What's happening
This bill requires mandatory collection of prescription drug co-payments at the point of sale in New York pharmacies.
Why it matters
Requires pharmacies to collect co-payments for prescription drugs at the time of purchase,. which means patients must pay these amounts before receiving their medications, potentially impacting those with limited cash on hand.
May reduce the flexibility that pharmacies previously had in allowing patients to defer or waive co-payment collection,. which could affect access to essential medications for people facing financial hardship or emergencies.
Could streamline administrative processes for pharmacies,. ensuring they are reimbursed properly by insurers or state programs and reducing uncertainty about whether co-payments will be collected.
May disproportionately affect low-income or vulnerable populations. who rely on Medicaid or similar programs, as even relatively small co-payments can be a barrier to medication adherence and overall health outcomes.
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Who cares
Headline styles
Require Pharmacy Co-Pay Payment
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to health
- Referred to health
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
5773
2017-2018 Regular Sessions
IN SENATE
April 28, 2017
Introduced by Sen. DeFRANCISCO -- read twice and ordered printed, and when printed to be committed to the Committee on Health
AN ACT to amend the social services law, in relation to the collection of prescription drug co-payments
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subparagraph (iii) of paragraph (c) of subdivision 6 of section 367-a of the social services law, as amended by section 16 of part D of chapter 57 of the laws of 2017, is amended to read as follows:
(iii) Notwithstanding any other provision of this paragraph, co-payments charged for each generic prescription drug dispensed shall be one dollar and for each brand name prescription drug dispensed shall be two dollars and fifty cents; provided, however, that the co-payments charged for each brand name prescription drug reimbursed pursuant to subparagraph (ii) of paragraph (a-1) of subdivision four of section three hundred sixty-five-a of this title shall be one dollar. The payment of such co-payments shall be mandatory at the point of sale in pharmacies.
§ 2. This act shall take effect on the one hundred eightieth day after it shall have become a law, provided, however, that if section 16 of part D of chapter 57 of the laws of 2017 shall not have taken effect on or before such date then section one of this act shall take effect on the same date and in the same manner as such chapter of the laws of 2017 takes effect; provided, further, that the amendments to subparagraph (iii) of paragraph (c) of subdivision 6 of section 367-a of the social services law made by section one of this act shall not affect the repeal of such paragraph and shall be deemed to be repealed therewith.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06785-02-7
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the social services law, in relation to the collection of prescription drug co-payments
Purpose
To require patients to pay co-payments for prescription drugs at the point-of-sale under Medicaid.
Summary of provisions
Section 1 - Amends section 367-a of the Social Services law to require the payment of prescription drug co-payments under Medicaid.
Section 2 - Effective date.
Justification
Co-payments for prescription drugs in the State Medicaid program were implemented in New York State in 1995. It is the current policy that Medicaid and beneficiaries cannot be denied services if they refuse to pay their co-payments at the point-of-sale. As a result, pharmacies in the State of New York have experienced serious financial losses through the inability to collect the co-payments of $1 for generics and $3 for brand name drugs under Medicaid. Survey data has found that the statewide average of uncollectible co-payments is 50%, and the rate is even higher in New York City with some pharmacies experiencing uncollectible co-payments of 90%.
Unlike other providers which receive funding from bad debt and charity pools, pharmacies cannot write off their bad debt and do not receive state assistance to make up for these losses. Uncollectible co-payments come directly out of the pockets of community pharmacies. Pharmacies have also recently experienced significant reductions in reimbursement under Medicaid and are currently paid one of the lowest rates in the country. This hardship is exacerbated by the losses incurred through uncollectible co-payments in the program. This situation is inequitable and also jeopardizes access to pharmacy services for all New Yorkers.
Recently, the pharmacy benefit under Medicaid was changed and will now be administered by private managed care plans for the majority of beneficiaries. However, the co-payments remain the same as does the policy regarding pharmacy collection. This means that pharmacies will continue to lose on average 50% of co-payments for the prescription drugs filled for approximately four million New Yorkers.
This inequity would be addressed through this legislation by requiring Medicaid beneficiaries to pay their co-payments to pharmacies at the point-of-sale when filling their prescriptions.
Legislative history
S.4749A/A.7727 of 2011-2012; S.2786 of 2013-2014; S.312 of 2015-2016
Fiscal implications
None
Effective date
This act shall take effect one hundred and eighty days after it shall become law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.