Bill Text: NY S02849 | 2019-2020 | General Assembly | Amended


Bill Title: Prohibits a health care plan from making prescription drug formulary changes during a contract year.

Spectrum: Slight Partisan Bill (Democrat 25-12)

Status: (Introduced) 2019-06-19 - SUBSTITUTED BY A2969A [S02849 Detail]

Download: New_York-2019-S02849-Amended.html



                STATE OF NEW YORK
        ________________________________________________________________________

                                         2849--A
            Cal. No. 462

                               2019-2020 Regular Sessions

                    IN SENATE

                                    January 29, 2019
                                       ___________

        Introduced  by Sens. BRESLIN, ADDABBO, AKSHAR, BENJAMIN, BIAGGI, BROOKS,
          CARLUCCI, COMRIE, FUNKE, GALLIVAN, GAUGHRAN, GIANARIS,  GRIFFO,  HELM-
          ING,  HOYLMAN,  JACOBS,  JORDAN,  KAMINSKY,  KENNEDY,  KRUEGER, LANZA,
          LAVALLE, MAY, MAYER, ORTT, PARKER, RITCHIE, RIVERA,  ROBACH,  SALAZAR,
          SANDERS,  SAVINO,  SEPULVEDA, SERINO, SERRANO, SKOUFIS, THOMAS -- read
          twice and ordered printed, and when printed to  be  committed  to  the
          Committee  on  Insurance  --  reported  favorably from said committee,
          ordered to first and  second  report,  ordered  to  a  third  reading,
          amended  and  ordered  reprinted,  retaining its place in the order of
          third reading

        AN ACT to amend the insurance law and the public health law, in relation
          to prescription drug formulary changes during a contract year

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

     1    Section  1.  The insurance law is amended by adding a new section 4909
     2  to read as follows:
     3    § 4909. Prescription drug formulary changes. (a) Except  as  otherwise
     4  provided  in  subsection  (c)  of this section, a health care plan shall
     5  not:
     6    (i) remove a prescription drug from a formulary;
     7    (ii) move a prescription drug to a  tier  with  a  larger  deductible,
     8  copayment, or coinsurance if the formulary includes two or more tiers of
     9  benefits  providing for different deductibles, copayments or coinsurance
    10  applicable to the prescription drugs in each tier; or
    11    (iii) add utilization management restrictions to a  prescription  drug
    12  on  a  formulary, unless such changes occur at the time of enrollment or
    13  issuance of coverage.
    14    (b) Prohibitions provided in subsection  (a)  of  this  section  shall
    15  apply  beginning  on the date on which open enrollment begins for a plan
    16  year and through the end of the plan year to which such open  enrollment
    17  period applies.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04720-05-9

        S. 2849--A                          2

     1    (c)  (i) A health care plan with a formulary that includes two or more
     2  tiers of benefits providing for  different  deductibles,  copayments  or
     3  coinsurance  applicable  to  prescription  drugs in each tier may move a
     4  prescription drug to a tier with a larger deductible, copayment or coin-
     5  surance  if an AB-rated generic equivalent or interchangeable biological
     6  product for such prescription drug is added to the formulary at the same
     7  time.
     8    (ii) A health care plan may remove a prescription drug from  a  formu-
     9  lary  if  the  federal Food and Drug Administration determines that such
    10  prescription drug should be  removed  from  the  market,  including  new
    11  utilization  management restrictions issued pursuant to federal Food and
    12  Drug Administration safety concerns.
    13    (d) A health care plan shall provide notice to  policyholders  of  the
    14  intent  to  remove a prescription drug from a formulary or alter deduct-
    15  ible, copayment or coinsurance requirements in the upcoming  plan  year,
    16  thirty days prior to the open enrollment period for the consecutive plan
    17  year.  Such  notice  of impending formulary and deductible, copayment or
    18  coinsurance changes shall also be posted on the plan's online  formulary
    19  and in any prescription drug finder system that the plan provides to the
    20  public.
    21    (e)  The provisions of this section shall not supersede the terms of a
    22  collective bargaining agreement, or the rights of  labor  representation
    23  groups to collectively bargain changes to the formularies.
    24    §  2. The public health law is amended by adding a new section 4909 to
    25  read as follows:
    26    § 4909. Prescription drug formulary changes. 1.  Except  as  otherwise
    27  provided  in subdivision three of this section, a health care plan shall
    28  not:
    29    (a) remove a prescription drug from a formulary;
    30    (b) move a prescription drug to  a  tier  with  a  larger  deductible,
    31  copayment, or coinsurance if the formulary includes two or more tiers of
    32  benefits  providing for different deductibles, copayments or coinsurance
    33  applicable to the prescription drugs in each tier; or
    34    (c) add utilization management restrictions to a prescription drug  on
    35  a  formulary,  unless  such  changes  occur at the time of enrollment or
    36  issuance of coverage.
    37    2. Prohibitions provided in subdivision  one  of  this  section  shall
    38  apply  beginning  on the date on which open enrollment begins for a plan
    39  year and through the end of the plan year to which such open  enrollment
    40  period applies.
    41    3.  (a)  A health care plan with a formulary that includes two or more
    42  tiers of benefits providing for  different  deductibles,  copayments  or
    43  coinsurance  applicable  to  prescription  drugs in each tier may move a
    44  prescription drug to a tier with a larger deductible, copayment or coin-
    45  surance if an AB-rated generic equivalent or interchangeable  biological
    46  product for such prescription drug is added to the formulary at the same
    47  time.
    48    (b) A health care plan may remove a prescription drug from a formulary
    49  if  the  federal  Food  and  Drug  Administration  determines  that such
    50  prescription drug should be  removed  from  the  market,  including  new
    51  utilization  management restrictions issued pursuant to federal Food and
    52  Drug Administration safety concerns.
    53    4. A health care plan shall provide notice  to  policyholders  of  the
    54  intent  to  remove a prescription drug from a formulary or alter deduct-
    55  ible, copayment or coinsurance requirements in the upcoming  plan  year,
    56  thirty days prior to the open enrollment period for the consecutive plan

        S. 2849--A                          3

     1  year.  Such  notice  of impending formulary and deductible, copayment or
     2  coinsurance changes shall also be posted on the plan's online  formulary
     3  and in any prescription drug finder system that the plan provides to the
     4  public.
     5    5.  The  provisions of this section shall not supersede the terms of a
     6  collective bargaining agreement, or the rights of  labor  representation
     7  groups to collectively bargain changes to the formularies.
     8    §  3.  This  act  shall take effect on the sixtieth day after it shall
     9  have become a law.    Effective  immediately,  the  addition,  amendment
    10  and/or repeal of any rule or regulation necessary for the implementation
    11  of  this  act  on  its  effective  date  are  authorized  to be made and
    12  completed on or before such effective date.
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