S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7817
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              April 11, 2025
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on Health
 
 AN  ACT  to amend part FFF of chapter 56 of the laws of 2020 relating to
   directing the department of health to remove the pharmacy benefit from
   the managed care benefit package and to provide the  pharmacy  benefit
   under  the  fee  for service program, in relation to pharmacy benefits
   where a physician is authorized to dispense  certain  medications  and
   practices medicine in the oncology setting
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 1 of part FFF of chapter 56 of  the  laws  of  2020
 relating  to  directing  the department of health to remove the pharmacy
 benefit from the managed care benefit package and to provide the pharma-
 cy benefit under the fee for service program, as amended by section 1 of
 part C of chapter 57 of the laws of 2021, is amended to read as follows:
   Section 1. The Legislature hereby  finds  and  declares  that  medical
 assistance  for needy persons is a matter of public concern and a neces-
 sity in promoting the public health and welfare and  for  promoting  the
 state's  goal  of making available to everyone, regardless of race, age,
 gender, national origin  or  economic  standing,  uniform,  high-quality
 medical  care.  As  the  department of health is the single state agency
 responsible for supervising the administration of  the  state's  medical
 assistance  program  (Medicaid),  it is tasked with ensuring efficiency,
 economy, and quality of care in providing benefits to the state's  needy
 persons. To this end and with the fiscal constraints facing our state in
 mind, the department of health continues to analyze the Medicaid program
 in search of ways to ensure Medicaid spending is held to the standard of
 efficiency, economy, and quality of care. In consideration of this stan-
 dard, the department of health is hereby directed to exercise its exist-
 ing administrative authority to remove the pharmacy benefit from managed
 care  benefit package and instead provide the pharmacy benefit under the
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11144-01-5
              

 A. 7817                             2
 
 fee for service program, except where otherwise required by federal  law
 OR WHERE A PHYSICIAN IS AUTHORIZED TO DISPENSE MEDICATIONS IN ACCORDANCE
 WITH  SECTION  6807  OF  THE EDUCATION LAW AND PRACTICES MEDICINE IN THE
 ONCOLOGY  SETTING,  to  ensure  transparency  and  that  the  benefit is
 provided to the fullest extent and as efficiently as possible; provided,
 however, that the department of health shall not implement  the  transi-
 tion  of  the  pharmacy benefit from the managed care benefit package to
 the fee for service program sooner than April 1, 2023, and until  it  is
 satisfied  that  all  necessary  and appropriate transition planning has
 occurred, in its  sole  discretion,  and  federal  approvals  have  been
 obtained  and  preparations  have  been  made. Furthermore, to ensure an
 orderly transition, continued access  to  medications,  and  appropriate
 patient  education  and  support,  the  department may establish uniform
 standards, payment policies  and  reimbursement  methodologies  for  any
 sites  where  drugs  may  be administered or dispensed under the fee for
 service program; provided that, subject to the availability  of  federal
 financial  participation,  when reimbursing covered entities, as defined
 under section 340B of the public health service act (42  U.S.C.  §256b),
 for  drugs  that  would  otherwise be eligible for pricing under section
 340B of the public health service act, the department shall examine  all
 reasonably available methods for determining actual acquisition cost and
 the professional dispensing fee and, beginning in the fiscal year start-
 ing  April  1, 2023, review and adjust reimbursement for such drugs such
 that no sooner than April 1, 2025,  reimbursement  shall  be  determined
 based  on  a  method  that the commissioner determines that utilizes the
 actual acquisition costs and professional dispensing fee.
   § 2. This act shall take effect immediately.