Bill Text: NY A02969 | 2019-2020 | General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Prohibits a health care plan from making prescription drug formulary changes during a contract year.

Spectrum: Moderate Partisan Bill (Democrat 43-8)

Status: (Vetoed) 2019-12-23 - tabled [A02969 Detail]

Download: New_York-2019-A02969-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          2969
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                    January 28, 2019
                                       ___________
        Introduced  by  M.  of  A.  PEOPLES-STOKES, BARRETT, NIOU, ORTIZ, GALEF,
          ABINANTI,  LAVINE,  COLTON,  JEAN-PIERRE,   TAYLOR,   BYRNE,   WEPRIN,
          SEAWRIGHT,  BARRON,  MOSLEY, LUPARDO -- Multi-Sponsored by -- M. of A.
          ENGLEBRIGHT, HEVESI, RA, THIELE --  read  once  and  referred  to  the
          Committee on Insurance
        AN ACT to amend the insurance law and the public health law, in relation
          to prescription drug formulary changes during a contract year
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. The insurance law is amended by adding a new  section  4909
     2  to read as follows:
     3    §  4909.  Prescription drug formulary changes. (a) Except as otherwise
     4  provided in subsection (c) of this section, a  health  care  plan  shall
     5  not:
     6    (i) remove a prescription drug from a formulary;
     7    (ii)  move  a  prescription  drug  to a tier with a larger deductible,
     8  copayment, or coinsurance if the formulary includes two or more tiers of
     9  benefits providing for different deductibles, copayments or  coinsurance
    10  applicable to the prescription drugs in each tier; or
    11    (iii)  add  utilization management restrictions to a prescription drug
    12  on a formulary, unless such changes occur at the time of  enrollment  or
    13  issuance of coverage.
    14    (b)  Prohibitions  provided  in  subsection  (a) of this section shall
    15  apply beginning on the date on which open enrollment begins for  a  plan
    16  year  and through the end of the plan year to which such open enrollment
    17  period applies.
    18    (c) (i) A health care plan with a formulary that includes two or  more
    19  tiers  of  benefits  providing  for different deductibles, copayments or
    20  coinsurance applicable to prescription drugs in each  tier  may  move  a
    21  prescription drug to a tier with a larger deductible, copayment or coin-
    22  surance  if an AB-rated generic equivalent or interchangeable biological
    23  product for such prescription drug is added to the formulary at the same
    24  time.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04720-01-9
        A. 2969                             2
     1    (ii) A health care plan may remove a prescription drug from  a  formu-
     2  lary  if  the  federal Food and Drug Administration determines that such
     3  prescription drug should be  removed  from  the  market,  including  new
     4  utilization  management restrictions issued pursuant to federal Food and
     5  Drug Administration safety concerns.
     6    (d)  A  health  care plan shall provide notice to policyholders of the
     7  intent to remove a prescription drug from a formulary or  alter  deduct-
     8  ible,  copayment  or coinsurance requirements in the upcoming plan year,
     9  thirty days prior to the open enrollment period for the consecutive plan
    10  year. Such notice of impending formulary and  deductible,  copayment  or
    11  coinsurance  changes shall also be posted on the plan's online formulary
    12  and in any prescription drug finder system that the plan provides to the
    13  public.
    14    § 2. The public health law is amended by adding a new section 4909  to
    15  read as follows:
    16    §  4909.  Prescription  drug formulary changes. 1. Except as otherwise
    17  provided in subdivision three of this section, a health care plan  shall
    18  not:
    19    (a) remove a prescription drug from a formulary;
    20    (b)  move  a  prescription  drug  to  a tier with a larger deductible,
    21  copayment, or coinsurance if the formulary includes two or more tiers of
    22  benefits providing for different deductibles, copayments or  coinsurance
    23  applicable to the prescription drugs in each tier; or
    24    (c)  add utilization management restrictions to a prescription drug on
    25  a formulary, unless such changes occur at  the  time  of  enrollment  or
    26  issuance of coverage.
    27    2.  Prohibitions  provided  in  subdivision  one of this section shall
    28  apply beginning on the date on which open enrollment begins for  a  plan
    29  year  and through the end of the plan year to which such open enrollment
    30  period applies.
    31    3. (a) A health care plan with a formulary that includes two  or  more
    32  tiers  of  benefits  providing  for different deductibles, copayments or
    33  coinsurance applicable to prescription drugs in each  tier  may  move  a
    34  prescription drug to a tier with a larger deductible, copayment or coin-
    35  surance  if an AB-rated generic equivalent or interchangeable biological
    36  product for such prescription drug is added to the formulary at the same
    37  time.
    38    (b) A health care plan may remove a prescription drug from a formulary
    39  if the  federal  Food  and  Drug  Administration  determines  that  such
    40  prescription  drug  should  be  removed  from  the market, including new
    41  utilization management restrictions issued pursuant to federal Food  and
    42  Drug Administration safety concerns.
    43    4.  A  health  care  plan shall provide notice to policyholders of the
    44  intent to remove a prescription drug from a formulary or  alter  deduct-
    45  ible,  copayment  or coinsurance requirements in the upcoming plan year,
    46  thirty days prior to the open enrollment period for the consecutive plan
    47  year. Such notice of impending formulary and  deductible,  copayment  or
    48  coinsurance  changes shall also be posted on the plan's online formulary
    49  and in any prescription drug finder system that the plan provides to the
    50  public.
    51    § 3. This act shall take effect on the sixtieth  day  after  it  shall
    52  have  become  a  law.    Effective  immediately, the addition, amendment
    53  and/or repeal of any rule or regulation necessary for the implementation
    54  of this act on  its  effective  date  are  authorized  to  be  made  and
    55  completed on or before such effective date.