Senate Bill S9434

                             
                     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:
 
   Section  1.  Section  1  of 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 pharma-
 cy benefit under the fee for service program, as amended by section 1 of
 part C of chapter 57 of the laws of 2021, is amended to read as follows:
   Section  1.  The  Legislature  hereby  finds and declares that medical
 assistance for needy persons is a matter of public concern and a  neces-
 sity  in  promoting  the public health and welfare and for promoting the
 state's goal of making available to everyone, regardless of  race,  age,
 gender,  national  origin  or  economic  standing, uniform, high-quality
 medical care. As the department of health is  the  single  state  agency
 responsible  for  supervising  the administration of the state's medical
 assistance program (Medicaid), it is tasked  with  ensuring  efficiency,
 economy,  and quality of care in providing benefits to the state's needy
 persons. To this end and with the fiscal constraints facing our state in
 mind, the department of health continues to analyze the Medicaid program
 in search of ways to ensure Medicaid spending is held to the standard of
 efficiency, economy, and quality of care. In consideration of this stan-
 dard, the department of health is hereby directed to exercise its exist-
 ing administrative authority to remove the pharmacy benefit from managed
 care benefit package and instead provide the pharmacy benefit under  the
 fee  for service program, except where otherwise required by federal law
 OR WHERE A PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER  IS  AUTHOR-
 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
 
 EDUCATION LAW AND IS PRACTICING MEDICINE IN AN 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,
 to  ensure  transparency and that the benefit is provided to the fullest
 extent and as efficiently  as  possible;  provided,  however,  that  the
 department  of health shall not implement the transition of the pharmacy
 benefit from the managed care benefit package to  the  fee  for  service
 program  sooner  than  April 1, 2023, and until it is satisfied that all
 necessary and appropriate transition planning has occurred, in its  sole
 discretion,  and  federal  approvals have been obtained and preparations
 have been made. Furthermore, to ensure an orderly transition,  continued
 access  to  medications,  and appropriate patient education and support,
 the department may establish uniform  standards,  payment  policies  and
 reimbursement  methodologies  for  any sites where drugs may be adminis-
 tered or dispensed under the fee for  service  program;  provided  that,
 subject  to  the  availability  of federal financial participation, when
 reimbursing covered entities, as  defined  under  section  340B  of  the
 public health service act (42 U.S.C. §256b), for drugs that would other-
 wise  be  eligible  for  pricing under section 340B of the public health
 service act, the department shall examine all reasonably available meth-
 ods  for  determining  actual  acquisition  cost  and  the  professional
 dispensing fee and, beginning in the fiscal year starting April 1, 2023,
 review  and adjust reimbursement for such drugs such that no sooner than
 April 1, 2025, reimbursement shall be determined based on a method  that
 the  commissioner  determines that utilizes the actual acquisition costs
 and professional dispensing fee.
   § 2. This act shall take effect immediately.