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As you know, the 2011-12 New York State Budget passed and was signed into law on March 31, 2011. Since that time, we have worked arduously with state officials to get clarity on budget provisions related to pharmacy. The following information is factual, as of now:
? The pharmacy Medicaid benefit will be bundled into managed care, effective October 1, 2011. This will effect approximately 3 million out of 4 million Medicaid beneficiaries who will be enrolled in managed care, meaning that PBMs will be managing the pharmacy portion of Medicaid.
? Medicaid pharmacy reimbursement is reduced from AWP -16.25% to AWP -17%, effective April 1, 2011. The dispensing fee for generic drugs is also reduced from $4.50 to $3.50, effective April 1, 2011. The Department of Health Commissioner now has flexibility to change pharmacy reimbursement rates and establish a new pricing benchmark, different from AWP.
The state is seeking federal approval for these changes, which may take time. Once federal approval is granted, we have been told that the state will attempt to seek a retroactive reimbursement cut to the April 1 date or will impose additional prospective cuts to regain the "lost savings" as a result of delayed federal approval.
? A 2% across the board cut for all Medicaid providers, including pharmacy, is effective April 1, 2011. The 2% cut will be deducted from weekly Medicaid checks for 2 years.
? A voluntary mail order program for Medicaid recipients will be effective October 1, 2011.
? The early refill process for Medicaid has been tightened. Pharmacists will no longer be able to override the early refill edit due to a medication being lost or stolen. Recipients must contact the Department of Health to request an override. This is effective on April 1, 2011.
? Opioid prescriptions will be limited to a maximum of four (per patient) every thirty days, effective December 1, 2011. There will be override criteria established.
? Starting on May 1, 2011, coverage for enteral nutritional supplements will be limited to persons who are fed via nasogastric, gastrostomy or jejunostomy tubes, persons with inborn metabolic disorders and children under 21 years of age with a documented diagnoses that prevents the absorption or the metabolizing of normal foods.
We will continue to update you as more information becomes available. Thank you.
NYSIIS Training Schedule January - June 2011
PSSNY's Annual Pharmacy Day: Join PSSNY and NYSCHP at the Capitol on Tuesday, April 12 at the Swyer Theater in the Egg.
PSSNY's Annual Convention & Exhibition: June 26-30, 2011 at the Fort William Henry in Lake George, NY!
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