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Pre-registration is REQUIRED for this event, NO ONSITE REGISTRATION is available. If you have not pre-registered, call your legislators district office to schedule a visit. Take the below talking points as your leave behind and report your visit on this survey so we can keep a record of your effort.
Legislative Agenda items:
MAC Appeal Talking Points (printer-friendly)
What the bill does and why it is needed
Clearly identifies Pharmacy Benefit Managers (PBMS) in state law.
- While controlling 90% to 95% of prescriptions dispensed, PBMs are an unregulated healthcare entity that operates completely outside of our state’s laws.
Mandates that PBM contracts include a process enabling network pharmacies to appeal reimbursements that are below cost.
- The right to appeal is fundamental due process that appears throughout state and federal laws.
- CMS currently requires Part D contracts to include a MAC appeals process, such as the one created in this bill.
- In addition, the mandate in this bill mirrors the generic price appeals process in effect for the Medicaid fee-for-service program.
Sets timelines and basic rules for the appeals process.
- This bill compares favorably with laws in 16 other states.
- The appeals process in current contracts has proven unenforceable without statute.
Instills generic pricing clarity into contracts between PBMs and pharmacies.
- While not the focus of this legislation, generic drug price increases (the subject of ongoing federal investigations) have recently been dramatic and unprecedented.
- A workable generic price appeals process, mandated by state law, will help ensure patients’ uninterrupted access to medications at community pharmacies throughout the state.
Medicaid Budget TALKING POINTS (printer-friendly)
The $36 million cut proposed for pharmacies in Governor Cuomo's Medicaid budget would result in a reimbursement cost basis of WAC minus 9% for fee-for-service brand name Rxs. This cut is much deeper than last year's.
Even before this unprecedented and devastating cut, New York State's Medicaid program provides our pharmacies with the LOWEST REIMBURSEMENTS IN THE COUNTRY; a result many years of decreases
NYS DOH officials improperly used results from the flawed 2012 AAC surveys to justify their proposed cut. Last year, NY state legislators passed a law ruling out use of that survey.
Under a directive from last year's NYS budget, PSSNY and other Pharmacy groups met with DOH officials to work on a new "adequate" reimbursement policy. At our November meeting, DOH expressed that fee-for-service Medicaid would remain unchanged. We were totally blind-sided by this new budget proposal of WAC minus 9% for brand name drugs.