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History
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Directs the department of health to evaluate and report on Medicaid prescription drug reimbursement to retail pharmacies
In Senate Committee · Health · Sponsor RoAnn Destito
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
Title of bill
An act to direct the department of health to evaluate and report on Medicaid prescription drug reimbursement to retail pharmacies
Purpose or general idea of bill
This bill directs the Department of Health to evaluate and report on Medicaid prescription drug reimbursement to retail pharmacies.
Summary of specific provisions
Section one of the bill creates a workgroup within the Department of Health to assist the Commissioner of Health in studying Medicaid prescription drug reimbursement to retail pharmacies. Section two outlines the different factors to be considered in the study. Section three requires the Commissioner of Health to issue a report to the Governor and the Legislature. section four sets forth the effective date.
Justification
It has become important for the legislature to have access to factual information on which to base policy and budget decisions with regard to payments to pharmacies. This legislation requires the Health Department, working with representatives of organized pharmacy and other stakeholders, to gather information and prepare a report to inform about the adequacy of present reimbursement in terms of actual costs both for medications and professional services.
Compounding the pharmacy reimbursement matter further is the use of the term 'Average Wholesale Price' (AWP) that, combined with a discount, forms the payment formula for brand drugs. For generics, New York State law allows the Department of Health to calculate 'State Maximum Allowable Cost' (SMAC). Pharmacies report that SMAC pricing is not based on any known methodology and it brings payment levels unrealistically low. Access to generics is an important key to our cost-containment strategies, and we should have confidence that our reimbursement policy is set appropriately.
As enumerated in this legislation, pharmacy overhead costs cover a wide range of elements that must be considered as part of a fair and reasonable payment standard. For consumers, the professional service components may represent the real value of having a local pharmacy with an accessible pharmacist, who has filled the prescription, checked for drug interactions and can provide important information about how to take the medicine prescribed for them. In this time of limited resources, it becomes more important that our Medicaid and EPIC beneficiaries derive the maximum therapeutic benefit from the medicines they are prescribed so that they can remain at home living independently as long as possible. Local pharmacies represent healthcare outreach into communities and a valuable cost-containment strategy.
Prior legislative history
2009: A.8782 - Passed Assembly.
Fiscal implications
To be determined.
Effective date
Immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.