Bill Text: NY A06789 | 2011-2012 | General Assembly | Introduced
Bill Title: Provides that every policy which provides coverage for prescribed drugs shall provide coverage for any drug most likely to provide relief; establishes certain exceptions.
Spectrum: Partisan Bill (Democrat 19-0)
Status: (Introduced - Dead) 2012-01-04 - referred to insurance [A06789 Detail]
Download: New_York-2011-A06789-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
6789
2011-2012 Regular Sessions
I N A S S E M B L Y
March 31, 2011
___________
Introduced by M. of A. ZEBROWSKI, COLTON, COOK, DINOWITZ, GUNTHER,
JAFFEE, KELLNER, LANCMAN, ORTIZ, PEOPLES-STOKES, PHEFFER -- Multi-
Sponsored by -- M. of A. BROOK-KRASNY, MAISEL, MAYERSOHN, REILLY,
ROBINSON, TITONE, TOWNS, WEISENBERG -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to insurance coverage for
prescribed drugs
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Paragraph 27 of subsection (i) of section 3216 of the
2 insurance law, as added by chapter 457 of the laws of 2010, is renum-
3 bered paragraph 28 and a new paragraph 29 is added to read as follows:
4 (29)(A) EVERY POLICY WHICH PROVIDES COVERAGE FOR PRESCRIBED DRUGS
5 APPROVED BY THE FOOD AND DRUG ADMINISTRATION OF THE UNITED STATES
6 GOVERNMENT SHALL PROVIDE COVERAGE TO ANY NAMED SUBSCRIBER OR OTHER
7 PERSON COVERED THEREUNDER FOR ANY DRUG PRESCRIBED BY A PHYSICIAN OR
8 OTHER LICENSED HEALTH CARE PROVIDER, LEGALLY AUTHORIZED TO PRESCRIBE
9 UNDER TITLE EIGHT OF THE EDUCATION LAW, AS THE DRUG MOST LIKELY TO
10 PROVIDE RELIEF TO SUCH PERSON. PROVIDED, HOWEVER, THAT SUCH DRUG MUST BE
11 RECOGNIZED FOR TREATMENT OF THE SPECIFIC TYPE OF ILLNESS OR INJURY FOR
12 WHICH THE DRUG HAS BEEN PRESCRIBED IN ONE OF THE FOLLOWING ESTABLISHED
13 REFERENCE COMPENDIA:
14 (I) THE AMERICAN MEDICAL ASSOCIATION DRUG EVALUATIONS;
15 (II) THE AMERICAN HOSPITAL FORMULARY SERVICE DRUG INFORMATION; OR
16 (III) THE UNITED STATES PHARMACOPEIA DRUG INFORMATION; OR RECOMMENDED
17 BY REVIEW ARTICLE OR EDITORIAL COMMENT IN A MAJOR PEER REVIEWED PROFES-
18 SIONAL JOURNAL.
19 (B) NOTWITHSTANDING THE PROVISIONS OF THIS PARAGRAPH, COVERAGE SHALL
20 NOT BE REQUIRED FOR ANY EXPERIMENTAL OR INVESTIGATIONAL DRUGS OR ANY
21 DRUG WHICH THE FOOD AND DRUG ADMINISTRATION HAS DETERMINED TO BE
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10304-01-1
A. 6789 2
1 CONTRAINDICATED FOR TREATMENT OF THE SPECIFIC TYPE OF ILLNESS OR INJURY
2 FOR WHICH THE DRUG HAS BEEN PRESCRIBED.
3 S 2. Subsection (k) of section 3221 of the insurance law is amended by
4 adding a new paragraph 17 to read as follows:
5 (17)(A) EVERY POLICY WHICH PROVIDES COVERAGE FOR PRESCRIBED DRUGS
6 APPROVED BY THE FOOD AND DRUG ADMINISTRATION OF THE UNITED STATES
7 GOVERNMENT SHALL PROVIDE COVERAGE TO ANY NAMED SUBSCRIBER OR OTHER
8 PERSON COVERED THEREUNDER FOR ANY DRUG PRESCRIBED BY A PHYSICIAN OR
9 OTHER LICENSED HEALTH CARE PROVIDER, LEGALLY AUTHORIZED TO PRESCRIBE
10 UNDER TITLE EIGHT OF THE EDUCATION LAW, AS THE DRUG MOST LIKELY TO
11 PROVIDE RELIEF TO SUCH PERSON. PROVIDED, HOWEVER, THAT SUCH DRUG MUST BE
12 RECOGNIZED FOR TREATMENT OF THE SPECIFIC TYPE OF ILLNESS OR INJURY FOR
13 WHICH THE DRUG HAS BEEN PRESCRIBED IN ONE OF THE FOLLOWING ESTABLISHED
14 REFERENCE COMPENDIA:
15 (I) THE AMERICAN MEDICAL ASSOCIATION DRUG EVALUATIONS;
16 (II) THE AMERICAN HOSPITAL FORMULARY SERVICE DRUG INFORMATION; OR
17 (III) THE UNITED STATES PHARMACOPEIA DRUG INFORMATION; OR RECOMMENDED
18 BY REVIEW ARTICLE OR EDITORIAL COMMENT IN A MAJOR PEER REVIEWED PROFES-
19 SIONAL JOURNAL.
20 (B) NOTWITHSTANDING THE PROVISIONS OF THIS PARAGRAPH, COVERAGE SHALL
21 NOT BE REQUIRED FOR ANY EXPERIMENTAL OR INVESTIGATIONAL DRUGS OR ANY
22 DRUG WHICH THE FOOD AND DRUG ADMINISTRATION HAS DETERMINED TO BE
23 CONTRAINDICATED FOR TREATMENT OF THE SPECIFIC TYPE OF ILLNESS OR INJURY
24 FOR WHICH THE DRUG HAS BEEN PRESCRIBED.
25 S 3. Subsection (gg) of section 4303 of the insurance law, as added by
26 chapter 536 of the laws of 2010, is relettered subsection (hh) and a new
27 subsection (ii) is added to read as follows:
28 (II) (1) EVERY POLICY WHICH PROVIDES COVERAGE FOR PRESCRIBED DRUGS
29 APPROVED BY THE FOOD AND DRUG ADMINISTRATION OF THE UNITED STATES
30 GOVERNMENT SHALL PROVIDE COVERAGE TO ANY NAMED SUBSCRIBER OR OTHER
31 PERSON COVERED THEREUNDER FOR ANY DRUG PRESCRIBED BY A PHYSICIAN OR
32 OTHER LICENSED HEALTH CARE PROVIDER, LEGALLY AUTHORIZED TO PRESCRIBE
33 UNDER TITLE EIGHT OF THE EDUCATION LAW, AS THE DRUG MOST LIKELY TO
34 PROVIDE RELIEF TO SUCH PERSON. PROVIDED, HOWEVER, THAT SUCH DRUG MUST BE
35 RECOGNIZED FOR TREATMENT OF THE SPECIFIC TYPE OF ILLNESS OR INJURY FOR
36 WHICH THE DRUG HAS BEEN PRESCRIBED IN ONE OF THE FOLLOWING ESTABLISHED
37 REFERENCE COMPENDIA:
38 (A) THE AMERICAN MEDICAL ASSOCIATION DRUG EVALUATIONS;
39 (B) THE AMERICAN HOSPITAL FORMULARY SERVICE DRUG INFORMATION; OR
40 (C) THE UNITED STATES PHARMACOPEIA DRUG INFORMATION; OR RECOMMENDED BY
41 REVIEW ARTICLE OR EDITORIAL COMMENT IN A MAJOR PEER REVIEWED PROFES-
42 SIONAL JOURNAL.
43 (2) NOTWITHSTANDING THE PROVISIONS OF THIS SUBSECTION, COVERAGE SHALL
44 NOT BE REQUIRED FOR ANY EXPERIMENTAL OR INVESTIGATIONAL DRUGS OR ANY
45 DRUG WHICH THE FOOD AND DRUG ADMINISTRATION HAS DETERMINED TO BE
46 CONTRAINDICATED FOR TREATMENT OF THE SPECIFIC TYPE OF ILLNESS OR INJURY
47 FOR WHICH THE DRUG HAS BEEN PRESCRIBED.
48 S 4. This act shall take effect on the first of January next succeed-
49 ing the date on which it shall have become a law, and shall apply to all
50 policies and contracts issued, renewed, modified, altered or amended on
51 or after such effective date; provided that any rule or regulation
52 necessary for the timely implementation of this act on its effective
53 date is authorized and directed to be promulgated on or before such
54 date.
