NY State Senate Bill 2019-S7109

Senate Bill S7109

2019-2020 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
Dec 28, 2020	committed to rules
Feb 03, 2020	advanced to third reading
Jan 29, 2020	2nd report cal.
Jan 28, 2020	1st report cal.310
Jan 08, 2020	referred to health

Votes

- Jan 28, 2020 - Health Committee Vote
  S7109
  
  15
  
  Aye
  
  0
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: Jan 28, 2020
      
      aye (15)
      
      Benjamin
      
      Biaggi
      
      Carlucci
      
      Gallivan
      
      Hoylman-Sigal
      
      Jacobs
      
      Kaminsky
      
      Little
      
      Metzger
      
      Montgomery
      
      Ortt
      
      Ritchie
      
      Rivera
      
      Salazar
      
      Stavisky

2019-S7109 (ACTIVE) - Details

See Assembly Version of this Bill:: A9012
Current Committee:: Senate Rules
Law Section:: Social Services Law
Laws Affected:: Amd §§367-a & 364-j, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:: S431, A187

2019-S7109 (ACTIVE) - Summary

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

2019-S7109 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S7109

SPONSOR: HOYLMAN
 
TITLE OF BILL:

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

 
PURPOSE OR GENERAL IDEA OF BILL:

To allow pharmacists to synchronize the dispensing of multiple
prescriptions for Medicaid recipients so they may pick up multiple
prescription refills at the same time.

 
SUMMARY OF SPECIFIC PROVISIONS:

This bill would allow synchronized dispensing of medications when it is
agreed among the patient, his or her prescriber and the pharmacist,
under certain conditions. The bill requires fee-for-service and managed
care benefit coverage for a partial fill and would allow a pharmacy to
over-ride denial codes indicating that a prescription is being too

refilled too soon.

The bill would permit pro-rated cost-sharing but keep the dispensing fee
whole. A given prescription may be synchronized only once unless the
prescriber changes the doses or frequency or prescribes a different
drug.

 
JUSTIFICATION:

Medication synchronization enables a partial-fill so that later refills
are coordinated with other prescriptions a patient may have, in order to
maximize convenience and compliance, reduce waste from unnecessary fills
and ensure that patients receive only the medication they need. Normal-
ly, a partial fill is blocked during the claim submission process
because the claim is for less than a 30-day supply. Patients may be
required to pay a full months' copayment for a month's supply, even if
questions remain about the medication's effectiveness or the likelihood
of an adverse event.

Since 2014, Medicare Part D plans are required to facilitate pro-rated
co-payments for dispensing in less than a 30 day supply when medications
are being synchronized. To date, 18 states have enabled commercial
health plan coverage for synchronization, and two have provided Medicaid
beneficiaries access to synchronization. It is estimated that 76% of
Americans aged 60 and over use two or more medicines and 37% take five
or more.  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.

 
PRIOR LEGISLATIVE HISTORY:

2019: S.3118-A (Hoylman) - Vetoed Memo.243

2018: S.5622-A (Hannon) - Died in Rules

2017: S.5622 (Hannon) - Died in Health

 
FISCAL IMPLICATIONS:

Potential Medicaid savings.

 
EFFECTIVE DATE:
This act shall take effect on the one hundred twentieth day after it
shall have become a law.

2019-S7109 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7109
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 8, 2020
                                ___________
 
 Introduced  by  Sen. HOYLMAN -- 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, NOR A SCHEDULE III
 CONTROLLED SUBSTANCE THAT CONTAINS 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
 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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD14664-01-0

 S. 7109                             2
 
   (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,  NOR  A  SCHEDULE  III
 CONTROLLED SUBSTANCE THAT CONTAINS 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
 MEDICATION SYNCHRONIZATION SHALL BE  PAID  IN  FULL  AND  SHALL  NOT  BE
 PRORATED.

 S. 7109                             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.  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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