Relates to pharmacy benefits where a physician is authorized to dispense certain medications and practices medicine in the oncology setting

• Democratic2

◆ The sponsor's argument

Why Gustavo Rivera says this is needed

The 2020 New York State budget included provisions that transitioned the Medicaid pharmacy benefit from Medicaid Managed Care (MMC) to Fee-For- Service (FFS). This transition has complicated oncologists' ability to dispense medications in office, and instead forces their patients to travel to obtain prescriptions in pharmacies outside of where they are being treated. The formula used to calculate physician-administered drug rate under MMC is significantly higher than the rate used under the FFS benefit, making it financially unsustainable for oncologists to store and dispense these specialized medications in-office. Cancer patients who are undergoing treatment require access to a variety of medications which include pain and symptom management, maintenance, pre-procedure, and preventative care medications. Adherence and access to these medications presents a significant challenge for these patients who undergo very complex treatment regimens, requiring coordination of care and consistent and precise timing of medication consumption. The ability to prescribe medications at on-site appointments creates a seam- less process for providers and patients since cancer treatment typically involves frequent adjustments to dosages or prescription changes which necessitates continuous coordination between patients and their health- care providers. The inability to dispense in-office prescriptions creates a significant risk for immuno-compromised patients who are required to travel off-site to pick-up their medications. Pharmaceutical environments are frequented by individuals with contagious illnesses which can be life threatening to those with an already compromised immune system. In-office prescriptions offer substantial benefits for cancer patients, including eliminating additional transportation costs and risks; enhancing medical adherence through direct provider oversight of medication changes; reducing patient exposure to potentially infectious environments at pharmacies; and reducing waste of unused medication. This bill would authorize reimbursement for oncology physicians at the MMC rate, rather than the lower FFS rate. This adjustment would enable more oncology physicians to dispense in-office, thereby improving quali- ty of care, treatment adherence, and overall health outcomes for cancer patients.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.