Mandated Recycling of Organic Waste
The Executive Budget had proposed a new requirement that certain high volume generators of food waste including health care facilities , manufacturers , supermarkets , large restaurants and higher educational institutions recycle their food waste beginning January 1 , 2021 . Under the proposed requirements , such businesses would have needed to divert excess edible food and food scraps to food banks , animal feed operations , composting facilities , anaerobic digesters , or other organics recycling facilities . The final budget does not include this proposal .
Pharmacy
• Reining in Rising Drug Spending Under Medicaid : The final budget modifies the Governor ’ s proposals to rein in rising prescription drug spending . As described above , it creates a Medicaid drug cap within the Medicaid global cap . If Medicaid spending on drugs is projected to exceed the cap , the Commissioner of Health may refer selected drugs to the Drug Utilization Review Board ( DURB ) to determine whether negotiation of a supplemental rebate with the manufacturers is justified . If a manufacturer is not willing to pay a supplemental rebate , the manufacturer will be required to provide extensive information to the Department regarding its costs , prices and margin . In addition , the Department may eliminate prescriber prevails requirements . If drug spending is still projected to exceed the cap , the Department may take various steps to reduce utilization of the selected drugs , including prior authorization and removal of drugs from formularies .
• Prior Authorization of Refills of Controlled Substances : The final budget accepts the Governor ’ s proposal to authorize DOH to require prior authorization of any refill of a controlled substance under feefor-service Medicaid , when more than a 7-day supply of the previously dispensed amount should remain , if the drugs had been used as directed .
• Opioid Prescribing : The final budget accepts the Governor ’ s proposal to make it an “ unacceptable practice ” in the Medicaid program to prescribe opioids in violation of applicable laws or contrary to recommendations issued by the Drug Utilization Review Board with additional procedural specifications and due process language . Commission of an “ unacceptable practice ” may lead to exclusion from the Medicaid program .
• Prior Authorization and Prescriber Prevails : The final budget rejects the Governor ’ s proposal to eliminate “ prescriber prevails ,” i . e ., prescribing professionals will continue to be able to override the formulary of the fee-for-service Medicaid preferred drug program regarding coverage of any prescription drug and the formularies of Medicaid managed care plans regarding coverage of atypical antipsychotic and anti-depressant , anti-retroviral , anti-rejection , seizure , epilepsy , endocrine , hematologic and immunologic therapeutic classes of prescription drugs .
• Reimbursement of Pharmacies under Fee-for-Service Medicaid : The final budget includes various changes to fee-for-service reimbursement rates for pharmacies for generic , brand name , and nonprescription drugs , and increases the dispensing fee to $ 10 for prescription drugs and certain nonprescription , covered out-patient drugs . Dispensing fees will be increased to $ 10 for all prescription drugs .
• Copayments : The final budget reduces beneficiary copayments on non-preferred brand name prescription drugs from $ 3.00 to $ 2.50 . However , brand name prescription drugs that cost less than their generic equivalents and preferred brand name drugs are subject to a $ 1.00 copayment . Generic drug copayments remain at $ 1.00 . Copayments do not apply to MLTC plan members .
• Generic Drug Rebates : The Governor proposes to reduce the price increase that triggers an additional rebate on generic drugs from 300 percent to 75 percent .
• Comprehensive Medication Management : The April 3 budget rejects the Governor ’ s proposal to expand the existing Collaborative Drug Therapy Management program currently authorized in Article 28 facilities .
LeadingAge New York / April 2017 Page 5