70.959 Pharmacy Benefit Managers’ or Payors’ Interference with the Course of Good Treatment and Requiring the Provision of Dangerous Quantities of Medicine:
MSSNY is to:
a) seek legislation and/or regulation prohibiting a payor or Pharmacy Benefit Manager (PBM) from either requiring a prescription to be filled with a quantity greater than that which is prescribed by a patient’s treating physician, or imposing significant additional cost-sharing responsibilities on patients for filling prescriptions with smaller quantities;
b) work with the State Insurance, Health and Education Departments to assure that patients can obtain prescription drugs consistent with the dosage, frequency and duration as prescribed by the physician;
c) continue to seek legislation and/or regulation that permits a patient to obtain a denied prescription drug pending an internal or external appeal of a denial by a health insurance company at the insurer’s expense; continue to advocate for legislation that would prevent insurance companies from coercing patients through financial disincentives to change a medication upon which a patient is stabilized, simply due to a change in formulary, change in plan or change in insurer. (HOD 2010-61; Reaffirmed HOD in lieu of 2017-103)
