S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3509
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 31, 2023
                                ___________
 
 Introduced  by  Sens. SKOUFIS, ADDABBO, CLEARE, KAVANAGH, THOMAS -- read
   twice and ordered printed, and when printed to  be  committed  to  the
   Committee 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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD06891-01-3
 S. 3509                             2
              

 
   (Y)  NOTWITHSTANDING  ANY  PROVISION OF LAW TO THE CONTRARY, A MANAGED
 CARE PROVIDER OR PHARMACY BENEFIT  MANAGER  ACTING  ON  ITS  BEHALF,  AS
 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.