Relates to excepting situations where a physician or other licensed health care provider is authorized to dispense certain medications and is practicing medicine in the oncology setting and is dispensing oncology drugs or drugs related to an approved course of treatment used to manage symptoms related to cancer or cancer therapies.
Impact
The implementation of S09434 will significantly modify how pharmacy benefits are administered under Medicaid. By shifting to a fee-for-service model, the bill is thought to potentially enhance visibility and efficiency in medication dispensing, particularly for patients dealing with cancer. This change could also lead to changes in reimbursement strategies for pharmacies, impacting how medications are priced and provided under this new system. The goal is to ensure that all Medicaid recipients, regardless of their circumstances, have access to the medications they require, all while adhering to the state’s fiscal constraints.
Summary
Bill S09434 aims to amend part of the New York law concerning pharmacy benefits within the state's Medicaid program. The primary focus is to shift the pharmacy benefit from a managed care package to a fee-for-service program. This transition is designed to improve the delivery of medications to individuals needing oncology drugs and related treatments, ensuring that patients receive necessary pharmaceuticals efficiently while maintaining high-quality healthcare standards. The legislation mandates the Department of Health to oversee this adjustment and make the necessary administrative changes to implement the new framework.
Contention
Despite its potential benefits, S09434 has sparked debates around its execution and the impact on healthcare providers, particularly in oncology settings. Critics express concern about the transition's complexity, especially regarding continuity of care and the potential for confusion among patients and providers during the changeover. Additionally, there are discussions regarding the adequacy of patient education and support that would need to accompany this change to ensure smooth access to medication during the transition period.
Same As
Relates to excepting situations where a physician or other licensed health care provider is authorized to dispense certain medications and is practicing medicine in the oncology setting and is dispensing oncology drugs or drugs related to an approved course of treatment used to manage symptoms related to cancer or cancer therapies.
Relates to excepting situations where a physician or other licensed health care provider is authorized to dispense certain medications and is practicing medicine in the oncology setting and is dispensing oncology drugs or drugs related to an approved course of treatment used to manage symptoms related to cancer or cancer therapies.
Relates to dispensing certain controlled substances for use by a person with a substance use disorder during certain emergency medical treatment, or to relieve acute withdrawal symptoms.
Relates to dispensing certain controlled substances for use by a person with a substance use disorder during certain emergency medical treatment, or to relieve acute withdrawal symptoms.
Requires a pharmacy benefit manager to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.
Requires a pharmacy benefit manager to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.