Relates to prescription drugs covered by managed care programs under the medical assistance program

BILL NUMBER:S5199

Title of bill

An act to amend the social services law, in relation to prescription drugs covered by managed care programs under the medical assistance program

Purpose or general idea of bill

Provides that a Medicaid manage care providers network shall allow pharmacies to fill prescriptions for participants at a price at comparable to an in-network pharmacy.

Summary of provisions

Subdivision 4 of the section 364-j of the social services law is amended by adding a new paragraph to provide that a managed care provider that provides coverage for prescription drugs shall permit each participant to fill any covered prescription, at his or her option, at any pharmacy registered with the department of education pursuant to section sixty-eight hundred eight of the education law if such pharmacy offers to accept a price that is comparable to that of any mail order or non-mail order retail pharmacy in the managed care provider network.

Justification

This legislation will assist in providing appropriate access to participants seeking to fill their prescriptions in Medicaid managed care at a price comparable to that of in-network pharmacies or network mail order pharmacies.

Access to prescriptions is critical in the state's efforts to save Medicaid dollars both through management of a Medicaid participant's acute and long term health issues. Importantly, the bill offers cost protections for the state by ensuring that any prescription filled must be at a rate comparable to that of any mail order or non-mail order retail pharmacy in the managed care provider network.

Furthermore, the neighborhood pharmacy in these situations is forced to bear the burden of educating the patient as to the use and potential effects of the prescribed drug. The inability of the participant to purchase the full prescription from the neighborhood pharmacy imposes this burden inequitably.

Finally, many participants, especially senior citizens and persons with disabilities, rely on their local pharmacist for the service that they provide with respect to monitoring the regimen of drugs that they take. This legislation provides that recent changes to the State's Medicaid program will save money but ensure a seamless transition for such participants.

Prior legislative history

None

Fiscal implications

None.

Effective date

Immediately, with provisions