Bill Text: NY A04477 | 2015-2016 | General Assembly | Introduced

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Bill Title: Provides that every insurance policy which provides coverage for prescription drugs shall insure that there is continuous coverage of a single source drug that is part of a prescribed therapy until such prescribed therapy is no longer medically necessary for the enrollee of such policy; defines "single source drug".

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2016-01-06 - referred to insurance [A04477 Detail]

Download: New_York-2015-A04477-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         4477
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                   February 2, 2015
                                      ___________
       Introduced  by M. of A. RAMOS -- read once and referred to the Committee
         on Insurance
       AN ACT to amend the insurance law, in relation to  coverage  for  single
         source drugs
         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
    2  amended by adding a new paragraph 32 to read as follows:
    3    (32) EVERY INDIVIDUAL OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIV-
    4  ERY  IN THIS STATE PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH THE
    5  USE OF A DRUG FORMULARY SHALL INCLUDE A PROVISION WHICH, IN THE EVENT OF
    6  A CHANGE TO SUCH FORMULARY, ALLOWS A COVERED  PERSON  WHO  IS  TAKING  A
    7  SINGLE  SOURCE DRUG COVERED UNDER SUCH POLICY THAT IS NO LONGER INCLUDED
    8  IN OR PREFERRED UNDER SUCH FORMULARY AND HAS FILED  A  GRIEVANCE  OR  AN
    9  APPEAL  OF  THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER OR A STATE
   10  OR FEDERAL AGENCY OR DESIGNEE OF  SUCH  AGENCY,  TO  CONTINUE  RECEIVING
   11  COVERAGE  FOR  SUCH  DRUG  UNDER  THE SAME TERMS AND CONDITIONS AS WOULD
   12  APPLY UNDER THE POLICY WERE SUCH DRUG STILL  INCLUDED  IN  OR  PREFERRED
   13  UNDER THE FORMULARY, UNTIL A FINAL DECISION IS RENDERED ON THE APPEAL OR
   14  GRIEVANCE. FOR THE PURPOSE OF THIS PARAGRAPH, "SINGLE SOURCE DRUG" MEANS
   15  A BRANDNAME DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
   16    S 2. Subsection (k) of section 3221 of the insurance law is amended by
   17  adding a new paragraph 20 to read as follows:
   18    (20) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN
   19  THIS  STATE PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH THE USE OF
   20  A DRUG FORMULARY SHALL INCLUDE A PROVISION WHICH,  IN  THE  EVENT  OF  A
   21  CHANGE TO SUCH FORMULARY, ALLOWS A COVERED PERSON WHO IS TAKING A SINGLE
   22  SOURCE  DRUG  COVERED UNDER SUCH POLICY THAT IS NO LONGER INCLUDED IN OR
   23  PREFERRED UNDER SUCH FORMULARY AND HAS FILED A GRIEVANCE OR AN APPEAL OF
   24  THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER OR A STATE OR  FEDERAL
   25  AGENCY  OR  DESIGNEE  OF SUCH AGENCY, TO CONTINUE RECEIVING COVERAGE FOR
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD00451-02-5
       A. 4477                             2
    1  SUCH DRUG UNDER THE SAME TERMS AND CONDITIONS AS WOULD APPLY  UNDER  THE
    2  POLICY  WERE  SUCH  DRUG STILL INCLUDED IN OR PREFERRED UNDER THE FORMU-
    3  LARY, UNTIL A FINAL DECISION IS RENDERED ON THE APPEAL OR GRIEVANCE. FOR
    4  THE  PURPOSE  OF  THIS PARAGRAPH, "SINGLE SOURCE DRUG" MEANS A BRANDNAME
    5  DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
    6    S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
    7  subsection (pp) to read as follows:
    8    (PP)  EVERY  CONTRACT  DELIVERED  OR ISSUED FOR DELIVERY IN THIS STATE
    9  PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH  THE  USE  OF  A  DRUG
   10  FORMULARY  SHALL  INCLUDE A PROVISION WHICH, IN THE EVENT OF A CHANGE TO
   11  SUCH FORMULARY, ALLOWS A COVERED PERSON WHO IS TAKING  A  SINGLE  SOURCE
   12  DRUG  COVERED  UNDER  SUCH  CONTRACT  THAT  IS  NO LONGER INCLUDED IN OR
   13  PREFERRED UNDER SUCH FORMULARY AND HAS FILED A GRIEVANCE OR AN APPEAL OF
   14  THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER CORPORATION OR  ORGAN-
   15  IZATION  CERTIFIED  PURSUANT  TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
   16  LAW OR A STATE OR FEDERAL AGENCY OR DESIGNEE OF SUCH AGENCY, TO CONTINUE
   17  RECEIVING COVERAGE FOR SUCH DRUG UNDER THE SAME TERMS AND CONDITIONS  AS
   18  WOULD  APPLY  UNDER  THE  CONTRACT  WERE  SUCH DRUG STILL INCLUDED IN OR
   19  PREFERRED UNDER THE FORMULARY, UNTIL A FINAL DECISION IS RENDERED ON THE
   20  APPEAL OR GRIEVANCE. FOR THE PURPOSE OF THIS SUBSECTION, "SINGLE  SOURCE
   21  DRUG" MEANS A BRANDNAME DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
   22    S  4.  This  act  shall take effect on the first of the calendar month
   23  next succeeding the sixtieth day after  it  shall  have  become  a  law;
   24  provided,  however,  that  this  act  shall  apply  only to policies and
   25  contracts issued, renewed or amended on or after such effective date.