New York S 6164: Relates to prescription drugs in Medicaid managed care programs; repealer

Bill Text

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S06164 Summary:

BILL NOS06164 

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SAME ASNo Same As

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SPONSORSKOUFIS

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COSPNSR

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MLTSPNSR

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Add §365-i, rpld §364-j subs 25 & 25-a, Soc Serv L; amd §§2511, 270 & 272, Pub Health L

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Requires Medicaid managed care, and Child Health Plus plans to adopt the procedural protections of the Preferred Drug Program, including "prescriber prevails", for all drugs.

Go to top S06164 Actions:

BILL NOS06164 

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03/06/2025REFERRED TO HEALTH

01/07/2026REFERRED TO HEALTH

Go to topS06164 Committee&nbspVotes:

Go to topS06164 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topS06164 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 6164

 2025-2026 Regular Sessions

 IN SENATE

 March 6, 2025
 ___________

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

 AN ACT to amend the social services law and the public health law, in
 relation to prescription drugs in Medicaid managed care programs; and
 to repeal certain provisions of the social services law, relating to
 payments for prescription drugs

 The People of the State of New York, represented in Senate and Assem-
 bly, do enact as follows:

 1 Section 1. The social services law is amended by adding a new section
 2 365-i to read as follows:
 3 § 365-i. Prescription drugs in Medicaid managed care programs. 1.
 4 Definitions. As used in this section, unless the context clearly
 5 requires otherwise:
 6 (a) "Article" means title eleven of article five of this chapter with
 7 respect to the medical assistance program, and title one-A of article
 8 twenty-five of the public health law with respect to the child health
 9 insurance plan.
 10 (b) "Clinical drug review program" means the clinical drug review
 11 program under section two hundred seventy-four of the public health law.
 12 (c) "Emergency condition" means a medical or behavioral condition as
 13 determined by the prescriber or pharmacist, the onset of which is
 14 sudden, that manifests itself by symptoms of sufficient severity,
 15 including severe pain, and for which delay in beginning treatment
 16 prescribed by the patient's health care practitioner would result in:
 17 (i) placing the health or safety of the person afflicted with such
 18 condition or other person or persons in serious jeopardy;
 19 (ii) serious impairment to such person's bodily functions;
 20 (iii) serious dysfunction of any bodily organ or part of such person;
 21 (iv) serious disfigurement of such person; or
 22 (v) severe discomfort.
 23 (d) "Managed care provider" means a managed care provider under
 24 section three hundred sixty-four-j of this title, a managed long term
 25 care plan or other care coordination model under section forty-four
 26 hundred three-f of the public health law, an approved organization under

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD06505-01-5

 S. 6164 2

 1 title one-A of article twenty-five of the public health law (child
 2 health insurance plan), or any other entity that provides or arranges
 3 for the provision of medical assistance services and supplies to partic-
 4 ipants directly or indirectly (including by referral), including case
 5 management, including the managed care provider's authorized agents.
 6 (e) "Non-preferred drug" means a prescription drug that requires prior
 7 authorization under the participant's managed care provider.
 8 (f) "Participant" means a medical assistance recipient who receives,
 9 is required to receive or elects to receive medical assistance services
 10 from a managed care provider.
 11 (g) "Preferred drug" means a prescription drug that is not a non-pre-
 12 ferred drug under the patient's managed care provider. "Preferred drug
 13 list" means a list of a managed care provider's preferred drugs.
 14 (h) "Preferred drug program" means the preferred drug program estab-
 15 lished under section two hundred seventy-two of the public health law.
 16 (i) "Prescriber" means a health care professional authorized to
 17 prescribe prescription drugs for a participant of the managed care
 18 provider, acting within their lawful scope of pract