NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9012
SPONSOR: Gottfried (MS) 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:
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:
2017-2018: A.7492-A - passed Assembly
2019: A. 2785A Vetoed
FISCAL IMPLICATIONS:
Potential Medicaid savings.
EFFECTIVE DATE:
120 days after becoming law.
STATE OF NEW YORK
________________________________________________________________________
9012
IN ASSEMBLY
January 10, 2020
___________
Introduced by M. of A. GOTTFRIED, ABINANTI, PHEFFER AMATO, SOLAGES,
JAFFEE, GARBARINO, STECK, SEAWRIGHT, ASHBY, BYRNE, McDONALD, BUTTENS-
CHON -- Multi-Sponsored by -- M. of A. HEVESI -- read once and
referred 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:
1 Section 1. Subdivision 9 of section 367-a of the social services law
2 is amended by adding a new paragraph (i) to read as follows:
3 (i)(i) The department of health shall establish a program for synchro-
4 nization of medications when it is agreed among the recipient, a provid-
5 er and a pharmacist that synchronization of multiple prescriptions for
6 the treatment of a chronic illness is in the best interest of the
7 patient for the management or treatment of a chronic illness provided
8 that the medications:
9 (A) are covered by the department of health pursuant to this title;
10 (B) are used for treatment and management of chronic conditions that
11 are subject to refills;
12 (C) are not a schedule II controlled substance, nor a schedule III
13 controlled substance that contains hydrocodone;
14 (D) meet all prior authorization criteria specific to the medications
15 at the time of the synchronization request;
16 (E) are of a formulation that can be effectively split over required
17 short fill periods to achieve synchronization; and
18 (F) do not have quantity limits or dose optimization criteria or
19 requirements that would be violated in fulfilling synchronization.
20 (ii) The department of health shall not deny coverage for the dispens-
21 ing of a medication by a pharmacy for a partial supply when it is for
22 the purpose of synchronizing the patient's medications. When applicable
23 to permit synchronization, the department of health shall allow a phar-
24 macy to override any denial codes indicating that a prescription is
25 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
A. 9012 2
1 (iii) To permit synchronization, the department of health shall apply
2 a prorated daily cost-sharing rate to any medication dispensed by a
3 pharmacy pursuant to this section.
4 (iv) The dispensing fee paid to a pharmacy contracted to provide
5 services pursuant to this section for a partial supply associated with a
6 medication synchronization shall be paid in full and shall not be
7 prorated.
8 (v) The requirement of this paragraph applies only once for each
9 prescription drug subject to medication synchronization except when
10 either of the following occurs:
11 (I) the prescriber changes the dosage or frequency of administration
12 of the prescription drug subject to a medication synchronization; or
13 (II) the prescriber prescribes a different drug.
14 (vi) Nothing in this paragraph shall be deemed to require health care
15 practitioners and pharmacists to synchronize the refilling of multiple
16 prescriptions for a recipient.
17 § 2. Subdivision 4 of section 364-j of the social services law is
18 amended by adding a new paragraph (w) to read as follows:
19 (w)(i) The department of health or a managed care organization
20 contracted to provide services pursuant to this section shall establish
21 a program for synchronization of medications when it is agreed among the
22 recipient, a provider and a pharmacist that synchronization of multiple
23 prescriptions for the treatment of a chronic illness is in the best
24 interest of the patient for the management or treatment of a chronic
25 illness provided that the medications:
26 (A) are covered by Medicaid services or a managed care organization
27 contracted to provide services pursuant to this chapter;
28 (B) are used for treatment and management of chronic conditions that
29 are subject to refills;
30 (C) are not a schedule II controlled substance, nor a schedule III
31 controlled substance that contains hydrocodone;
32 (D) meet all prior authorization criteria specific to the medications
33 at the time of the synchronization request;
34 (E) are of a formulation that can be effectively split over required
35 short fill periods to achieve synchronization; and
36 (F) do not have quantity limits or dose optimization criteria or
37 requirements that would be violated in fulfilling synchronization.
38 (ii) The department of health or a managed care organization
39 contracted to provide services under this section shall not deny cover-
40 age for the dispensing of a medication by a pharmacy for a partial
41 supply when it is for the purpose of synchronizing the patient's medica-
42 tions. When applicable to permit synchronization, the department of
43 health or a managed care organization contracted to provide services
44 under this title shall allow a pharmacy to override any denial codes
45 indicating that a prescription is being refilled too soon for the
46 purposes of medication synchronization.
47 (iii) To permit synchronization, the department of health or a managed
48 care organization contracted to provide services pursuant to this title
49 shall apply a prorated daily cost-sharing rate to any medication
50 dispensed by a pharmacy pursuant to this section.
51 (iv) The dispensing fee paid to a pharmacy contracted to provide
52 services pursuant to this section for a partial supply associated with a
53 medication synchronization shall be paid in full and shall not be
54 prorated.
A. 9012 3
1 (v) The requirement of this paragraph applies only once for each
2 prescription drug subject to medication synchronization except when
3 either of the following occurs:
4 (A) the prescriber changes the dosage or frequency of administration
5 of the prescription drug subject to a medication synchronization; or
6 (B) the prescriber prescribes a different drug.
7 (vi) Nothing in this paragraph shall be deemed to require health care
8 practitioners and pharmacists to synchronize the refilling of multiple
9 prescriptions for a covered individual.
10 § 3. This act shall take effect on the one hundred twentieth day after
11 it shall have become a law. The amendments to subdivision 9 of section
12 367-a of the social services law, made by section one of this act, shall
13 not affect the expiration of that subdivision, and shall expire there-
14 with.
15 The amendments to section 364-j of the social services law, made by
16 section two of this act, shall not affect the repeal of that section,
17 and shall be deemed repealed therewith. Effective immediately, the
18 commissioner of health shall make regulations and take other actions
19 reasonably necessary to implement this act on that date.
