Bill Text: NY A05502 | 2011-2012 | General Assembly | Amended
Bill Title: Prohibits health insurers from requiring the insured purchase prescribed drugs from a mail order pharmacy or pay a co-payment fee when such purchases are not made from a mail order pharmacy if a similar fee is not charged for drugs from a mail order pharmacy.
Spectrum: Slight Partisan Bill (Democrat 47-28)
Status: (Passed) 2011-12-12 - approval memo.14 [A05502 Detail]
Download: New_York-2011-A05502-Amended.html
S T A T E O F N E W Y O R K
________________________________________________________________________
5502--B
2011-2012 Regular Sessions
I N A S S E M B L Y
February 22, 2011
___________
Introduced by M. of A. HEASTIE, GOTTFRIED, COLTON, ROSENTHAL, M. MILLER,
CYMBROWITZ, MOYA, O'DONNELL, THIELE, GALEF, CASTRO, DenDEKKER, BENE-
DETTO, GUNTHER, SCHROEDER, MAISEL, SPANO, SCHIMEL, V. LOPEZ, WEISEN-
BERG, LAVINE, WEPRIN, ENGLEBRIGHT, SWEENEY, PAULIN, DINOWITZ, MENG,
RODRIGUEZ, HOYT, GABRYSZAK, TITONE -- Multi-Sponsored by -- M. of A.
ABBATE, ABINANTI, BOYLE, BURLING, CASTELLI, CERETTO, CORWIN, CRESPO,
CROUCH, DUPREY, GIGLIO, GRAF, HAYES, JACOBS, KATZ, LATIMER, P. LOPEZ,
LOSQUADRO, MALLIOTAKIS, J. MILLER, MONTESANO, MURRAY, PALMESANO,
PEOPLES-STOKES, RA, RAIA, P. RIVERA, ROBERTS, SALADINO, SAYWARD,
SMARDZ -- read once and referred to the Committee on Insurance --
committee discharged, bill amended, ordered reprinted as amended and
recommitted to said committee -- again reported from said committee
with amendments, ordered reprinted as amended and recommitted to said
committee
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. Subsection (i) of section 3216 of the insurance law is
2 amended by adding a new paragraph 28 to read as follows:
3 (28) ANY POLICY WHICH PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL
4 PERMIT EACH PARTICIPANT TO FILL ANY MAIL ORDER COVERED PRESCRIPTION, AT
5 HIS OR HER OPTION, AT ANY MAIL ORDER PHARMACY OR NETWORK PARTICIPATING
6 NON-MAIL ORDER RETAIL PHARMACY IF THE NETWORK PARTICIPATING NON-MAIL
7 ORDER RETAIL PHARMACY OFFERS TO ACCEPT A PRICE THAT IS COMPARABLE TO
8 THAT OF THE MAIL ORDER PHARMACY. ANY POLICY WHICH PROVIDES COVERAGE FOR
9 PRESCRIPTION DRUGS SHALL NOT IMPOSE A CO-PAYMENT FEE OR OTHER CONDITION
10 ON ANY INSURED WHO ELECTS TO PURCHASE DRUGS FROM A NETWORK PARTICIPATING
11 NON-MAIL ORDER RETAIL PHARMACY WHICH IS NOT ALSO IMPOSED ON INSUREDS
12 ELECTING TO PURCHASE DRUGS FROM A DESIGNATED MAIL ORDER PHARMACY;
13 PROVIDED, HOWEVER, THAT THE PROVISIONS OF THIS SECTION SHALL NOT SUPER-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09145-06-1
A. 5502--B 2
1 SEDE THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT OR APPLY TO A POLICY
2 THAT IS THE RESULT OF A COLLECTIVE BARGAINING AGREEMENT BETWEEN AN
3 EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGANIZATION.
4 S 2. Subsection (1) of section 3221 of the insurance law is amended by
5 adding a new paragraph 18 to read as follows:
6 (18) ANY INSURER DELIVERING A GROUP OR BLANKET POLICY OR ISSUING A
7 GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE WHICH PROVIDES COVER-
8 AGE FOR PRESCRIPTION DRUGS SHALL PERMIT EACH PARTICIPANT TO FILL ANY
9 MAIL ORDER COVERED PRESCRIPTION, AT HIS OR HER OPTION, AT ANY MAIL ORDER
10 PHARMACY OR NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY IF THE
11 NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY OFFERS TO ACCEPT A
12 PRICE THAT IS COMPARABLE TO THAT OF THE MAIL ORDER PHARMACY. ANY POLICY
13 WHICH PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL NOT IMPOSE A
14 CO-PAYMENT FEE OR OTHER CONDITION ON ANY INSURED WHO ELECTS TO PURCHASE
15 DRUGS FROM A NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY WHICH
16 IS NOT ALSO IMPOSED ON INSUREDS ELECTING TO PURCHASE DRUGS FROM A DESIG-
17 NATED MAIL ORDER PHARMACY; PROVIDED, HOWEVER, THAT THE PROVISIONS OF
18 THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF A COLLECTIVE BARGAINING
19 AGREEMENT OR APPLY TO A POLICY THAT IS THE RESULT OF A COLLECTIVE
20 BARGAINING AGREEMENT BETWEEN AN EMPLOYER AND A RECOGNIZED OR CERTIFIED
21 EMPLOYEE ORGANIZATION.
22 S 3. Section 4303 of the insurance law is amended by adding a new
23 subsection (hh) to read as follows:
24 (HH) ANY POLICY ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION, A
25 HOSPITAL SERVICE CORPORATION OR A HEALTH SERVICES CORPORATION WHICH
26 PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL PERMIT EACH PARTICIPANT
27 TO FILL ANY MAIL ORDER COVERED PRESCRIPTION, AT HIS OR HER OPTION, AT
28 ANY MAIL ORDER PHARMACY OR NETWORK PARTICIPATING NON-MAIL ORDER RETAIL
29 PHARMACY IF THE NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY
30 OFFERS TO ACCEPT A PRICE THAT IS COMPARABLE TO THAT OF THE MAIL ORDER
31 PHARMACY. ANY POLICY WHICH PROVIDES COVERAGE FOR PRESCRIPTION DRUGS
32 SHALL NOT IMPOSE A COPAYMENT FEE OR OTHER CONDITION ON ANY INSURED WHO
33 ELECTS TO PURCHASE DRUGS FROM A NETWORK PARTICIPATING NON-MAIL ORDER
34 RETAIL PHARMACY WHICH IS NOT ALSO IMPOSED ON INSUREDS ELECTING TO
35 PURCHASE DRUGS FROM A DESIGNATED MAIL ORDER PHARMACY; PROVIDED, HOWEVER,
36 THAT THE PROVISIONS OF THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF A
37 COLLECTIVE BARGAINING AGREEMENT OR APPLY TO A POLICY THAT IS THE RESULT
38 OF A COLLECTIVE BARGAINING AGREEMENT BETWEEN AN EMPLOYER AND A RECOG-
39 NIZED OR CERTIFIED EMPLOYEE ORGANIZATION.
40 S 4. If any clause, subparagraph, subsection, section or other part
41 of this act, or the application thereof be held to be invalid, such
42 holding shall not affect, impair or invalidate the remainder of this
43 act, or the application of such section or part of a section held inval-
44 id.
45 S 5. This act shall take effect on the thirtieth day after it shall
46 have become a law and shall apply to all policies and contracts issued,
47 renewed, modified, altered or amended on or after such effective date.
