EqualPharmacyAccess

Patients with Medicaid Managed Care should not be barred from accessing the pharmacy of their choice. This bill enables Medicaid patients to have the same ability as other New Yorkers to choose their local pharmacy or pharmacist of choice and how to receive their medications (in-person or delivery without restrictive pharmacy benefit manager (PBM) networks.

When patients have better access to pharmacy services, better health and lower overall healthcare system costs follow. This bill helps ensure limited Medicaid dollars are invested in patient care and local communities.

If Medicaid Managed Care (MMC) is not reformed to cover a pharmacy’s costs for serving patients, New York pharmacies may continue to be forced to close, as many have already, which could further limit patient access. Instead, this bill would convert excessive administrative fees paid currently under the program to pay for actual patient care and improve transparency. The bill would do this by requiring MMC plans and their PBMs to pay a pharmacy in alignment with those rates paid under the state’s Medicaid Fee for Service (FFS) program as established by the Centers for Medicare & Medicaid Services.

S7909/A9165 would allow any pharmacy to participate in a MMC network if the pharmacy, among other terms, accepts the Medicaid FFS reimbursement rate. Today, 31 states now allow “any willing provider” for their MMC plan networks. And 9 states have established a MMC pharmacy payment in alignment with those rates paid under the state’s FFS program established by the Centers for Medicare & Medicaid Services.