Requires managed care providers to annually provide each participant in their programs with a written list of mail-order pharmacies with which the managed care provider has a contract for coverage of prescription drugs.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7119
SPONSOR: Bichotte Hermelyn TITLE OF BILL:
An act to amend the social services law, in relation to requiring each
managed care provider to annually provide each participant in its
program with a written list of mail-order pharmacies with which the
managed care provider has a contract for coverage of prescription drugs
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of the bill is to better ensure seamless care for patients
that utilize mail-order pharmacies.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1. Paragraph (u) of subdivision 4 of section 364-j of the
social services law, as amended by section 12 of part A of chapter 56 of
the laws of 2013, is amended to read as follows:
(u) A managed care provider that provides coverage for prescription
drugs shall permit each participant to fill any mail order covered
prescription, at his or her option, at any mail order pharmacy or non-
mail-order retail pharmacy in the managed care provider network. If the
managed care provider has designated one or more pharmacies for filling
prescriptions for a particular drug or drugs, then such prescriptions
may be filled, at the participant's option, at any other pharmacy in the
network, if the network pharmacy chosen by the participant offers to
accept a price that is comparable to that of the pharmacy designated by
the managed care provider. For the purposes of this section, "mail order
pharmacy" means a pharmacy whose primary business is to receive
prescriptions by mail, telefax or through electronic submissions, and to
dispense medication to patients through the use of the United States
mail or other common or contract carrier services, and provides any
consultation with patients electronically rather than face to face.
Every non-mail-order retail pharmacy, in the managed care provider's
network with respect to any prescription drug shall be deemed to be in
he managed care provider's network for every covered prescription drug.
Each managed care provider subject to the provisions of this paragraph
shall annually provide each participant in its program with a written
list of mail-order pharmacies with which the managed care provider has a
contract for coverage of prescription drugs.
JUSTIFICATION:
Taking one's medicine on time and consistently is critical to better
health outcomes. Managed care provider lists are often outdated. In the
case of mail-order pharmacies, not having an updated provider list can
be very detrimental to the patient. By providing a written list of mail-
order pharmacies that is covered by the managed care network, a patient
will be able to have seamless experience.
PRIOR LEGISLATIVE HISTORY:
01/03/24 referred to health
02/08/23 referred to health
2021-22:A06409; referred to health.
2019-20:A2336; referred to health
2017-18:A7834; referred to health
FISCAL IMPLICATIONS:
None
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall have become a law; and shall apply to all contracts, agreements
and leases entered into on or after such date; provided, however that
the amendments to 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.
STATE OF NEW YORK
________________________________________________________________________
7119
2025-2026 Regular Sessions
IN ASSEMBLY
March 20, 2025
___________
Introduced by M. of A. BICHOTTE HERMELYN, GIBBS -- read once and
referred to the Committee on Health
AN ACT to amend the social services law, in relation to requiring each
managed care provider to annually provide each participant in its
program with a written list of mail-order pharmacies with which the
managed care provider has a contract for coverage of prescription
drugs
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph (u) of subdivision 4 of section 364-j of the
2 social services law, as amended by section 12 of part A of chapter 56 of
3 the laws of 2013, is amended to read as follows:
4 (u) A managed care provider that provides coverage for prescription
5 drugs shall permit each participant to fill any mail order covered
6 prescription, at [his or her] the participant's option, at any mail
7 order pharmacy or non-mail-order retail pharmacy in the managed care
8 provider network. If the managed care provider has designated one or
9 more pharmacies for filling prescriptions for a particular drug or
10 drugs, then such prescriptions may be filled, at the participant's
11 option, at any other pharmacy in the network, if the network pharmacy
12 chosen by the participant offers to accept a price that is comparable to
13 that of the pharmacy designated by the managed care provider. For the
14 purposes of this section, "mail order pharmacy" means a pharmacy whose
15 primary business is to receive prescriptions by mail, telefax or through
16 electronic submissions, and to dispense medication to patients through
17 the use of the United States mail or other common or contract carrier
18 services, and provides any consultation with patients electronically
19 rather than face to face. Every non-mail-order retail pharmacy in the
20 managed care provider's network with respect to any prescription drug
21 shall be deemed to be in the managed care provider's network for every
22 covered prescription drug. Each managed care provider subject to the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD10987-01-5
A. 7119 2
1 provisions of this paragraph shall annually provide each participant in
2 its program with a written list of mail-order pharmacies with which the
3 managed care provider has a contract for coverage of prescription drugs.
4 § 2. This act shall take effect on the one hundred eightieth day after
5 it shall have become a law; and shall apply to all contracts, agreements
6 and leases entered into on or after such date, provided, however that
7 the amendments to section 364-j of the social services law made by
8 section one of this act shall not affect the repeal of such section and
9 shall be deemed repealed therewith.
