What's happening
This bill requires managed care providers to annually give participants a written list of contracted mail-order pharmacies for prescription drug coverage.
Why it matters
Improves transparency for participants. By requiring managed care providers to give an annual written list of contracted mail-order pharmacies, participants can more easily identify where they can fill prescriptions and compare options, reducing confusion and potential out-of-network costs.
Empowers consumer choice and planning. With clear information about available mail-order pharmacies, participants can make more informed decisions about where to fill their prescriptions, potentially leading to better convenience, cost savings, or improved service based on their needs.
Holds managed care providers accountable. The bill creates a new compliance responsibility for managed care providers, ensuring they regularly communicate essential network information to participants rather than leaving individuals to search for these details on their own.
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Who cares
Headline styles
List Mail Pharmacies Required
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Sponsors
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History
- Referred to health
- Referred to health
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
7834
2017-2018 Regular Sessions
IN ASSEMBLY
May 16, 2017
Introduced by M. of A. BICHOTTE -- 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 Assembly, do enact as follows:
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 nonmail-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 the managed care provider's network for every covered prescription drug. Each managed care provider subject to the provisions of this paragraph
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11262-01-7
A. 7834 2
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.
§ 2. 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.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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