Bill Text: NY A05502 | 2011-2012 | General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                        5502--A
                              2011-2012 Regular Sessions
                                 I N  A S S E M B L Y
                                   February 22, 2011
                                      ___________
       Introduced  by  M. of A. HEASTIE, COLTON, ROSENTHAL, M. MILLER, CYMBROW-
         ITZ, MOYA, O'DONNELL, THIELE,  GALEF,  CASTRO,  DenDEKKER,  BENEDETTO,
         GUNTHER,  SCHROEDER,  MAISEL,  SPANO,  SCHIMEL,  V. LOPEZ, WEISENBERG,
         LAVINE, WEPRIN, PHEFFER, ENGLEBRIGHT, SWEENEY, PAULIN, DINOWITZ, MENG,
         RODRIGUEZ, HOYT, GABRYSZAK -- Multi-Sponsored by -- M. of  A.  ABBATE,
         ABINANTI,  BURLING, CASTELLI, CERETTO, CORWIN, CRESPO, CROUCH, DUPREY,
         GIGLIO, GRAF,  HAYES,  JACOBS,  KATZ,  LATIMER,  P. LOPEZ,  LOSQUADRO,
         MALLIOTAKIS,   J. MILLER,  MONTESANO,  MURRAY,  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
       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-
   14  SEDE THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT OR APPLY TO A POLICY
   15  THAT  IS  THE  RESULT  OF  A  COLLECTIVE BARGAINING AGREEMENT BETWEEN AN
   16  EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGANIZATION. NOTHING IN
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD09145-04-1
       A. 5502--A                          2
    1  THIS PARAGRAPH SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND THIR-
    2  TEEN-O OF THE  WORKERS'  COMPENSATION  LAW  REGARDING  THE  PURCHASE  OF
    3  PRESCRIPTION DRUGS AND THE USE OF MAIL ORDER PHARMACY.
    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.  NOTHING  IN  THIS  PARAGRAPH  SHALL  ALTER  ANY
   22  PROVISIONS OF SECTIONS THIRTEEN AND THIRTEEN-O OF THE  WORKERS'  COMPEN-
   23  SATION  LAW  REGARDING THE PURCHASE OF PRESCRIPTION DRUGS AND THE USE OF
   24  MAIL ORDER PHARMACY.
   25    S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
   26  subsection (hh) to read as follows:
   27    (HH)  ANY  POLICY ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION, A
   28  HOSPITAL SERVICE CORPORATION OR  A  HEALTH  SERVICES  CORPORATION  WHICH
   29  PROVIDES  COVERAGE  FOR PRESCRIPTION DRUGS SHALL PERMIT EACH PARTICIPANT
   30  TO FILL ANY MAIL ORDER COVERED PRESCRIPTION, AT HIS OR  HER  OPTION,  AT
   31  ANY  MAIL  ORDER PHARMACY OR NETWORK PARTICIPATING NON-MAIL ORDER RETAIL
   32  PHARMACY IF THE NETWORK PARTICIPATING  NON-MAIL  ORDER  RETAIL  PHARMACY
   33  OFFERS  TO  ACCEPT  A PRICE THAT IS COMPARABLE TO THAT OF THE MAIL ORDER
   34  PHARMACY. ANY POLICY WHICH  PROVIDES  COVERAGE  FOR  PRESCRIPTION  DRUGS
   35  SHALL  NOT  IMPOSE A COPAYMENT FEE OR OTHER CONDITION ON ANY INSURED WHO
   36  ELECTS TO PURCHASE DRUGS FROM A  NETWORK  PARTICIPATING  NON-MAIL  ORDER
   37  RETAIL  PHARMACY  WHICH  IS  NOT  ALSO  IMPOSED  ON INSUREDS ELECTING TO
   38  PURCHASE DRUGS FROM A DESIGNATED MAIL ORDER PHARMACY; PROVIDED, HOWEVER,
   39  THAT THE PROVISIONS OF THIS SECTION SHALL NOT SUPERSEDE THE TERMS  OF  A
   40  COLLECTIVE  BARGAINING AGREEMENT OR APPLY TO A POLICY THAT IS THE RESULT
   41  OF A COLLECTIVE BARGAINING AGREEMENT BETWEEN AN EMPLOYER  AND  A  RECOG-
   42  NIZED  OR  CERTIFIED  EMPLOYEE  ORGANIZATION. NOTHING IN THIS SUBSECTION
   43  SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND  THIRTEEN-O  OF  THE
   44  WORKERS'  COMPENSATION  LAW REGARDING THE PURCHASE OF PRESCRIPTION DRUGS
   45  AND THE USE OF MAIL ORDER PHARMACY.
   46    S 4. The opening paragraph  of  paragraph  25  of  subsection  (b)  of
   47  section 4322 of the insurance law, as amended by chapter 554 of the laws
   48  of 2002, is amended to read as follows:
   49    Prescription  drugs, including contraceptive drugs or devices approved
   50  by the federal food  and  drug  administration  or  generic  equivalents
   51  approved  as substitutes by such food and drug administration and nutri-
   52  tional supplements (formulas) for the therapeutic treatment of phenylke-
   53  tonuria,  branched-chain  ketonuria,  galactosemia  and  homocystinuria,
   54  obtained  at a participating pharmacy under a prescription written by an
   55  in-plan or out-of-plan provider. Health  maintenance  organizations,  in
   56  addition to providing coverage for prescription drugs at a participating
       A. 5502--A                          3
    1  pharmacy,  may utilize a mail order prescription drug program.  HOWEVER,
    2  NO HEALTH MAINTENANCE ORGANIZATION SHALL MANDATE THAT PRESCRIPTION DRUGS
    3  BE PURCHASED BY THE INSURED FROM A MAIL  ORDER  PHARMACY  IF  A  NETWORK
    4  PARTICIPATING  NON-MAIL  ORDER  RETAIL PHARMACY OFFERS TO ACCEPT A PRICE
    5  THAT IS COMPARABLE TO THAT OF THE MAIL ORDER PHARMACY.  NO HEALTH  MAIN-
    6  TENANCE ORGANIZATION SHALL IMPOSE A CO-PAYMENT FEE OR OTHER CONDITION ON
    7  ANY  INSURED  WHO  ELECTS TO PURCHASE DRUGS FROM A NETWORK PARTICIPATING
    8  NON-MAIL ORDER RETAIL PHARMACY.  THE PROVISIONS OF  THIS  SECTION  SHALL
    9  NOT SUPERSEDE THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT OR APPLY TO
   10  A POLICY THAT IS THE RESULT OF A COLLECTIVE BARGAINING AGREEMENT BETWEEN
   11  AN EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGANIZATION. NOTHING
   12  IN  THIS  PARAGRAPH  SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND
   13  THIRTEEN-O OF THE WORKERS' COMPENSATION LAW REGARDING  THE  PURCHASE  OF
   14  PRESCRIPTION  DRUGS  AND  THE USE OF MAIL ORDER PHARMACY. Health mainte-
   15  nance organizations may provide prescription drugs pursuant  to  a  drug
   16  formulary;  however,  health maintenance organizations must implement an
   17  appeals process so that the use of non-formulary prescription drugs  may
   18  be requested by a physician or other provider.
   19    S 5. If any clause, subparagraph, subsection, section or other part of
   20  this  act, or the  application thereof be held to be invalid, such hold-
   21  ing shall not affect, impair or invalidate the remainder of this act, or
   22  the application of such section or part of a section held invalid.
   23    S 6. This act shall take effect on the thirtieth day  after  it  shall
   24  have  become a law and shall apply to all policies and contracts issued,
   25  renewed, modified, altered or amended on or after such effective date.