Bill Text: NY A02969 | 2019-2020 | General Assembly | Amended
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-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 2969--A R. R. 69 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, ASHBY, REYES, L. ROSENTHAL, VANEL, STIRPE, D. ROSENTHAL, GRIFFIN, JAFFEE, BUCHWALD, GOTTFRIED, D'URSO, MAGNARELLI, STERN, HUNTER, JACOBSON, LiPETRI, HEVESI, OTIS, CARROLL, STECK, SIMON, MIKULIN, PICHARDO, EPSTEIN, ROZIC, WALLACE, MALLIOTAKIS, BUTTENSCHON, SCHMITT -- Multi-Sponsored by -- M. of A. ENGLEBRIGHT, RA, THIELE -- read once and referred to the Committee on Insurance -- reported and referred to the Committee on Codes -- reported and referred to the Committee on Rules -- amended on the special order of third reading, ordered reprinted as amended, retaining its place on the special order of third reading 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 EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD04720-04-9A. 2969--A 2 1 year and through the end of the plan year to which such open enrollment 2 period applies. 3 (c) (i) A health care plan with a formulary that includes two or more 4 tiers of benefits providing for different deductibles, copayments or 5 coinsurance applicable to prescription drugs in each tier may move a 6 prescription drug to a tier with a larger deductible, copayment or coin- 7 surance if an AB-rated generic equivalent or interchangeable biological 8 product for such prescription drug is added to the formulary at the same 9 time. 10 (ii) A health care plan may remove a prescription drug from a formu- 11 lary if the federal Food and Drug Administration determines that such 12 prescription drug should be removed from the market, including new 13 utilization management restrictions issued pursuant to federal Food and 14 Drug Administration safety concerns. 15 (d) A health care plan shall provide notice to policyholders of the 16 intent to remove a prescription drug from a formulary or alter deduct- 17 ible, copayment or coinsurance requirements in the upcoming plan year, 18 thirty days prior to the open enrollment period for the consecutive plan 19 year. Such notice of impending formulary and deductible, copayment or 20 coinsurance changes shall also be posted on the plan's online formulary 21 and in any prescription drug finder system that the plan provides to the 22 public. 23 (e) The provisions of this section shall not supersede the terms of a 24 collective bargaining agreement, or the rights of labor representation 25 groups to collectively bargain changes to the formularies. 26 § 2. The public health law is amended by adding a new section 4909 to 27 read as follows: 28 § 4909. Prescription drug formulary changes. 1. Except as otherwise 29 provided in subdivision three of this section, a health care plan shall 30 not: 31 (a) remove a prescription drug from a formulary; 32 (b) move a prescription drug to a tier with a larger deductible, 33 copayment, or coinsurance if the formulary includes two or more tiers of 34 benefits providing for different deductibles, copayments or coinsurance 35 applicable to the prescription drugs in each tier; or 36 (c) add utilization management restrictions to a prescription drug on 37 a formulary, unless such changes occur at the time of enrollment or 38 issuance of coverage. 39 2. Prohibitions provided in subdivision one of this section shall 40 apply beginning on the date on which open enrollment begins for a plan 41 year and through the end of the plan year to which such open enrollment 42 period applies. 43 3. (a) A health care plan with a formulary that includes two or more 44 tiers of benefits providing for different deductibles, copayments or 45 coinsurance applicable to prescription drugs in each tier may move a 46 prescription drug to a tier with a larger deductible, copayment or coin- 47 surance if an AB-rated generic equivalent or interchangeable biological 48 product for such prescription drug is added to the formulary at the same 49 time. 50 (b) A health care plan may remove a prescription drug from a formulary 51 if the federal Food and Drug Administration determines that such 52 prescription drug should be removed from the market, including new 53 utilization management restrictions issued pursuant to federal Food and 54 Drug Administration safety concerns. 55 4. A health care plan shall provide notice to policyholders of the 56 intent to remove a prescription drug from a formulary or alter deduct-A. 2969--A 3 1 ible, copayment or coinsurance requirements in the upcoming plan year, 2 thirty days prior to the open enrollment period for the consecutive plan 3 year. Such notice of impending formulary and deductible, copayment or 4 coinsurance changes shall also be posted on the plan's online formulary 5 and in any prescription drug finder system that the plan provides to the 6 public. 7 5. The provisions of this section shall not supersede the terms of a 8 collective bargaining agreement, or the rights of labor representation 9 groups to collectively bargain changes to the formularies. 10 § 3. This act shall take effect on the sixtieth day after it shall 11 have become a law. Effective immediately, the addition, amendment 12 and/or repeal of any rule or regulation necessary for the implementation 13 of this act on its effective date are authorized to be made and 14 completed on or before such effective date.