What's happening
This bill requires the Department of Health to create a program allowing patients with chronic illnesses to synchronize multiple prescription refills for better medication management.
Why it matters
Improves adherence and health outcomes. By allowing patients with chronic conditions to align their medication refill dates, the bill aims to reduce missed doses and improve the effectiveness of long-term treatments, which can lead to better health and fewer emergency situations.
Reduces administrative and access barriers. The legislation requires the Department of Health and managed care plans to override “refill too soon” denials and allow partial medication fills when synchronizing prescriptions, making it easier for patients to manage complex medication regimens.
Protects patient and provider autonomy. Synchronization is only implemented when agreed upon by the patient, provider, and pharmacist, and the bill explicitly states that no one is required to participate, preserving choice for both healthcare professionals and patients.
Ensures fair pharmacy reimbursement. Pharmacies dispensing partial supplies for synchronization receive full dispensing fees instead of prorated payments, supporting the financial viability of pharmacies and ensuring their cooperation in facilitating this service.
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Who cares
Headline styles
Sync Medicaid Prescriptions
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Substituted by A2785A
- Advanced to third reading
- 2nd report cal.
- 1st report cal.293
- Print number 3118a
- Amend and recommit to health
- 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.
Sync Prescription Refills for Medicaid
Vetoed · Sponsor Richard Gottfried
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3118--A
2019-2020 Regular Sessions
IN SENATE
February 4, 2019
Introduced by Sen. HOYLMAN -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
AN ACT to amend the social services law, in relation to synchronization of multiple prescriptions
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subdivision 9 of section 367-a of the social services law is amended by adding a new paragraph (i) to read as follows:
(i)(i) The department of health shall establish a program for synchronization of medications when it is agreed among the recipient, a provider and a pharmacist that synchronization of multiple prescriptions for the treatment of a chronic illness is in the best interest of the patient for the management or treatment of a chronic illness provided that the medications:
(A) are covered by the department of health pursuant to this title;
(B) are used for treatment and management of chronic conditions that are subject to refills;
(C) are not a schedule II controlled substance, nor a schedule III controlled substance that contains hydrocodone;
(D) meet all prior authorization criteria specific to the medications at the time of the synchronization request;
(E) are of a formulation that can be effectively split over required short fill periods to achieve synchronization; and
(F) do not have quantity limits or dose optimization criteria or requirements that would be violated in fulfilling synchronization.
(ii) The department of health shall not deny coverage for the dispensing of a medication by a pharmacy for a partial supply when it is for the purpose of synchronizing the patient's medications. When applicable to permit synchronization, the department of health shall allow a phar-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03580-03-9
S. 3118--A 2
macy to override any denial codes indicating that a prescription is being refilled too soon for the purposes of medication synchronization.
(iii) To permit synchronization, the department of health shall apply a prorated daily cost-sharing rate to any medication dispensed by a pharmacy pursuant to this section.
(iv) The dispensing fee paid to a pharmacy contracted to provide services pursuant to this section for a partial supply associated with a medication synchronization shall be paid in full and shall not be prorated.
(v) The requirement of this paragraph applies only once for each prescription drug subject to medication synchronization except when either of the following occurs:
(I) the prescriber changes the dosage or frequency of administration of the prescription drug subject to a medication synchronization; or
(II) the prescriber prescribes a different drug.
(vi) Nothing in this paragraph shall be deemed to require health care practitioners and pharmacists to synchronize the refilling of multiple prescriptions for a recipient.
§ 2. Subdivision 4 of section 364-j of the social services law is amended by adding a new paragraph (w) to read as follows:
(w)(i) The department of health or a managed care organization contracted to provide services pursuant to this section shall establish a program for synchronization of medications when it is agreed among the recipient, a provider and a pharmacist that synchronization of multiple prescriptions for the treatment of a chronic illness is in the best interest of the patient for the management or treatment of a chronic illness provided that the medications:
(A) are covered by Medicaid services or a managed care organization contracted to provide services pursuant to this chapter;
(B) are used for treatment and management of chronic conditions that are subject to refills;
(C) are not a schedule II controlled substance, nor a schedule III controlled substance that contains hydrocodone;
(D) meet all prior authorization criteria specific to the medications at the time of the synchronization request;
(E) are of a formulation that can be effectively split over required short fill periods to achieve synchronization; and (F) do not have quantity limits or dose optimization criteria or requirements that would be violated in fulfilling synchronization.
(ii) The department of health or a managed care organization contracted to provide services under this section shall not deny coverage for the dispensing of a medication by a pharmacy for a partial supply when it is for the purpose of synchronizing the patient's medications. When applicable to permit synchronization, the department of health or a managed care organization contracted to provide services under this title shall allow a pharmacy to override any denial codes indicating that a prescription is being refilled too soon for the purposes of medication synchronization.
(iii) To permit synchronization, the department of health or a managed care organization contracted to provide services pursuant to this title shall apply a prorated daily cost-sharing rate to any medication dispensed by a pharmacy pursuant to this section.
(iv) The dispensing fee paid to a pharmacy contracted to provide services pursuant to this section for a partial supply associated with a medication synchronization shall be paid in full and shall not be prorated.
S. 3118--A 3
(v) The requirement of this paragraph applies only once for each prescription drug subject to medication synchronization except when either of the following occurs:
(A) the prescriber changes the dosage or frequency of administration of the prescription drug subject to a medication synchronization; or
(B) the prescriber prescribes a different drug.
(vi) Nothing in this paragraph shall be deemed to require health care practitioners and pharmacists to synchronize the refilling of multiple prescriptions for a covered individual.
§ 3. This act shall take effect on the one hundred twentieth day after it shall have become a law. The amendments to subdivision 9 of section 367-a of the social services law, made by section one of this act, shall not affect the expiration of that subdivision, and shall expire therewith.
The amendments to section 364-j of the social services law, made by section two of this act, shall not affect the repeal of that section, and shall be deemed repealed therewith. Effective immediately, the commissioner of health shall make regulations and take other actions reasonably necessary to implement this act on that date.
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 synchronization of multiple prescriptions
Purpose or general idea of bill
To allow pharmacists to synchronize the dispensing of multiple prescriptions for Medicaid recipients so they may pick up multiple prescription refills at the same time.
Summary of specific provisions
This bill would allow synchronized dispensing of medications when it is agreed among the patient, his or her prescriber and the pharmacist, under certain conditions. The bill requires fee-for-service and managed care benefit coverage for a partial fill and would allow a pharmacy to over-ride denial codes indicating that a prescription is being too refilled too soon.
The bill would permit pro-rated cost-sharing but keep the dispensing fee whole. A given prescription may be synchronized only once unless the prescriber changes the doses or frequency or prescribes a different drug.
Justification
Medication synchronization enables a partial-fill so that later refills are coordinated with other prescriptions a patient may have, in order to maximize convenience and compliance, reduce waste from unnecessary fills and ensure that patients receive only the medication they need. Normal- ly, a partial fill is blocked during the claim submission process because the claim is for less than a 30-day supply. Patients may be required to pay a full months' copayment for a month's supply, even if questions remain about the medication's effectiveness or the likelihood of an adverse event.
Since 2014, Medicare Part D plans are required to facilitate pro-rated co-payments for dispensing in less than a 30 day supply when medications are being synchronized. To date, 18 states have enabled commercial health plan coverage for synchronization, and two have provided Medicaid beneficiaries access to synchronization. It is estimated that 76% of Americans aged 60 and over use two or more medicines and 37% take five or more.
Nothing in this bill requires medication synchronization. It simply establishes a mechanism for medication synchronization for patients with chronic illness when there is a voluntary agreed-upon plan between the patient, the health care provider and the pharmacist.
Prior legislative history
2018: S.5622-A (Hannon) - Died in Rules 2017: S.5622 (Hannon) - Died in Health
Fiscal implications
Potential Medicaid savings.
Effective date
This act shall take effect on the one hundred twentieth day after it shall have become a law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.