senate Bill S6054A

Relates to the purchase of prescription drugs

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 04 / Jan / 2012
    • REFERRED TO INSURANCE
  • 04 / Jan / 2012
    • REFERRED TO INSURANCE
  • 04 / Jan / 2012
    • AMEND AND RECOMMIT TO INSURANCE
  • 04 / Jan / 2012
    • PRINT NUMBER 6054A
  • 09 / Jan / 2012
    • REPORTED AND COMMITTED TO RULES
  • 09 / Jan / 2012
    • ORDERED TO THIRD READING CAL.11
  • 06 / Feb / 2012
    • SUBSTITUTED BY A8904

Summary

Relates to the purchase of prescription drugs; relates to applicable terms and conditions of participating mail order or other non-retail pharmacy.

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Bill Details

See Assembly Version of this Bill:
A8904
Versions:
S6054
S6054A
Legislative Cycle:
2011-2012
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221 & 4303, Ins L

Votes

Sponsor Memo

BILL NUMBER:S6054A

TITLE OF BILL:
An act to amend the insurance law, in relation to the purchase of
prescription drugs

PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill is to make clarifying changes to Chapter 597 of
the Laws of 2011 to ensure proper implementation of the intent of the
law.

SUMMARY OF SPECIFIC PROVISIONS:
This bill would amend sections 3216, 3221 and 4303 of the Insurance Law
to simplify the statute by establishing that if an individual chooses to
purchase their prescription drugs at a network participating non-mail
order retail pharmacy, such pharmacy would be required to accept the
same contractual terms and conditions that the insurer has established
with the network participating mail order and non-retail specialty phar-
macies.

The bill would also make conforming changes within sections 3216, 3221
and 4303 of the Insurance Law that are necessary for the implementation
of these provisions as well as other minor technical modifications to
ensure consistency with existing law.

JUSTIFICATION:
The Legislature's intent in enacting Chapter 597 of the Laws of 2011 was
to ensure that consumers would be afforded a choice in how they make
their prescription drug purchases. These amendments are intended to
simplify the previsions of Chapter 597 to make implementation easier for
insurance companies and affected pharmacies.

PRIOR LEGISLATIVE HISTORY:
This is a new bill.

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
Unknown.

EFFECTIVE DATE:
This act shall take effect on the same date and in the same manner as
Chapter 597 of the Laws of 2011.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 6054--A

                            I N  S E N A T E

                               (PREFILED)

                             January 4, 2012
                               ___________

Introduced  by  Sen. MAZIARZ -- read twice and ordered printed, and when
  printed to be committed 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:

  Section  1.  Paragraph  28  of  subsection  (i) of section 3216 of the
insurance law, as added by chapter 597 of the laws of 2011,  is  amended
to read as follows:
  (28)  Any policy [which] THAT provides coverage for prescription drugs
shall permit each [participant] INSURED to fill any [mail order] covered
prescription THAT MAY BE OBTAINED AT A NETWORK PARTICIPATING MAIL  ORDER
OR  OTHER  NON-RETAIL PHARMACY, at [his or her] THE INSURED'S option, at
[any mail order pharmacy or]  A  network  participating  non-mail  order
retail  pharmacy  [if  the  network  participating non-mail order retail
pharmacy offers to accept a price that is comparable to that of the mail
order pharmacy] PROVIDED THAT THE NETWORK PARTICIPATING  NON-MAIL  ORDER
RETAIL  PHARMACY AGREES IN ADVANCE, THROUGH A CONTRACTUAL NETWORK AGREE-
MENT, TO THE SAME REIMBURSEMENT AMOUNT, AS WELL AS THE  SAME  APPLICABLE
TERMS  AND  CONDITIONS, THAT THE INSURER HAS ESTABLISHED FOR THE NETWORK
PARTICIPATING MAIL ORDER OR OTHER  NON-RETAIL  PHARMACY.    [Any  policy
which  provides  coverage  for  prescription  drugs] IN SUCH A CASE, THE
POLICY shall not impose a co-payment  fee  or  other  condition  on  any
insured who elects to purchase PRESCRIPTION drugs from a network partic-
ipating  non-mail  order  retail  pharmacy  which is not also imposed on
insureds electing to purchase drugs from a [designated] NETWORK  PARTIC-
IPATING  mail  order  OR  OTHER NON-RETAIL pharmacy[; provided, however,
that the provisions of this section shall not supersede the terms  of  a
collective  bargaining agreement or apply to a policy that is the result
of a collective bargaining agreement between an employer  and  a  recog-
nized or certified employee organization].

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09145-10-2

S. 6054--A                          2

  S  2.  Paragraph 18 of subsection (1) of section 3221 of the insurance
law, as added by chapter 597 of the laws of 2011, is amended to read  as
follows:
  (18)  Any  insurer  delivering  a group or blanket policy or issuing a
group or blanket policy for delivery in this state [which] THAT provides
coverage for prescription drugs shall permit each [participant]  INSURED
to  fill any [mail order] covered prescription THAT MAY BE OBTAINED AT A
NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY,  at  [his
or  her] THE INSURED'S option, at [any mail order pharmacy or] A network
participating non-mail order retail pharmacy [if the network participat-
ing non-mail order retail pharmacy offers to  accept  a  price  that  is
comparable to that of the mail order pharmacy] PROVIDED THAT THE NETWORK
PARTICIPATING  NON-MAIL ORDER RETAIL PHARMACY AGREES IN ADVANCE, THROUGH
A CONTRACTUAL NETWORK AGREEMENT, TO THE SAME  REIMBURSEMENT  AMOUNT,  AS
WELL  AS  THE SAME APPLICABLE TERMS AND CONDITIONS, THAT THE INSURER HAS
ESTABLISHED FOR THE NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL
PHARMACY.  [Any policy which provides coverage for  prescription  drugs]
IN  SUCH  A  CASE, THE POLICY shall not impose a co-payment fee or other
condition on any insured who elects to purchase  drugs  from  a  network
participating  non-mail  order retail pharmacy which is not also imposed
on insureds electing to  purchase  drugs  from  a  [designated]  NETWORK
PARTICIPATING  mail order OR OTHER NON-RETAIL pharmacy; provided, howev-
er, that the provisions of this section shall not supersede the terms of
a collective bargaining agreement or apply  to  a  policy  that  is  the
result  of  a  collective bargaining agreement between an employer and a
recognized or certified employee organization.
  S 3. Subsection (hh) of section 4303 of the insurance law, as added by
chapter 597 of the laws of 2011, is amended to read as follows:
  (hh) Any [policy] CONTRACT  issued  by  a  medical  expense  indemnity
corporation,  a hospital service corporation or a health services corpo-
ration [which] THAT  provides  coverage  for  prescription  drugs  shall
permit  each  [participant]  COVERED  PERSON  to  fill  any [mail order]
covered prescription THAT MAY BE OBTAINED  AT  A  NETWORK  PARTICIPATING
MAIL  ORDER  OR  OTHER  NON-RETAIL PHARMACY, at [his or her] THE COVERED
PERSON'S option, at [any mail order pharmacy or] A network participating
non-mail order retail pharmacy [if the  network  participating  non-mail
order  retail  pharmacy  offers  to accept a price that is comparable to
that of the mail order pharmacy] PROVIDED THAT THE NETWORK PARTICIPATING
NON-MAIL ORDER RETAIL PHARMACY AGREES IN ADVANCE, THROUGH A  CONTRACTUAL
NETWORK AGREEMENT, TO THE SAME REIMBURSEMENT AMOUNT, AS WELL AS THE SAME
APPLICABLE  TERMS  AND  CONDITIONS, THAT THE CORPORATION HAS ESTABLISHED
FOR THE NETWORK PARTICIPATING MAIL ORDER OR OTHER  NON-RETAIL  PHARMACY.
[Any  policy  which  provides coverage for prescription drugs] IN SUCH A
CASE, THE CONTRACT shall not impose a copayment fee or  other  condition
on  any  [insured]  COVERED  PERSON  who elects to purchase drugs from a
network participating non-mail order retail pharmacy which is  not  also
imposed  on [insureds] COVERED PERSONS electing to purchase drugs from a
[designated] NETWORK PARTICIPATING mail order OR OTHER NON-RETAIL  phar-
macy;  provided,  however, that the provisions of this section shall not
supersede the terms of a collective bargaining agreement or apply  to  a
[policy]  CONTRACT  that is the result of a collective bargaining agree-
ment between an employer and a recognized or certified  employee  organ-
ization.
  S  4.  This  act  shall  take  effect on the same date and in the same
manner as chapter 597 of the laws of 2011, takes effect.

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