Bill > A07817

This bill modifies a previous law regarding the New York State Department of Health's management of pharmacy benefits in the Medicaid program. Specifically, the bill creates an exception to the original directive that the Department of Health remove pharmacy benefits from managed care and provide them under a fee-for-service program. The exception applies to situations where a physician is authorized to dispense medications in accordance with section 6807 of the education law and practices medicine in an oncology (cancer treatment) setting. The bill maintains the original law's goal of ensuring efficiency, economy, and quality of care in the Medicaid program, while providing flexibility for oncology physicians to dispense medications. The Department of Health is still directed to transition pharmacy benefits to a fee-for-service program, but not before April 1, 2023, and only after ensuring proper transition planning and obtaining necessary federal approvals. The bill also requires the department to establish uniform standards for drug administration and dispensing, and to review reimbursement methods for covered entities, with the aim of determining reimbursement based on actual acquisition costs and professional dispensing fees by April 1, 2025.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/A7817