Relates to the specialty pharmacy program

Title of bill

An act to amend the social services law, in relation to the specialty pharmacy program

Purpose

This bill would exempt any pharmacy owned and operated by a not-for-profit organization solely for the purpose of providing drugs to individuals diagnosed with cystic fibrosis as part of a comprehensive clinical care program approved by the national organization that accredits cystic fibrosis (CF) care centers provide such not for profit organization maintains a national registry of cystic fibrosis clinical data shall be exempt from the specialty pharmacy program.

Summary of provisions

Section 1 amends the social services law to exempt pharmacies owned and operated by a not-for profit organization solely for the purpose of providing drugs to individuals diagnosed with cystic fibrosis as part of a comprehensive clinical care program approved by the national organization that accredits cystic fibrosis care centers and maintains a national registry of cystic fibrosis clinical care from the specialty pharmacy program.

Justification

Cystic fibrosis is an inherited chronic disease that affects the lungs and digestive system of about 30,000 children and adults in the United State (70,000 worldwide). A defective gene and its protein product cause the body to produce unusually thick, sticky mucus that clogs the lungs and leads to life-threatening lung infections; and obstructs the pancreas and stops natural enzymes from helping the body break down and absorb food. In the 1950s, few children with cystic fibrosis lived to attend elementary school. Today, advances in research and medical treatments have further enhanced and extended life for children and adults with CF. The predicted age of a survival for a person with Cystic Fibrosis is now more than 37 years of age. Many children and young adults with CF take over twenty medications per day including four orally inhaled medications with treatment times exceeding three hours per day.

The Cystic Fibrosis Foundation has since its inception in the 1950s provided pharmacy services to patients as part of a comprehensive clinical support program which includes CF care centers across the state.

CF Services is the largest provider of pharmacy services, including specialty medications, for the state's CF Medicaid patients, serving 40% of those with the disease. Under the current criteria for the Special Pharmacy Program, CF Services is ineligible to participate as it does not and cannot provide the number and range or drugs required. The CF pharmacy only provides drugs exclusively for the treatment of Cystic Fibrosis.

In fact, if enacted the specialty pharmacy program as recently proposed would exclude the CF pharmacy which threatens the continuity and coordination of care. People with CF are routinely more on and off the Medicaid rolls as their income fluctuates. The CF pharmacy provides a safety net for those who lose their Medicaid eligibility so they do not also lose access to their critical medications. CF Services provides emergency supplies of medications and works with patients to find other coverage. This allows New York Medicaid patients who lose eligibility to continue treatment and keeps them out of the hospital. This practice ultimately saves the state money since

these same patients are likely to become Medicaid eligible again and will require less care if they are able to maintain their health.

The importance of the CF pharmacy to patients and the coordinated care of CF patients cannot be understated. Finally, and importantly, the pharmacy continues to provide an effective fulfillment function for the development of new drugs to effectively treat the disease.

Bill history

None.

Fiscal implications

None.

Effective date

This bill shall take effect immediately.