S T A T E   O F   N E W   Y O R K
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                                   2795
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 25, 2019
                                ___________
 
 Introduced by M. of A. GOTTFRIED, THIELE, RODRIGUEZ, MOSLEY, MAGNARELLI,
   LUPARDO,  CRESPO, BLAKE, GALEF, JAFFEE, SEAWRIGHT, MONTESANO, GUNTHER,
   LIFTON, DINOWITZ, OTIS, ABINANTI, HYNDMAN,  ORTIZ,  COLTON  --  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:
   (I) "MANAGED CARE  PROVIDER"  MEANS  A  MANAGED  CARE  PROVIDER  UNDER
 SECTION  THREE HUNDRED SIXTY-FOUR-J OF THIS ARTICLE, A MANAGED LONG TERM
              

 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03489-01-9

 A. 2795                             2
 
 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.