BILL NUMBER: S9159

SPONSOR: FERNANDEZ
 
TITLE OF BILL:

An act to amend the public health law, in relation to requiring feder-
ally qualified health centers and rural health centers cover the cost of
all ovulation enhancing drugs dispensed

 
PURPOSE:

To ensure that the cost of ovulation enhancing drugs are included in the
calculation of the alternative payment reimbursement methodology for
federally qualified health centers and rural health clinics related to
the carveout of the pharmacy benefit from managed care to fee-for-ser-
vice

 
SUMMARY OF PROVISIONS:

Section  1: Amends section 2807 of the Public Health Law by adding a new
paragraph to require the inclusion of ovulation enhancing drugs  in  the
Department  of Health's calculation of alternative reimbursement method-
              

ology for entities defined under  section  340B  of  the  Public  Health
Service   Act   (42  U.S.C,  §  256b)  regarding  the  carveout  of  the
prescription drug benefit from managed care to fee-for-service.

Section 2: Effective date.

 
JUSTIFICATION:

While some ovulation enhancing drugs used for fertility  treatments  are
currently  covered  by  Medicaid,  the  more effective injectable drugs,
which provide better outcomes for patients, are currently  not  covered.
To  bridge  this gap, many health centers have been subsidizing the cost
of these drugs for their Medicaid patients so they can access  the  full
range  of fertility treatments. However, these more effective injectable
ovulation enhancing drugs are generally covered by commercial insurance.
This imbalance of coverage has led to individuals on Medicaid not  being
able  to  access  the  full  spectrum  of fertility treatments currently
available to patients with commercial insurance, including state employ-
ees.

With the transition of the pharmacy benefit from managed  care  to  fee-
for-service,  other  funding  that health centers have been utilizing to
cover the out-of-pocket costs for their Medicaid patients that  seek  to
access  the  full spectrum of infertility services, including all ovula-
tion enhancing drugs, has ended.

This bill serves to ensure that community  health  center  340B  covered
entities continue to realize funding for these ovulation enhancing drugs
by  requiring  DOH to factor in the cost of these drugs when determining
the alternative payment methodologies  for  federally  qualified  health
centers  as a result of the pharmacy benefit carveout from managed care.
This will help to ensure that these  critical  drugs  are  available  to
their  patients who otherwise would not be able to access the full range
of fertility treatments.

 
LEGISLATIVE HISTORY:

New Bill

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
Immediately