Bill S6763-2013

Provides for the insurance coverage of the synchronization of multiple prescriptions and dispensing fee standardization

Provides for the insurance coverage of the synchronization of multiple prescriptions and dispensing fee standardization.

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  • Mar 6, 2014: REFERRED TO INSURANCE

Memo

BILL NUMBER:S6763

TITLE OF BILL: An act to amend the insurance law, in relation to synchronization of multiple prescriptions and dispensing fee standardization

PURPOSE: 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 PROVISIONS:

Sections 1 and 2 add the following provisions:

(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 his bill requires health care practitioners and pharmacists to synchronize the filling of prescriptions.

Section 3 is 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 medication adherence and thus, lower overall healthcare 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 aged 60 and over 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 minimizes confusion over when a prescription is due to be refilled, and minimizes disrupting treatment through delayed or missed refills. The Medication Synchronization model improves adherence and provides a more coordinated level of care; resulting in healthier patients, and more effective delivery of care which can reduce 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 effectiveness or adverse impacts of that medication on that patient.

The Centers for Medicare & 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 beneficiaries 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 patient is just starting out on 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 pharmacists. 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 a 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

LEGISLATIVE HISTORY: New bill.

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This act shall take effect on the 120th day after becoming law.


Text

STATE OF NEW YORK ________________________________________________________________________ S. 6763 A. 8975 S E N A T E - A S S E M B L Y March 6, 2014 ___________
IN SENATE -- Introduced by Sen. LANZA -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance IN ASSEMBLY -- Introduced by M. of A. QUART -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to synchronization of multiple prescriptions and dispensing fee standardization THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The insurance law is amended by adding a new section 3224-d to read as follows: S 3224-D. PRESCRIPTION SYNCHRONIZATION AND DISPENSING FEE STANDARDI- ZATION. (A) EVERY INDIVIDUAL OR GROUP HEALTH INSURANCE POLICY PROVIDING PRESCRIPTION DRUG COVERAGE SHALL PERMIT AND APPLY A PRO-RATED COST-SHAR- ING RATE TO PRESCRIPTIONS THAT ARE DISPENSED BY A NETWORK PHARMACY FOR LESS THAN A THIRTY DAY SUPPLY, IF THE PRESCRIBER OR PHARMACIST INDICATES THAT THE FILL OR REFILL COULD BE IN THE BEST INTEREST OF THE COVERED INDIVIDUAL OR IS FOR THE PURPOSE OF SYNCHRONIZING THE COVERED INDIVID- UAL'S CHRONIC MEDICATIONS. (B) NO INDIVIDUAL OR GROUP HEALTH INSURANCE POLICY PROVIDING PRESCRIPTION DRUG COVERAGE SHALL DENY COVERAGE FOR THE DISPENSING OF ANY DRUG PRESCRIBED FOR THE TREATMENT OF A CHRONIC ILLNESS THAT IS MADE IN ACCORDANCE WITH A PLAN ESTABLISHED AMONG THE COVERED INDIVIDUAL, A HEALTH CARE PRACTITIONER AND A PHARMACIST TO SYNCHRONIZE THE REFILLING OF MULTIPLE PRESCRIPTIONS FOR THE COVERED INDIVIDUAL. (C) NO INDIVIDUAL OR GROUP HEALTH INSURANCE POLICY PROVIDING PRESCRIPTION DRUG COVERAGE SHALL USE PAYMENT STRUCTURES INCORPORATING PRO-RATED DISPENSING FEES DETERMINED BY CALCULATION OF THE DAYS' SUPPLY OF MEDICATION DISPENSED. DISPENSING FEES SHALL BE DETERMINED SOLELY ON THE TOTAL NUMBER OF PRESCRIPTIONS DISPENSED. (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.
S 2. The insurance law is amended by adding a new section 4303-a to read as follows: S 4303-A. PRESCRIPTION SYNCHRONIZATION AND DISPENSING FEE STANDARDI- ZATION. (A) EVERY HOSPITAL SERVICE CORPORATION AND HEALTH SERVICE CORPORATION PROVIDING PRESCRIPTION DRUG COVERAGE SHALL PERMIT AND APPLY A PRO-RATED COST-SHARING RATE TO PRESCRIPTIONS THAT ARE DISPERSED BY A NETWORK PHARMACY FOR LESS THAN A THIRTY DAY SUPPLY, IF THE PRESCRIBER OR PHARMACIST INDICATES THAT THE FILL OR REFILL COULD BE IN THE BEST INTER- EST OF THE COVERED INDIVIDUAL OR IS FOR THE PURPOSE OF SYNCHRONIZING THE COVERED INDIVIDUAL'S CHRONIC MEDICATIONS. (B) NO HOSPITAL SERVICE CORPORATION OR HEALTH SERVICE CORPORATION PROVIDING PRESCRIPTION DRUG COVERAGE SHALL DENY COVERAGE FOR THE DISPENSING OF ANY DRUG PRESCRIBED FOR THE TREATMENT OF A CHRONIC ILLNESS THAT IS MADE IN ACCORDANCE WITH A PLAN ESTABLISHED AMONG THE COVERED INDIVIDUAL, A HEALTH CARE PRACTITIONER AND A PHARMACIST TO SYNCHRONIZE THE REFILLING OF MULTIPLE PRESCRIPTIONS FOR THE COVERED INDIVIDUAL. (C) NO HOSPITAL SERVICE CORPORATION OR HEALTH SERVICE CORPORATION PROVIDING PRESCRIPTION DRUG COVERAGE SHALL USE PAYMENT STRUCTURES INCOR- PORATING PRO-RATED DISPENSING FEES DETERMINED BY CALCULATION OF THE DAYS' SUPPLY OF MEDICATION DISPENSED. DISPENSING FEES SHALL BE DETER- MINED SOLELY ON THE TOTAL NUMBER OF PRESCRIPTIONS DISPENSED. (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. S 3. This act shall take effect on the one hundred twentieth day after it shall have become a law.

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