Bill Text: NY A08533 | 2019-2020 | General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Establishes a drug assistance demonstration program and authorizes emergency prescriptions.

Spectrum: Strong Partisan Bill (Democrat 53-5)

Status: (Enrolled - Dead) 2020-12-30 - DELIVERED TO GOVERNOR [A08533 Detail]

Download: New_York-2019-A08533-Amended.html



                STATE OF NEW YORK
        ________________________________________________________________________

                                         8533--A

                               2019-2020 Regular Sessions

                   IN ASSEMBLY

                                     August 14, 2019
                                       ___________

        Introduced  by  M.  of  A.  JOYNER,  O'DONNELL, LENTOL, WILLIAMS, REYES,
          SEAWRIGHT, SIMON, HEVESI, FERNANDEZ, DINOWITZ, BURKE, MOSLEY, DICKENS,
          L. ROSENTHAL,  ARROYO,  FALL,  SMITH,  McDONOUGH,  MONTESANO,   ORTIZ,
          COLTON,  THIELE,  JAFFEE,  GUNTHER,  CRUZ,  COOK,  MAGNARELLI, WALKER,
          CARROLL, DE LA ROSA, BLAKE, GRIFFIN, D'URSO, BRONSON, DenDEKKER, BENE-
          DETTO, SAYEGH, JACOBSON, STIRPE, MANKTELOW, GOTTFRIED,  BARRON,  OTIS,
          TAYLOR,  SIMOTAS  -- Multi-Sponsored by -- M. of A. BUCHWALD, TAGUE --
          read once and referred to the Committee on Health  --  recommitted  to
          the  Committee on Health in accordance with Assembly Rule 3, sec. 2 --
          committee discharged, bill amended, ordered reprinted as  amended  and
          recommitted to said committee

        AN  ACT  to  amend the public health law, in relation to drug assistance
          demonstration and emergency prescriptions; and to amend the  insurance
          law, in relation to capping cost sharing for insulin

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. The public health law is amended by adding two new sections
     2  279-a and 279-b to read as follows:
     3    § 279-a. Drug assistance demonstration program. The commissioner shall
     4  develop a demonstration program to ensure access to  insulin  and  other
     5  life  sustaining, maintenance prescription medications identified by the
     6  commissioner for residents of the state who are uninsured, are  ineligi-
     7  ble for Medicaid or other publicly funded health coverage, or are other-
     8  wise  determined to be eligible by the commissioner and depend upon such
     9  medication for their survival. In developing such  program  the  commis-
    10  sioner shall:
    11    1.  consider modeling the drug assistance demonstration program on the
    12  state's HIV/AIDS drug assistance program providing  access  to  eligible
    13  individuals  at  certain  income  thresholds  above  the federal poverty
    14  level;

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD13323-09-0

        A. 8533--A                          2

     1    2. engage  with  pharmaceutical  manufacturers  to  explore  a  public
     2  private partnership designed to bring affordable medications through the
     3  demonstration program to eligible individuals; and
     4    3.  report to the governor, the temporary president of the senate, the
     5  speaker of the assembly, and the  chairs  of  the  senate  and  assembly
     6  health  committees  on the available options to establish a drug assist-
     7  ance demonstration program, various cost  sharing  models  for  eligible
     8  participants  and  the related costs to the state associated with imple-
     9  menting such a program no later than sixty days after the effective date
    10  of this section.
    11    § 279-b. Emergency prescriptions. 1. A health care practitioner who is
    12  authorized  to  prescribe  drugs   may   issue      non-patient-specific
    13  prescriptions  for  pharmacists to dispense   emergency prescriptions to
    14  refill  expired  prescriptions  pursuant  to  subdivision  two  of  this
    15  section.
    16    2.  A  pharmacist  may dispense insulin and related supplies, or other
    17  life sustaining, maintenance prescription medications identified by  the
    18  commissioner, through non-patient-specific prescriptions, to an individ-
    19  ual  who has had a valid prescription for any types of insulin, or other
    20  medications identified by the  commissioner,  during  the  prior  twelve
    21  month  period  which  have since expired, on an emergency basis provided
    22  the pharmacist:
    23    (a) first attempts to obtain  an  authorization  from  the  authorized
    24  prescriber and cannot obtain the authorization;
    25    (b)  believes,  that  in  the  pharmacist's professional judgment, the
    26  interruption of the therapy  reasonably  might  produce  an  undesirable
    27  health  consequence  detrimental to the patient's welfare or cause phys-
    28  ical or mental discomfort;
    29    (c) provides refill of the prescription or prescriptions and the quan-
    30  tity of that refill or refills is  in  conformity  with  the  prescribed
    31  directions  for use, but limited to an amount not to exceed a thirty-day
    32  emergency supply; and
    33    (d) notifies, within seventy-two hours of  dispensing  the  refill  or
    34  refills,  the prescriber that an emergency prescription or prescriptions
    35  have been dispensed.
    36    § 2. Subparagraph (B) of paragraph 15-a of subsection (i)  of  section
    37  3216  of  the insurance law, as added by chapter 378 of the laws of 1993
    38  and such paragraph as renumbered by chapter 338 of the laws of 2003,  is
    39  amended to read as follows:
    40    (B) Such coverage may be subject to annual deductibles and coinsurance
    41  as may be deemed appropriate by the superintendent and as are consistent
    42  with  those  established  for  other  benefits  within  a  given policy;
    43  provided however, the total amount that a covered person is required  to
    44  pay out of pocket for covered prescription insulin drugs shall be capped
    45  at  an  amount  not to exceed one hundred dollars per thirty-day supply,
    46  regardless of the amount or types of insulin needed to fill such covered
    47  person's prescriptions  and  regardless  of  the  insured's  deductible,
    48  copayment,  coinsurance, out of pocket maximum or any other cost sharing
    49  requirement.
    50    § 3. Subparagraph (B) of paragraph 7 of subsection (k) of section 3221
    51  of the insurance law, as amended by chapter 338 of the laws of 2003,  is
    52  amended to read as follows:
    53    (B) Such coverage may be subject to annual deductibles and coinsurance
    54  as may be deemed appropriate by the superintendent and as are consistent
    55  with  those  established  for  other  benefits  within  a  given policy;
    56  provided however, the total amount that a covered person is required  to

        A. 8533--A                          3

     1  pay out of pocket for covered prescription insulin drugs shall be capped
     2  at  an  amount  not to exceed one hundred dollars per thirty-day supply,
     3  regardless of the amount or types of insulin needed to fill such covered
     4  person's  prescriptions  and  regardless  of  the  insured's deductible,
     5  copayment, coinsurance, out of pocket maximum or any other cost  sharing
     6  requirement.
     7    §  4.  Paragraph  2 of subsection (u) of section 4303 of the insurance
     8  law, as amended by chapter 338 of the laws of 2003, is amended  to  read
     9  as follows:
    10    (2) Such coverage may be subject to annual deductibles and coinsurance
    11  as may be deemed appropriate by the superintendent and as are consistent
    12  with  those  established  for  other  benefits  within  a  given policy;
    13  provided however, the total amount that a covered person is required  to
    14  pay out of pocket for covered prescription insulin drugs shall be capped
    15  at  an  amount  not to exceed one hundred dollars per thirty-day supply,
    16  regardless of the amount or types of insulin needed to fill such covered
    17  person's prescriptions  and  regardless  of  the  insured's  deductible,
    18  copayment,  coinsurance, out of pocket maximum or any other cost sharing
    19  requirement.
    20    § 5. Subdivision 7 of section 4406-c of  the  public  health  law,  as
    21  added by chapter 536 of the laws of 2010, is amended to read as follows:
    22    7.  (i) No health maintenance organization which provides coverage for
    23  prescription drugs and for which cost-sharing, deductibles  or  co-insu-
    24  rance obligations are determined by category of prescription drugs shall
    25  impose  cost-sharing,  deductibles  or  co-insurance obligations for any
    26  prescription drug that exceeds the dollar amount of cost-sharing, deduc-
    27  tibles or co-insurance obligations for non-preferred brand drugs or  its
    28  equivalent (or brand drugs if there is no non-preferred brand drug cate-
    29  gory).
    30    (ii)  The total amount that a covered person is required to pay out of
    31  pocket for covered prescription insulin drugs  shall  be  capped  at  an
    32  amount  not to exceed one hundred dollars per thirty-day supply, regard-
    33  less of the amount or types of  insulin  needed  to  fill  such  covered
    34  person's  prescriptions  and  regardless  of  the  insured's deductible,
    35  copayment, coinsurance, out of pocket maximum or any other cost  sharing
    36  requirement.
    37    §  6.  This  act  shall take effect immediately; provided however that
    38  sections two, three, four and five of this act shall take effect January
    39  1, 2021.
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