Relates to pharmacy benefits where a physician is authorized to dispense certain medications and practices medicine in the oncology setting

S T A T E   O F   N E W   Y O R K
        ________________________________________________________________________

                                          9434

                                    I N  S E N A T E

                                     March 12, 2026
                                       ___________

        Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
          printed to be committed to the Committee on Health

        AN ACT to amend part FFF of chapter 56 of the laws of 2020  relating  to
          directing the department of health to remove the pharmacy benefit from
          the  managed  care benefit package and to provide the pharmacy benefit
          under the fee for service program, in relation  to  pharmacy  benefits
          where  a  physician  is authorized to dispense certain medications and
          practices medicine in the oncology setting

          THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
        BLY, DO ENACT AS FOLLOWS:

     1    Section  1.  Section  1  of part FFF of chapter 56 of the laws of 2020
     2  relating to directing the department of health to  remove  the  pharmacy
     3  benefit from the managed care benefit package and to provide the pharma-
     4  cy benefit under the fee for service program, as amended by section 1 of
     5  part C of chapter 57 of the laws of 2021, is amended to read as follows:
     6    Section  1.  The  Legislature  hereby  finds and declares that medical
     7  assistance for needy persons is a matter of public concern and a  neces-
     8  sity  in  promoting  the public health and welfare and for promoting the
     9  state's goal of making available to everyone, regardless of  race,  age,
    10  gender,  national  origin  or  economic  standing, uniform, high-quality
    11  medical care. As the department of health is  the  single  state  agency
    12  responsible  for  supervising  the administration of the state's medical
    13  assistance program (Medicaid), it is tasked  with  ensuring  efficiency,
    14  economy,  and quality of care in providing benefits to the state's needy
    15  persons. To this end and with the fiscal constraints facing our state in
    16  mind, the department of health continues to analyze the Medicaid program
    17  in search of ways to ensure Medicaid spending is held to the standard of
    18  efficiency, economy, and quality of care. In consideration of this stan-
    19  dard, the department of health is hereby directed to exercise its exist-
    20  ing administrative authority to remove the pharmacy benefit from managed
    21  care benefit package and instead provide the pharmacy benefit under  the
    22  fee  for service program, except where otherwise required by federal law
    23  OR WHERE A PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER  IS  AUTHOR-
    24  IZED  TO  DISPENSE  MEDICATIONS  IN  ACCORDANCE WITH SECTION 6807 OF THE

         EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11144-03-6
        S. 9434                             2

     1  EDUCATION LAW AND IS PRACTICING MEDICINE IN AN ONCOLOGY SETTING  AND  IS
     2  DISPENSING  ONCOLOGY  DRUGS  OR  DRUGS  RELATED TO AN APPROVED COURSE OF
     3  TREATMENT USED TO MANAGE SYMPTOMS RELATED TO CANCER OR CANCER THERAPIES,
     4  to  ensure  transparency and that the benefit is provided to the fullest
     5  extent and as efficiently  as  possible;  provided,  however,  that  the
     6  department  of health shall not implement the transition of the pharmacy
     7  benefit from the managed care benefit package to  the  fee  for  service
     8  program  sooner  than  April 1, 2023, and until it is satisfied that all
     9  necessary and appropriate transition planning has occurred, in its  sole
    10  discretion,  and  federal  approvals have been obtained and preparations
    11  have been made. Furthermore, to ensure an orderly transition,  continued
    12  access  to  medications,  and appropriate patient education and support,
    13  the department may establish uniform  standards,  payment  policies  and
    14  reimbursement  methodologies  for  any sites where drugs may be adminis-
    15  tered or dispensed under the fee for  service  program;  provided  that,
    16  subject  to  the  availability  of federal financial participation, when
    17  reimbursing covered entities, as  defined  under  section  340B  of  the
    18  public health service act (42 U.S.C. §256b), for drugs that would other-
    19  wise  be  eligible  for  pricing under section 340B of the public health
    20  service act, the department shall examine all reasonably available meth-
    21  ods  for  determining  actual  acquisition  cost  and  the  professional
    22  dispensing fee and, beginning in the fiscal year starting April 1, 2023,
    23  review  and adjust reimbursement for such drugs such that no sooner than
    24  April 1, 2025, reimbursement shall be determined based on a method  that
    25  the  commissioner  determines that utilizes the actual acquisition costs
    26  and professional dispensing fee.
    27    § 2. This act shall take effect immediately.