What's happening
This bill requires health insurance policies to allow synchronized refills of multiple prescriptions for chronic illnesses, including pro-rated copays and overrides for early refills.
Why it matters
Improves medication adherence for people with chronic illnesses. by making it easier to pick up all their prescriptions at once, reducing missed doses and simplifying complex medication schedules.
Reduces unnecessary costs and barriers for patients. by requiring insurers to allow early or partial refills for synchronization, with pro-rated copays—so patients don’t pay extra to align their medications.
Supports pharmacists and providers in care coordination. by ensuring they are fully reimbursed for partial fills and do not face insurance denials when helping patients synchronize medications.
Limits apply to protect against misuse. Controlled substances like Schedule II drugs and hydrocodone-containing medications are excluded, and synchronization generally applies only once per drug unless there’s a medically necessary change, reducing risk of abuse or waste.
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Who cares
Headline styles
Sync Prescription Refills Coverage
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Recommit, enacting clause stricken
- Referred to insurance
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 Coverage
Signed by Governor · Sponsor Dan Quart
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
416
2019-2020 Regular Sessions
IN SENATE (Prefiled)
January 9, 2019
Introduced by Sen. LANZA -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance 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. The insurance law is amended by adding a new section 3224-d to read as follows:
§ 3224-d. Prescription synchronization. (a) Every individual or group health insurance policy providing prescription drug coverage when applicable to permit synchronization shall permit and apply a daily pro-rated cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a thirty day supply, when it is agreed among the covered individual, a health care practitioner, and a pharmacist that synchronization of multiple prescriptions for the treatment of a chronic illness is in the best interest of the covered individual for the management or treatment of that chronic illness provided that all of the following apply:
(i) The medications are covered by the policy or plan.
(ii) The medications are used for treatment and management of chronic conditions that are subject to refills.
(iii) The medications are not a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone.
(iv) The medications meet all prior authorization criteria specific to medications at the time of the synchronization request.
(v) The medications are of a formulation that can be effectively split over required short fill periods to achieve synchronization.
(vi) The medications do not have quantity limits or dose optimization criteria or requirements that would be violated in fulfilling synchronization.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01416-01-9
S. 416 2
(b) No individual or group health insurance policy providing prescription drug coverage shall deny coverage for the dispensing of a medication for partial fill when it is for purposes of synchronizing the patient's medications. When applicable to permit synchronization, every individual or group health insurance policy must allow a pharmacy to override any denial codes indicating that a prescription is being refilled too soon for the purposes of medication synchronization.
(c) Dispensing fees for partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any pro-rated copay for the beneficiary or fee paid for alignment services.
(d) Nothing in this section shall be deemed to require health care practitioners and pharmacists to synchronize the refilling of multiple prescriptions for a covered individual.
(e) The requirements of this paragraph shall apply 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.
§ 2. The insurance law is amended by adding a new section 4303-a to read as follows:
§ 4303-a. Prescription synchronization. (a) Every hospital service corporation and health service corporation providing prescription drug coverage when applicable to permit synchronization shall permit and apply a daily pro-rated cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a thirty day supply, when it is agreed among the covered individual, a health care practitioner, and a pharmacist that synchronization of multiple prescriptions for the treatment of a chronic illness is in the best interest of the covered individual for the management or treatment of that chronic illness provided that all of the following apply:
(i) The medications are covered by the policy or plan.
(ii) The medications are used for treatment and management of chronic conditions that are subject to refills.
(iii) The medications are not a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone.
(iv) The medications meet all prior authorization criteria specific to medications at the time of the synchronization request.
(v) The medications are of a formulation that can be effectively split over required short fill periods to achieve synchronization.
(vi) The medications do not have quantity limits or dose optimization criteria or requirements that would be violated in fulfilling synchronization.
(b) No hospital service corporation or health service corporation providing prescription drug coverage shall deny coverage for the dispensing of a medication for partial fill when it is for purposes of synchronizing the patient's medications. When applicable to permit synchronization, every hospital service corporation or health service corporation providing prescription drug coverage must allow a pharmacy to override any denial codes indicating that a prescription is being refilled too soon for the purposes of medication synchronization.
(c) Dispensing fees for partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any pro-rated copay for the beneficiary or fee paid for alignment services.
S. 416 3
(d) Nothing in this section shall be deemed to require health care practitioners and pharmacists to synchronize the refilling of multiple prescriptions for a covered individual.
(e) The requirements of this paragraph shall apply 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.
§ 3. This act shall take effect on the first of January, 2020, and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such 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 insurance law, in relation to synchronization of multiple prescriptions
Purpose or general idea of bill
Provides for the insurance coverage of the synchronization of multiple prescriptions and dispensing fee standardization. Specifically, this bill would amend the insurance law by adding Article 32, governing for- profit commercial health insurance policies, and Article 43, governing nonprofit health insurance policies. The bill would provide coverage for a pharmaceutical claim for less than a 30 day supply for patients enrolling in medication synchronization programs.
Summary of specific provisions
Sections 1 and 2 add the following provisions:
Read the full memo (942 words)
(a) Provides that a pro-rated cost-sharing rate shall be permitted and applied to prescriptions that are dispensed for less than a 30 day supply for the purpose of synchronizing the covered individual's chronic medication.
(b) Provides that drug coverage shall not be denied for a partial fill for any drug prescribed for the treatment of a chronic illness made in accordance with a medication synchronization plan among the insured, a health care practitioner and a pharmacist.
(c) Ensures that the dispensing fee stays whole for the pharmacist for a partial fill.
(d) Specifies that nothing in this bill requires health care practition- ers and pharmacists to synchronize the filling of prescriptions.
Section 3 sets the effective date.
Justification
This bill would eliminate barriers to the implementation of medication synchronization, a service that has been shown to improve rates of medi- cation adherence and thus, lower overall health care expenditures.
Medication synchronization is a pharmacy service that improves patient adherence to prescribed medications by coordinating the refill dates for all of a patient's chronic prescription medications so these can be picked up on the same date each month. It is estimated that 76 percent of Americans over the age of 60 use two or more medicines and 37 percent take five or more medicines. Patient and caregiver lives are simplified by eliminating multiple trips to the pharmacy each month. It also mini- mizes confusion over when a prescription is due to be refilled and mini- mizes disrupting treatment through delayed or missed refills. The medi- cation synchronization model improves adherence and provides a more coordinated level of care, resulting in healthier patients and more effective delivery of care, reducing overall costs to payers and the health care system. Despite the benefits of synchronization, patients and pharmacies still face several challenges when trying to synchronize all of a patient's prescriptions. A "short fill" or partial fill is often needed to align the patient's medications to a single refill date. Currently, many payers do not have payment policies in place to provide coverage for a claim for less than a 30 day supply. Therefore, patients are required to pay a full month's copayment or coinsurance for a month's supply of medications, even if questions remain as to the effec- tiveness or adverse impacts of that medication on that patient.
The Centers for Medicare and Medicaid Services (CMS), the largest payer for health care in the nation, is implementing several policy changes that will help remove current barriers to the medication synchronization process, reduce waste from unnecessary fills, and ensure that benefici- aries are only receiving the medications they need. Beginning January 1, 2014, Medicare Part D sponsors will be required to apply a daily cost- sharing rate to most prescriptions that are dispensed for less than a 30 day supply. This provides a common sense approach when a patient is just starting out on a new therapy and may not require a full month's supply, or is attempting to synchronize their refills. State-level legislation would help remove existing operational and payment barriers presented by other payers and facilitate an even greater uptake of medication synchronization programs and other methods that promote adherence and appropriate medication use.
This bill is voluntary for patients, health care practitioners and phar- macists. Nothing in this bill requires health care practitioners and pharmacists to synchronize the filling of prescriptions. 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.
This legislation would:
*Eliminate barriers to the implementation of medication synchronization, a service that has been shown to improve rates of medication adherence and thus, lower overall health care expenditures.
*Benefit the patient, particularly when they are initially prescribed a new medication that has significant side effects, is frequently poorly tolerated, may pose drug-drug interactions with their current regimen, and when less than a month's supply of the prescription is clinically appropriate.
*Improve the ongoing issue of medication waste when medications are changed during a mid-30 day supply.
*Provide a patient with the ability to synchronize their prescriptions in consultation with their pharmacists without having to pay a full month's cost-sharing when less than a month's supply of medication(s) is dispensed during the synchronization process until all medications are on the same thirty or more days refill schedule.
*Protect a pharmacist from being compensated a pro-rated dispensing fee when a partial fill is provided. A dispensing fee does not relate to the amount of medication dispensed. It is the fee associated with operating costs, overhead, packaging and other costs of operating a pharmacy.
Prior legislative history
2018: S.5196-B - Referred to Insurance/ A.4306-B - Passed Assembly 2017: S.5196-A - Referred to Insurance 2016: S.2809A - Referred to Insurance /A.4036-A - Passed Assembly 2015: S.2809A - Referred to Insurance /A.4036-A - Passed Assembly 2014: S.6763 - Referred to Insurance /A.8975 - Referred to Insurance
Fiscal implications
None
Effective date
This act shall take effect January 1, 2019.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.