adherence and lower overall healthcare costs.

Medication synchronization refers to a voluntary program initiated by a
pharmacist in coordination with a physician and a beneficiary in which
the medication refills are coordinated so that every prescription refill
is due on the same day each month. The coordinated timing of refills
creates an opportunity for a meaningful dialogue between a pharmacist
and a patient about the goals of the medication therapy, as well as
problems with compliance and the strategies to overcome or manage them.

It is estimated that 76% of Americans aged 60 and over use two or more
medicines and 37% take five or more. In fact, medication synchronization
was first studied in a clinical trial that specifically addressed medi-
cation non adherence in the elderly. The Federal Study of Adherence to
Medications in the Elderly (FAME) was conducted between June 2004 and
August 2006. It involved 200 patients 65 years and older. FAME repres-
ents one of the few randomized controlled studies to demonstrate
improvement in both adherence and health outcomes through a pharmacy
program that used reminder packaging in the form of blister packs. After
six months of pharmacists' intervention, medication adherence increased
to 96.9% from the baseline of 61.25% at the start of the study.
The Centers for Medicare and Medicaid Services (CMS), the largest payer
for healthcare in the nation, implemented medication synchronization as
policy for Medicare Part D plans effective January 1, 2014. The Federal
Register No1.77/April 12, 2012, estimates $1.8 billion in net savings
(over 6 years) in Part D. Part D plans are required to establish a daily
cost-sharing rate to facilitate pro-rated co-payments for prescriptions
written for 30-day supplies, which the pharmacist is dispensing in a
smaller days' supply because medications are being synchronized. One
goal is to reduce waste from unnecessary fills and ensure that benefici-
aries receive only the medication they need.

To date, 18 states have removed statutory and/or regulatory barriers to
medication synchronization through proactive legislation in commercial
plans. Importantly, legislation passed in Kentucky in 2015 and Ohio in
2016 gave Medicaid beneficiaries access to medication synchronization.

Nothing in this bill requires medication synchronization. It simply
establishes a mechanism for medication synchronization for patients with
chronic illness when there is a voluntary agreed-upon plan between the
patient, the health care provider and the pharmacist.

 
LEGISLATIVE HISTORY:

New Bill

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
This act shall take effect on the 120th day after becoming law.

2017-S5622A (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5622--A
     Cal. No. 199
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                              April 20, 2017
                                ___________
 
 Introduced  by  Sens.  HANNON, AVELLA, VALESKY -- read twice and ordered
   printed, and when printed to be committed to the Committee  on  Health
   --  recommitted  to  the Committee on Health in accordance with Senate
   Rule 6, sec. 8 -- reported favorably from said committee,  ordered  to
   first  and  second  report,  ordered  to  a third reading, amended and
   ordered reprinted, retaining its place in the order of third reading
 
 AN ACT to amend the social services law, in relation to  synchronization
   of multiple prescriptions
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 9 of section 367-a of the social  services  law
 is amended by adding a new paragraph (i) to read as follows:
   (I)(I) THE DEPARTMENT OF HEALTH SHALL ESTABLISH A PROGRAM FOR SYNCHRO-
 NIZATION OF MEDICATIONS WHEN IT IS AGREED AMONG THE RECIPIENT, A PROVID-
 ER  AND  A PHARMACIST THAT SYNCHRONIZATION OF MULTIPLE PRESCRIPTIONS FOR
 THE TREATMENT OF A CHRONIC ILLNESS  IS  IN  THE  BEST  INTEREST  OF  THE
 PATIENT  FOR  THE  MANAGEMENT OR TREATMENT OF A CHRONIC ILLNESS PROVIDED
 THAT THE MEDICATIONS:
   (A) ARE COVERED BY THE DEPARTMENT OF HEALTH PURSUANT TO THIS TITLE;
   (B) ARE USED FOR TREATMENT AND MANAGEMENT OF CHRONIC  CONDITIONS  THAT
 ARE SUBJECT TO REFILLS;
   (C)  ARE  NOT  A  SCHEDULE  II  CONTROLLED SUBSTANCE OR A SCHEDULE III
 CONTROLLED SUBSTANCE CONTAINING HYDROCODONE;
   (D) MEET ALL PRIOR AUTHORIZATION CRITERIA SPECIFIC TO THE  MEDICATIONS
 AT THE TIME OF THE SYNCHRONIZATION REQUEST;
   (E)  ARE  OF A FORMULATION THAT CAN BE EFFECTIVELY SPLIT OVER REQUIRED
 SHORT FILL PERIODS TO ACHIEVE SYNCHRONIZATION; AND
   (F) DO NOT HAVE QUANTITY  LIMITS  OR  DOSE  OPTIMIZATION  CRITERIA  OR
 REQUIREMENTS THAT WOULD BE VIOLATED IN FULFILLING SYNCHRONIZATION.
   (II) THE DEPARTMENT OF HEALTH SHALL NOT DENY COVERAGE FOR THE DISPENS-
 ING  OF  A  MEDICATION BY A PHARMACY FOR A PARTIAL SUPPLY WHEN IT IS FOR
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD11066-03-8

 S. 5622--A                          2
 
 THE PURPOSE OF SYNCHRONIZING THE PATIENT'S MEDICATIONS. WHEN  APPLICABLE
 TO  PERMIT SYNCHRONIZATION, THE DEPARTMENT OF HEALTH SHALL ALLOW A PHAR-
 MACY TO OVERRIDE ANY DENIAL CODES  INDICATING  THAT  A  PRESCRIPTION  IS
 BEING REFILLED TOO SOON FOR THE PURPOSES OF MEDICATION SYNCHRONIZATION.
   (III)  TO PERMIT SYNCHRONIZATION, THE DEPARTMENT OF HEALTH SHALL APPLY
 A PRORATED DAILY COST-SHARING RATE TO  ANY  MEDICATION  DISPENSED  BY  A
 PHARMACY PURSUANT TO THIS SECTION.
   (IV)  THE  DISPENSING  FEE  PAID  TO  A PHARMACY CONTRACTED TO PROVIDE
 SERVICES PURSUANT TO THIS SECTION FOR A PARTIAL SUPPLY ASSOCIATED WITH A
 MEDICATION SYNCHRONIZATION SHALL BE  PAID  IN  FULL  AND  SHALL  NOT  BE
 PRORATED.
   (V)  THE  REQUIREMENT  OF  THIS  PARAGRAPH  APPLIES ONLY ONCE FOR EACH
 PRESCRIPTION DRUG SUBJECT  TO  MEDICATION  SYNCHRONIZATION  EXCEPT  WHEN
 EITHER OF THE FOLLOWING OCCURS:
   (I)  THE  PRESCRIBER CHANGES THE DOSAGE OR FREQUENCY OF ADMINISTRATION
 OF THE PRESCRIPTION DRUG SUBJECT TO A MEDICATION SYNCHRONIZATION; OR
   (II) THE PRESCRIBER PRESCRIBES A DIFFERENT DRUG.
   (VI) NOTHING IN THIS PARAGRAPH SHALL BE DEEMED TO REQUIRE HEALTH  CARE
 PRACTITIONERS  AND  PHARMACISTS TO SYNCHRONIZE THE REFILLING OF MULTIPLE
 PRESCRIPTIONS FOR A RECIPIENT.
   § 2. Subdivision 4 of section 364-j of  the  social  services  law  is
 amended by adding a new paragraph (w) to read as follows:
   (W)(I)  THE  DEPARTMENT  OF  HEALTH  OR  A  MANAGED  CARE ORGANIZATION
 CONTRACTED TO PROVIDE SERVICES PURSUANT TO THIS SECTION SHALL  ESTABLISH
 A PROGRAM FOR SYNCHRONIZATION OF MEDICATIONS WHEN IT IS AGREED AMONG THE
 RECIPIENT,  A PROVIDER AND A PHARMACIST THAT SYNCHRONIZATION OF MULTIPLE
 PRESCRIPTIONS FOR THE TREATMENT OF A CHRONIC  ILLNESS  IS  IN  THE  BEST
 INTEREST  OF  THE  PATIENT  FOR THE MANAGEMENT OR TREATMENT OF A CHRONIC
 ILLNESS PROVIDED THAT THE MEDICATIONS:
   (A) ARE COVERED BY MEDICAID SERVICES OR A  MANAGED  CARE  ORGANIZATION
 CONTRACTED TO PROVIDE SERVICES PURSUANT TO THIS CHAPTER;
   (B)  ARE  USED FOR TREATMENT AND MANAGEMENT OF CHRONIC CONDITIONS THAT
 ARE SUBJECT TO REFILLS;
   (C) ARE NOT A SCHEDULE II  CONTROLLED  SUBSTANCE  OR  A  SCHEDULE  III
 CONTROLLED SUBSTANCE CONTAINING HYDROCODONE;
   (D)  MEET ALL PRIOR AUTHORIZATION CRITERIA SPECIFIC TO THE MEDICATIONS
 AT THE TIME OF THE SYNCHRONIZATION REQUEST;
   (E) ARE OF A FORMULATION THAT CAN BE EFFECTIVELY SPLIT  OVER  REQUIRED
 SHORT FILL PERIODS TO ACHIEVE SYNCHRONIZATION; AND
  (F)  DO  NOT  HAVE  QUANTITY  LIMITS  OR  DOSE OPTIMIZATION CRITERIA OR
 REQUIREMENTS THAT WOULD BE VIOLATED IN FULFILLING SYNCHRONIZATION.
   (II)  THE  DEPARTMENT  OF  HEALTH  OR  A  MANAGED  CARE   ORGANIZATION
 CONTRACTED  TO PROVIDE SERVICES UNDER THIS SECTION SHALL NOT DENY COVER-
 AGE FOR THE DISPENSING OF A MEDICATION  BY  A  PHARMACY  FOR  A  PARTIAL
 SUPPLY WHEN IT IS FOR THE PURPOSE OF SYNCHRONIZING THE PATIENT'S MEDICA-
 TIONS.  WHEN  APPLICABLE  TO  PERMIT  SYNCHRONIZATION, THE DEPARTMENT OF
 HEALTH OR A MANAGED CARE ORGANIZATION  CONTRACTED  TO  PROVIDE  SERVICES
 UNDER  THIS  TITLE  SHALL  ALLOW A PHARMACY TO OVERRIDE ANY DENIAL CODES
 INDICATING THAT A PRESCRIPTION  IS  BEING  REFILLED  TOO  SOON  FOR  THE
 PURPOSES OF MEDICATION SYNCHRONIZATION.
   (III) TO PERMIT SYNCHRONIZATION, THE DEPARTMENT OF HEALTH OR A MANAGED
 CARE  ORGANIZATION CONTRACTED TO PROVIDE SERVICES PURSUANT TO THIS TITLE
 SHALL APPLY  A  PRORATED  DAILY  COST-SHARING  RATE  TO  ANY  MEDICATION
 DISPENSED BY A PHARMACY PURSUANT TO THIS SECTION.
   (IV)  THE  DISPENSING  FEE  PAID  TO  A PHARMACY CONTRACTED TO PROVIDE
 SERVICES PURSUANT TO THIS SECTION FOR A PARTIAL SUPPLY ASSOCIATED WITH A

 S. 5622--A                          3
 
 MEDICATION SYNCHRONIZATION SHALL BE  PAID  IN  FULL  AND  SHALL  NOT  BE
 PRORATED.
   (V)  THE  REQUIREMENT  OF  THIS  PARAGRAPH  APPLIES ONLY ONCE FOR EACH
 PRESCRIPTION DRUG SUBJECT  TO  MEDICATION  SYNCHRONIZATION  EXCEPT  WHEN
 EITHER OF THE FOLLOWING OCCURS:
   (A)  THE  PRESCRIBER CHANGES THE DOSAGE OR FREQUENCY OF ADMINISTRATION
 OF THE PRESCRIPTION DRUG SUBJECT TO A MEDICATION SYNCHRONIZATION; OR
   (B) THE PRESCRIBER PRESCRIBES A DIFFERENT DRUG.
   (VI) NOTHING IN THIS PARAGRAPH SHALL BE DEEMED TO REQUIRE HEALTH  CARE
 PRACTITIONERS  AND  PHARMACISTS TO SYNCHRONIZE THE REFILLING OF MULTIPLE
 PRESCRIPTIONS FOR A COVERED INDIVIDUAL.
   § 3. This act shall take effect on the one hundred twentieth day after
 it shall have become a law.  The amendments to subdivision 9 of  section
 367-a of the social services law, made by section one of this act, shall
 not  affect  the expiration of that subdivision, and shall expire there-
 with.
   The amendments to section 364-j of the social services  law,  made  by
 section  two  of  this act, shall not affect the repeal of that section,
 and shall be  deemed  repealed  therewith.  Effective  immediately,  the
 commissioner  of  health  shall  make regulations and take other actions
 reasonably necessary to implement this act on that date.

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Senate Bill S5622A

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Sponsored By

Kemp Hannon

Archive: Last Bill Status - In Senate Committee Rules Committee

Bill Amendments

co-Sponsors

Tony Avella

David J. Valesky

2017-S5622 - Details

2017-S5622 - Summary

2017-S5622 - Sponsor Memo

2017-S5622 - Bill Text download pdf

co-Sponsors

Tony Avella

Luis R. Sepúlveda

David J. Valesky

2017-S5622A (ACTIVE) - Details

2017-S5622A (ACTIVE) - Summary

2017-S5622A (ACTIVE) - Sponsor Memo

2017-S5622A (ACTIVE) - Bill Text download pdf

Comments