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Legislative Failed Bills
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Legislative Action - Failed Bills of Interest (2014 Legislative Session)

AMMO Reform (S 3995-B Maziarz/A 5723-B Heastie)

 This bill amends the “No Mandatory Mail Order” sections of Insurance Law in four places.  In the section that describes how network community pharmacies qualify to dispense any medication otherwise covered by network mail order pharmacies,  the community pharmacy must agree to accept the same reimbursement amount.  The bill removes the requirement that the community pharmacy must meet “the same applicable terms and conditions” and have a separate signed agreement “in advance”. 

The bill also defines “same reimbursement amount” to be the “same benchmark index, including the same average wholesale price, maximum allowable cost and national prescription drug codes to reimburse all pharmacies in the network.

Mail order pharmacy is defined in the bill as “a pharmacy whose primary business is to receive prescriptions by mail, telefax or through electronic submissions and to dispense medication to patients through the use of the United States mail or other common or contract carrier services and provides any consultation with patients electronically rather than face-to-face.”

The Assembly passed the bill in a unanimous vote June 10.  When the Senate session ended Friday, June 20 the bill remained in Senate Insurance Committee, never having been placed on agenda.  In our view, votes would have been sufficient for passage based on lobbyists’ and pharmacists’ feedback from individual senators.

Memos in Support were filed by PSSNY, Chain Pharmacy Association of NYS, NYS Chapter of American Society of Consultant Pharmacists, New Yorkers for Accessible Health Coverage, Gay Mens Health Crisis, Lupus Agencies of NYS, Southern Tier Independence Center, Latino Commission on Aids/Hispanic Health Network,  Treatment Action Group, BOOM! Health and Sage (Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders). 

Additional support from Patient Advocates:  A letter addressed to Governor Cuomo, Speaker Silver, Senator Klein and Senator Skelos signed by 38 separate associations representing approximately 70 separate groups throughout New York, including patient advocacy organizations that did not issue individual memos of support was hand delivered on May 12th, one of several lobby days organized by patient advocates in support of the bill.   

Additional support from NCPA:  A letter addressed to legislative leaders.

Memos in Opposition were filed by Pharmaceutical Care Management Association (national association representing PBMs), NY Health Plan Association, Unshackle Upstate, Blue Cross and Blue Shield Plans, National Federation of Independent Business, Employer Alliance for Affordable Health Care, NYS Business Council. 

Statements made by opponents of the bill

  • Will increase drug costs   (Mail order costs less because of volume discounts.)
  • Will increase premiums
  • Will stifle competition
  • Mail order pharmacies provide better service – 24/7 access and patient support
  • ‘Terms and conditions’ are there to protect patients. Removal harms patients.
  • Community pharmacies do not meet the “high-level standards” of specialty pharmacies

Refuting evidence

  • PBMs add costs. An analysis of insurance exchange plans in 46 states by HealthPocket found co-payments and co-insurance increased by an average of 34%.  (Jean O’Donnell. “Do drug benefit managers reduce health costs?” USA Today, March 3, 2014.)  (Katherine Eban.  “Painful prescription: pharmacy benefit managers make out better than their customers”.  Fortune Magazine
  • Mail order costs are higher.  Report issued by NCPA February 28, 2013.
  • Experiences of Patients   Better care and service from community pharmacies
  • Action by NYS Attorney General June 3, 2013.

 

Generic Fair Pricing – MAC Appeals (A9264-A Rosenthal/S7025-A Hannon)

 This bill amends public health law to define a pharmacy benefit manager as an “entity that enters into contracts with pharmacies on behalf of a health plan, state agency, insurer, managed care organization, or other third party payor to provide pharmacy health benefit services or administration”and to require contracts between pharmacies and PBMs to include a “reasonable process to appeal, investigate and resolve disputes regarding multi-source generic drug pricing”. 

Under the bill, a pharmacy’s right to appeal is limited to 60 days following the initial claim, and the pharmacy benefit manager must respond within seven business days after receiving the appeal.  When an appeal is successful, the adjustment to the maximum allowable cost (MAC) must be retroactive and apply to all similarly situated pharmacies.   A denial must be in writing and it must include the NDC at a price at or below the MAC.  The bill requires the contract to include the telephone number of the individual who is in charge of processing appeals.

On May 28th the Assembly Health committee unanimously passed the bill which was then reported to Ways & Means.  Senate Health Committee chair (and bill sponsor) agreed to move the bill to the Rules Committee provided that senate leaders agreed to pass it.  The Memorandum of Opposition filed by PCMA  charged that this bill would “increase prescription drug expenditures by 2% across all payers, or $408 million in the first year alone.”  Although the SMAC appeals process in the Medicaid program has clearly not increased costs, analysts for both  the Assembly Ways & Means and Senate central program staff could not confidently accept the argument that this legislation would not increase costs. 

 

Immunizer Expansion and Reform (A9211-A Paulin/ S5688-A Hannon)

 This bill amends the pharmacy section of Education Law and is supported by the NYS Health Department.  It removes the county restriction, the requirement for pharmacists to report their immunizations to DOH, and all the sunsets.  It adds Tdap, authorizes the Commissioner of Health to issue a statewide standing order and allows vaccines to be authorized by either patient-specific or non-patient-specific orders.

The Chair of the Assembly Higher Education has assured the bill sponsor and advocates that the committee will take up this bill once questions about insurance coverage are resolved.  Pharmacist-administered immunizations are widely covered by Medicaid and health plans, except for the NYS Insurance Program administered by the Department of Civil Service.  PSSNY and the NY Chain Association have a written statement from Civil Service that this policy will change in the near future.  It is important to note that insurance coverage was the only outstanding question regarding passage of this bill.

 

CDTM (A7521 McDonald)

 This bill amends the Pharmacy Practice Act to authorize qualified pharmacists an any practice setting to provide clinical services to patients under written collaborative agreements with a physician, physician assistant, nurse practitioner or facility.  Clinical services are defined in the bill as “the review, evaluation and management of drug therapy to a patient.”   The Education Department would certify pharmacists to perform CDTM. 

To qualify for CDTM a pharmacist must meet two of these criteria: (a) be certified by a national accrediting body approved by the Department; (b) complete an accredited postgraduate residency with at least 50% of the experience in direct patient care; or (c) have provided clinical services to patients for at least one year  by having already practiced under a CDTM or documented experience in providing clinical services for 1,000 hours acceptable to the department.

Assemblyman John McDonald, a practicing pharmacist, developed this legislation in consultation with representatives of pharmacy associations after NYS Board of Pharmacy and Education Department released its comprehensive and well-researched report to the legislature entitled “The Impact of Pharmacist-Physician Collaboration on Medication-Related Outcomes” on May 6, 2014.   Progress on this legislation is expected in the next Legislative Session due to begin January 1, 2015.

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