Relates to prescription drugs in Medicaid managed care programs; repealer

BILL NUMBER:S7632

Title of bill

An act to amend the social services law and the public health law, in relation to prescription drugs in Medicaid managed care programs; and to repeal certain provisions of the social services law and chapter 56 of the laws of 2012 enacting the health and mental hygiene budget for the 2012-2013 state fiscal plan, relating to payments for prescription drugs

Purpose

Restore the "prescriber prevails" rule and other patient protections previously provided under the Preferred Drug Program for Medicaid managed care recipients.

Summary of provisions

Section 1, Adds Social Services Law 365-i to require that for a Medicaid managed care provider to have prescription drugs included in its capitation rate, it must use a "qualified prescription drug system" that follows the prior authorization procedures in the bill. The procedures in the bill are taken from the Preferred Drug Program law (Public Health Law Art. 2-A). Allows Medicaid managed care providers to contract with the Dept. of Health to use the Preferred Drug Program.

Section 2. Repeals § 55 of Part D of chapter 56 of the laws of2012, which enacts SSL § 364j, subdiv. 25, relating to prior authorization for drugs in Medicaid managed care.

Section 3. Establishes similar provisions in section 369-ee of the social services (Family Health Plus).

Section 4. Establishes similar provisions in Public Health Law Section 2511 (Child Health Plus).

Section 5. Amends PHL Art. 2-A to include Child Health Plus under the Preferred Drug Program, for plans that do not adopt a qualified prescription drug system.

Section 6. Restores the exemption from the prior authorization requirement under the preferred drug program for atypical anti-psychotics; antidepressants; anti-retrovirals; anti-rejection drugs; and any other therapeutic class for the treatment of mental illness or HIV/AIDS recommended by the Commissioner of Health.

Section 7. Effective date: 180 days after it becomes a law.

Justification

The 2011-12 State budget took prescription drug coverage for Medicaid managed care enrollees out of the Preferred Drug Program and put it under contra] of the managed care plans. Under that new law, "prescriber prevails" and other consumer protections were eliminated. This bill would restore these essential patient protections and apply them to Family Health Plus and Child Health Plush.

Legislative history

New bill.

Local fiscal implications

To be determined.

Effective date

180 days after it becomes law.