Bill Text: NY A03043 | 2019-2020 | General Assembly | Introduced


Bill Title: Relates to the purchase of prescription drugs.

Spectrum: Strong Partisan Bill (Democrat 34-2)

Status: (Engrossed) 2019-05-06 - REFERRED TO INSURANCE [A03043 Detail]

Download: New_York-2019-A03043-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                          3043
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                    January 28, 2019
                                       ___________
        Introduced  by M. of A. JOYNER, AUBRY, BLAKE, BUCHWALD, CUSICK, CYMBROW-
          ITZ, DINOWITZ, GALEF,  GOTTFRIED,  GUNTHER,  HEVESI,  JAFFEE,  LAVINE,
          PAULIN,  PERRY,  RODRIGUEZ,  L. ROSENTHAL,  SIMON,  THIELE, ZEBROWSKI,
          COLTON, COOK, ORTIZ, MONTESANO, GLICK, CARROLL, D'URSO, CRESPO,  SIMO-
          TAS,  WOERNER, TAYLOR, STECK, MOSLEY -- Multi-Sponsored by -- M. of A.
          BRAUNSTEIN, CROUCH, NOLAN -- read once and referred to  the  Committee
          on Insurance
        AN  ACT  to  amend  the  insurance  law,  in relation to the purchase of
          prescription drugs
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
     1    Section  1.  Paragraph  28  of  subsection  (i) of section 3216 of the
     2  insurance law, as amended by chapter 11 of the laws of 2012, is  amended
     3  to read as follows:
     4    (28) (A) Definitions. For the purpose of this paragraph:
     5    (1) "Same reimbursement amount" shall mean that any coverage described
     6  under  subparagraph  (B) of this paragraph shall provide the same bench-
     7  mark index, including the same average wholesale price,  maximum  allow-
     8  able  cost and national prescription drug codes to reimburse all pharma-
     9  cies participating in the insurance  network  regardless  of  whether  a
    10  pharmacy is a mail order pharmacy or a non-mail order pharmacy.
    11    (2)  "Mail  order pharmacy" means a pharmacy whose primary business is
    12  to  receive  prescriptions  by  mail,  telefax  or  through   electronic
    13  submissions  and  to  dispense medication to patients through the use of
    14  the United States mail or other common or contract carrier services  and
    15  provides any consultation with patients electronically rather than face-
    16  to-face.
    17    (B)  Any  policy  that  provides coverage for prescription drugs shall
    18  permit each insured  to  fill  any  covered  prescription  that  may  be
    19  obtained at a network participating mail order or other non-retail phar-
    20  macy, at the insured's option, at a network participating non-mail order
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00271-01-9

        A. 3043                             2
     1  retail  pharmacy  provided that the network participating non-mail order
     2  retail pharmacy agrees [in advance, through a contractual network agree-
     3  ment,] to the same reimbursement amount[, as well as the same applicable
     4  terms  and conditions,] that the insurer has established for the network
     5  participating mail order or other non-retail pharmacy. In such  a  case,
     6  the  policy  shall not impose a co-payment fee or other condition on any
     7  insured who elects to purchase prescription drugs from a network partic-
     8  ipating non-mail order retail pharmacy which  is  not  also  imposed  on
     9  insureds  electing  to  purchase drugs from a network participating mail
    10  order or other non-retail pharmacy.
    11    § 2. Paragraph 18 of subsection (l) of section 3221 of  the  insurance
    12  law, as amended by chapter 11 of the laws of 2012, is amended to read as
    13  follows:
    14    (18) (A) Definitions. For the purpose of this paragraph:
    15    (1) "Same reimbursement amount" shall mean that any coverage described
    16  under  subparagraph  (B) of this paragraph shall provide the same bench-
    17  mark index, including the same average wholesale price,  maximum  allow-
    18  able  cost and national prescription drug codes to reimburse all pharma-
    19  cies participating in the insurance  network  regardless  of  whether  a
    20  pharmacy is a mail order pharmacy or a non-mail order pharmacy.
    21    (2)  "Mail  order pharmacy" means a pharmacy whose primary business is
    22  to  receive  prescriptions  by  mail,  telefax  or  through   electronic
    23  submissions  and  to  dispense medication to patients through the use of
    24  the United States mail or other common or contract carrier services  and
    25  provides any consultation with patients electronically rather than face-
    26  to-face.
    27    (B)  Any  insurer  delivering  a  group or blanket policy or issuing a
    28  group or blanket policy for delivery in this state that provides  cover-
    29  age for prescription drugs shall permit each insured to fill any covered
    30  prescription  that may be obtained at a network participating mail order
    31  or other non-retail pharmacy, at the  insured's  option,  at  a  network
    32  participating  non-mail  order retail pharmacy provided that the network
    33  participating non-mail order retail pharmacy agrees [in advance, through
    34  a contractual network agreement,] to the same reimbursement amount[,  as
    35  well  as the same applicable terms and conditions,] that the insurer has
    36  established for the network participating mail order or other non-retail
    37  pharmacy. In such a case, the policy shall not impose a  co-payment  fee
    38  or  other  condition  on any insured who elects to purchase drugs from a
    39  network participating non-mail order retail pharmacy which is  not  also
    40  imposed  on  insureds  electing to purchase drugs from a network partic-
    41  ipating mail order or other non-retail pharmacy; provided, however, that
    42  the provisions of this section  shall  not  supersede  the  terms  of  a
    43  collective  bargaining agreement or apply to a policy that is the result
    44  of a collective bargaining agreement between an employer  and  a  recog-
    45  nized or certified employee organization.
    46    §  3. Subsection (kk) of section 4303 of the insurance law, as amended
    47  by chapter 11 of the laws of 2012 and as relettered  by  section  55  of
    48  part D of chapter 56 of the laws of 2013, is amended to read as follows:
    49    (kk) (1) Definitions. For the purpose of this subsection:
    50    (A) "Same reimbursement amount" shall mean that any coverage described
    51  under  paragraph two of this subsection shall provide the same benchmark
    52  index, including the same average  wholesale  price,  maximum  allowable
    53  cost  and  national  prescription drug codes to reimburse all pharmacies
    54  participating in the health benefit plan regardless of whether a pharma-
    55  cy is a mail order pharmacy or a non-mail order pharmacy.

        A. 3043                             3
     1    (B) "Mail order pharmacy" means a pharmacy whose primary  business  is
     2  to   receive  prescriptions  by  mail,  telefax  or  through  electronic
     3  submissions and to dispense medication to patients through  the  use  of
     4  the  United States mail or other common or contract carrier services and
     5  provides any consultation with patients electronically rather than face-
     6  to-face.
     7    (2)  Any contract issued by a medical expense indemnity corporation, a
     8  hospital service corporation  or  a  health  services  corporation  that
     9  provides  coverage  for  prescription  drugs  shall  permit each covered
    10  person to fill any covered  prescription  that  may  be  obtained  at  a
    11  network  participating  mail  order or other non-retail pharmacy, at the
    12  covered person's option,  at  a  network  participating  non-mail  order
    13  retail  pharmacy  provided that the network participating non-mail order
    14  retail pharmacy agrees [in advance, through a contractual network agree-
    15  ment,] to the same reimbursement amount[, as well as the same applicable
    16  terms and conditions,] that the  corporation  has  established  for  the
    17  network  participating mail order or other non-retail pharmacy.  In such
    18  a case, the contract shall not impose a copayment fee or other condition
    19  on any covered person who  elects  to  purchase  drugs  from  a  network
    20  participating  non-mail  order retail pharmacy which is not also imposed
    21  on covered persons electing to purchase drugs from a network participat-
    22  ing mail order or other non-retail pharmacy; provided, however, that the
    23  provisions of this section shall not supersede the terms of a collective
    24  bargaining agreement or apply to a contract that  is  the  result  of  a
    25  collective  bargaining agreement between an employer and a recognized or
    26  certified employee organization.
    27    § 4. This act shall take effect immediately.
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