STATE OF NEW YORK ________________________________________________________________________ 7197 2023-2024 Regular Sessions IN ASSEMBLY May 12, 2023 ___________ Introduced by M. of A. DINOWITZ -- read once and referred to the Commit- tee on Health AN ACT to amend the social services law and the public health law, in relation to protecting access to pharmacy services The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subdivision 4 of section 364-j of the social services law 2 is amended by adding two new paragraphs (x) and (y) to read as follows: 3 (x) Notwithstanding any provision of law to the contrary, administra- 4 tive fees paid to a managed care provider or a pharmacy benefit manager 5 under the medical assistance program shall be reduced for the purpose of 6 increasing reimbursement rates to retail pharmacies under the Medicaid 7 managed care program. Beginning on and after July first, two thousand 8 twenty-three, all reimbursement paid by Medicaid managed care plans to 9 retail pharmacies shall include a professional dispensing fee and the 10 drug acquisition cost for each outpatient drug dispensed at no less than 11 the amount established under the fee-for-service program, as defined in 12 section three hundred sixty-seven-a of this title, regardless of whether 13 such reimbursement is paid directly by the Medicaid managed care plan or 14 passed through a pharmacy benefit manager or other entity. The 15 reimbursement provided for under this paragraph shall not apply to any 16 existing reimbursement arrangements involving an eligible provider under 17 section 340B of the federal public health services act or a comprehen- 18 sive HIV special needs plan under section forty-four hundred three-c of 19 the public health law under the medical assistance program. No managed 20 care provider or pharmacy benefit manager shall reimburse a pharmacy 21 owned by or affiliated with such entity at a higher rate than that paid 22 by such entity to a pharmacy it does not own or is not otherwise affil- 23 iated with. 24 (y) Notwithstanding any provision of law to the contrary, a managed 25 care provider or pharmacy benefit manager acting on its behalf, as EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD06891-01-3

A. 7197 2 1 defined in section two hundred eighty-a of the public health law, shall 2 not deny any retail pharmacy the opportunity to participate in another 3 provider's pharmacy network under the medical assistance program at 4 preferred participation status, provided that such retail pharmacy 5 agrees to the same reimbursement amount, as defined in paragraph (x) of 6 this subdivision, and is able to fill and dispense prescription and 7 over-the-counter medications for those enrolled in the medical assist- 8 ance program. 9 § 2. Section 280-a of the public health law is amended by adding a new 10 subdivision 6 to read as follows: 11 6. Delivery option. Notwithstanding any provision of law to the 12 contrary, no pharmacy benefit manager shall limit the option for an 13 individual receiving prescription or over-the-counter medications to 14 receive such medications from their local, non-mail order pharmacy of 15 choice via delivery including in-person delivery, United States postal 16 service or other mail or courier service. No restrictions, prohibitions 17 or prior authorization requirements shall be based on the individual's 18 choice in delivery type or distance from a pharmacy. 19 § 3. This act shall take effect immediately; provided, however, that: 20 (a) section one of this act shall take effect July 1, 2023; 21 (b) if this act shall have become a law after such effective date it 22 shall take effect immediately and shall be deemed to have been in full 23 force and effect on and after July 1, 2023; 24 (c) the amendments to subdivision 4 of section 364-j of the social 25 services law made by section one of this act shall not affect the repeal 26 of such section and shall be deemed repealed therewith; and 27 (d) section two of this act shall take effect on the thirtieth day 28 after it shall have become a law.

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