Bill > S1089

Introduced Session

This bill provides that a Medicaid managed care contract shall include pharmacy choice as a required benefit for any enrollee. Under the bill, any Medicaid managed care organization (MCO) operating in the State would permit all pharmacies in the State to dispense prescriptions for all covered medications regardless of the cost of medication or other criteria developed by the carrier. A pharmacy in this State would be required to accept the terms and conditions of the plan, but in no case would the pharmacy be required to dispense medication at a rate below the pharmacy's cost of acquisition. The terms and conditions must be designed to allow fair participation by all pharmacies. To ensure that enrollees have access to a competitive selection of providers, the bill requires a Medicaid MCO to permit the enrollee to choose any qualified pharmacy provided that the qualified pharmacy is a contracting provider with the MCO. Additionally, the bill provides that no pharmacy will be denied the right to participate as a contracting provider with an MCO, under the same terms and conditions currently applicable to all other contracting providers, provided that the pharmacy accepts the terms and conditions of the Medicaid managed care contract. Furthermore, the bill prohibits the Medicaid MCO from imposing a copayment, fee, or other condition upon an enrollee selecting a pharmacy that is not also equally imposed upon all enrollees selecting a qualified provider. These conditions would apply to any Medicaid managed care contract executed on or after the effective date of the bill.

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Vin Gopal (D)*,  Joe Vitale (D)*, 

Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee (on 01/30/2020)

Official Document