Requires the collection of prescription drug co-payments at the point of sale in pharmacies.
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 and Family Health Plus
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- Amends section 369-ee of the Social Services law to require the payment of prescription drug co-payments under Family Health Plus.
Section 3- Effective date.
JUSTIFICATION: Co-payments for prescription drugs in the State Medicaid program were implemented in New York State in 1995. Prescription drug co-payments were also included when the Family Health Plus program was created. It is the current policy that Medicaid and Family Health Plus 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 and $3 for generics and $6 for brand name drugs under Family Health Plus. 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 Family Health and are currently are paid one of the lowest rates in the country. This hardship is exacerbated by the losses incurred through uncollectible co-payments in these programs. This situation is inequitable and also jeopardizes access to pharmacy services for all New Yorkers.
Recently, the pharmacy benefit under Medicaid and Family Health Plus 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 and Family Health Plus 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
FISCAL IMPLICATIONS: None
EFFECTIVE DATE: This act shall take effect one hundred and eighty days after it shall become law.
STATE OF NEW YORK ________________________________________________________________________ 2786 2013-2014 Regular Sessions IN SENATE January 23, 2013 ___________Introduced by Sens. DeFRANCISCO, LARKIN, RANZENHOFER -- 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 ASSEM- BLY, 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 47 of part C of chapter 58 of the laws of 2009, 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 three dollars; provided, however, that the co-payments charged for each brand name prescription drug on the preferred drug list established pursuant to section two hundred seventy-two of the public health law and 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. S 2. Paragraph (i) of subdivision 2-a of section 369-ee of the social service law, as amended by section 26 of part E of chapter 63 of the laws of 2005, is amended to read as follows: (i) co-payments charged for each generic prescription drug dispensed shall be three dollars and for each brand name prescription drug dispensed shall be six dollars AND THE PAYMENT OF SUCH CO-PAYMENTS SHALL BE MANDATORY AT THE POINT OF SALE IN PHARMACIES; S 3. This act shall take effect on the one hundred eightieth day after it shall have become a law, provided, however, 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 repeal therewith.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07805-01-3