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 26-12)
Status: (Vetoed) 2019-12-23 - tabled [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. LBD04720-05-9S. 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 planS. 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.
