Bill Text: NY A04899 | 2019-2020 | General Assembly | Amended

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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) 2020-04-15 - print number 4899a [A04899 Detail]

Download: New_York-2019-A04899-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         4899--A

                               2019-2020 Regular Sessions

                   IN ASSEMBLY

                                    February 5, 2019
                                       ___________

        Introduced  by M. of A. RAMOS -- read once and referred to the Committee
          on Insurance -- recommitted to the Committee on Insurance  in  accord-
          ance  with  Assembly  Rule  3,  sec.  2  -- committee discharged, bill
          amended, ordered reprinted as amended and recommitted to said  commit-
          tee

        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 36 to read as follows:
     3    (36) 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    § 2. Subsection (k) of section 3221 of the insurance law is amended by
    17  adding a new paragraph 22 to read as follows:
    18    (22) 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

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD07563-02-0
        A. 4899--A                          2

     1  preferred under such formulary and has filed a grievance or an appeal of
     2  the  denial of access to the drug with the insurer or a state or federal
     3  agency or designee of such agency, to continue  receiving  coverage  for
     4  such  drug  under the same terms and conditions as would apply under the
     5  policy were such drug still included in or preferred  under  the  formu-
     6  lary, until a final decision is rendered on the appeal or grievance. For
     7  the  purpose  of  this paragraph, "single source drug" means a brandname
     8  drug for which there is no generic equivalent.
     9    § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
    10  subsection (ss) to read as follows:
    11    (ss)  Every  contract  delivered  or issued for delivery in this state
    12  providing coverage for prescription drugs through  the  use  of  a  drug
    13  formulary  shall  include a provision which, in the event of a change to
    14  such formulary, allows a covered person who is taking  a  single  source
    15  drug  covered  under  such  contract  that  is  no longer included in or
    16  preferred under such formulary and has filed a grievance or an appeal of
    17  the denial of access to the drug with the insurer corporation or  organ-
    18  ization  certified  pursuant  to article forty-four of the public health
    19  law or a state or federal agency or designee of such agency, to continue
    20  receiving coverage for such drug under the same terms and conditions  as
    21  would  apply  under  the  contract  were  such drug still included in or
    22  preferred under the formulary, until a final decision is rendered on the
    23  appeal or grievance. For the purpose of this subsection, "single  source
    24  drug" means a brandname drug for which there is no generic equivalent.
    25    §  4.  This  act  shall take effect on the first of the calendar month
    26  next succeeding the sixtieth day after  it  shall  have  become  a  law;
    27  provided,  however,  that  this  act  shall  apply  only to policies and
    28  contracts issued, renewed or amended on or after such effective date.