S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7197
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 12, 2023
                                ___________
 
 Introduced by M. of A. DINOWITZ -- read once and referred to the Commit-
   tee on Health
 
 AN  ACT  to  amend the social services law and the public health law, in
   relation to protecting access to pharmacy services
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  Subdivision 4 of section 364-j of the social services law
 is amended by adding two new paragraphs (x) and (y) to read as follows:
   (X) NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY,  ADMINISTRA-
 TIVE  FEES PAID TO A MANAGED CARE PROVIDER OR A PHARMACY BENEFIT MANAGER
 UNDER THE MEDICAL ASSISTANCE PROGRAM SHALL BE REDUCED FOR THE PURPOSE OF
 INCREASING REIMBURSEMENT RATES TO RETAIL PHARMACIES UNDER  THE  MEDICAID
 MANAGED  CARE  PROGRAM.  BEGINNING ON AND AFTER JULY FIRST, TWO THOUSAND
 TWENTY-THREE, ALL REIMBURSEMENT PAID BY MEDICAID MANAGED CARE  PLANS  TO
 RETAIL  PHARMACIES  SHALL  INCLUDE A PROFESSIONAL DISPENSING FEE AND THE
 DRUG ACQUISITION COST FOR EACH OUTPATIENT DRUG DISPENSED AT NO LESS THAN
 THE AMOUNT ESTABLISHED UNDER THE FEE-FOR-SERVICE PROGRAM, AS DEFINED  IN
 SECTION THREE HUNDRED SIXTY-SEVEN-A OF THIS TITLE, REGARDLESS OF WHETHER
 SUCH REIMBURSEMENT IS PAID DIRECTLY BY THE MEDICAID MANAGED CARE PLAN OR
 PASSED  THROUGH  A  PHARMACY  BENEFIT  MANAGER  OR  OTHER  ENTITY.   THE
 REIMBURSEMENT PROVIDED FOR UNDER THIS PARAGRAPH SHALL NOT APPLY  TO  ANY
 EXISTING REIMBURSEMENT ARRANGEMENTS INVOLVING AN ELIGIBLE PROVIDER UNDER
 SECTION  340B  OF THE FEDERAL PUBLIC HEALTH SERVICES ACT OR A COMPREHEN-
 SIVE HIV SPECIAL NEEDS PLAN UNDER SECTION FORTY-FOUR HUNDRED THREE-C  OF
 THE  PUBLIC  HEALTH LAW UNDER THE MEDICAL ASSISTANCE PROGRAM. NO MANAGED
 CARE PROVIDER OR PHARMACY BENEFIT MANAGER  SHALL  REIMBURSE  A  PHARMACY
 OWNED  BY OR AFFILIATED WITH SUCH ENTITY AT A HIGHER RATE THAN THAT PAID
 BY SUCH ENTITY TO A PHARMACY IT DOES NOT OWN OR IS NOT OTHERWISE  AFFIL-
 IATED WITH.
   (Y)  NOTWITHSTANDING  ANY  PROVISION OF LAW TO THE CONTRARY, A MANAGED
 CARE PROVIDER OR PHARMACY BENEFIT  MANAGER  ACTING  ON  ITS  BEHALF,  AS
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD06891-01-3
              

 A. 7197                             2
 
 DEFINED  IN SECTION TWO HUNDRED EIGHTY-A OF THE PUBLIC HEALTH LAW, SHALL
 NOT DENY ANY RETAIL PHARMACY THE OPPORTUNITY TO PARTICIPATE  IN  ANOTHER
 PROVIDER'S  PHARMACY  NETWORK  UNDER  THE  MEDICAL ASSISTANCE PROGRAM AT
 PREFERRED  PARTICIPATION  STATUS,  PROVIDED  THAT  SUCH  RETAIL PHARMACY
 AGREES TO THE SAME REIMBURSEMENT AMOUNT, AS DEFINED IN PARAGRAPH (X)  OF
 THIS  SUBDIVISION,  AND  IS  ABLE  TO FILL AND DISPENSE PRESCRIPTION AND
 OVER-THE-COUNTER MEDICATIONS FOR THOSE ENROLLED IN THE  MEDICAL  ASSIST-
 ANCE PROGRAM.
   § 2. Section 280-a of the public health law is amended by adding a new
 subdivision 6 to read as follows:
   6.  DELIVERY  OPTION.  NOTWITHSTANDING  ANY  PROVISION  OF  LAW TO THE
 CONTRARY, NO PHARMACY BENEFIT MANAGER SHALL  LIMIT  THE  OPTION  FOR  AN
 INDIVIDUAL  RECEIVING  PRESCRIPTION  OR  OVER-THE-COUNTER MEDICATIONS TO
 RECEIVE SUCH MEDICATIONS FROM THEIR LOCAL, NON-MAIL  ORDER  PHARMACY  OF
 CHOICE  VIA  DELIVERY INCLUDING IN-PERSON DELIVERY, UNITED STATES POSTAL
 SERVICE OR OTHER MAIL OR COURIER SERVICE. NO RESTRICTIONS,  PROHIBITIONS
 OR  PRIOR  AUTHORIZATION REQUIREMENTS SHALL BE BASED ON THE INDIVIDUAL'S
 CHOICE IN DELIVERY TYPE OR DISTANCE FROM A PHARMACY.
   § 3. This act shall take effect immediately; provided, however, that:
   (a) section one of this act shall take effect July 1, 2023;
   (b) if this act shall have become a law after such effective  date  it
 shall  take  effect immediately and shall be deemed to have been in full
 force and effect on and after July 1, 2023;
   (c) the amendments to subdivision 4 of section  364-j  of  the  social
 services law made by section one of this act shall not affect the repeal
 of such section and shall be deemed repealed therewith; and
   (d)  section  two  of  this act shall take effect on the thirtieth day
 after it shall have become a law.