senate Bill S6126

Relates to the purchase of prescription drugs

download pdf

Sponsor

Bill Status


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

actions

  • 04 / Jan / 2012
    • REFERRED TO INSURANCE
  • 09 / Jan / 2012
    • REPORTED AND COMMITTED TO RULES
  • 09 / Jan / 2012
    • ORDERED TO THIRD READING CAL.18
  • 06 / Feb / 2012
    • SUBSTITUTED BY A8900

Summary

Enacts chapter amendment to Chapter 598 of 2011 relating to the purchase of prescription drugs through a network participating non-mail order retail pharmacy.

do you support this bill?

Bill Details

See Assembly Version of this Bill:
A8900
Versions:
S6126
Legislative Cycle:
2011-2012
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221 & 4303, Ins L

Votes

17
0
17
Aye
0
Nay
1
aye with reservations
0
absent
0
excused
0
abstained
show Insurance committee vote details

Sponsor Memo

BILL NUMBER:S6126

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

PURPOSE:
The purpose of this bill is to make clarifying changes to Chapter 598
of the Laws of 2011 to ensure proper implementation of the intent of
the law.

SUMMARY OF PROVISIONS:
This bill would clarify the provisions of Chapter 598 of the Laws of
2011 to require that insurance policies that provide coverage for
prescription fertility drugs purchased through a network
participating mail order or non-retail specialty pharmacy shall
provide the same coverage when such drugs are purchased from a
network participating non-mail order retail pharmacy. The bill would
further require that prior to such coverage by the insurer, the
network participating non-mail order retail pharmacy must accept the
reimbursement rate and other contractual terms and conditions as the
insurer has established for network participating mail order or
non-retail specialty pharmacies.

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 598 of the Laws of 2011
was to ensure that consumers with insurance policies that provide
coverage for prescription fertility drugs are afforded a choice in
the manner in which they make their prescription drug purchases. This
bill would make clearer, the provisions of Chapter 598 and facilitate
its implementation by the affected parties.

LEGISLATIVE HISTORY:
This is a new bill.

FISCAL IMPLICATIONS:
None.

LOCAL FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect on the same date and in the same manner as
Chapter 598 of the Laws of 2011.

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

                                  6126

                            I N  S E N A T E

                               (PREFILED)

                             January 4, 2012
                               ___________

Introduced  by  Sen.  SKELOS -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

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 13-a of subsection (i) of  section  3216  of  the
insurance  law,  as added by Chapter 598 of the laws of 2011, is amended
to read as follows:
  (13-a) Every policy that provides coverage for prescription  fertility
drugs and requires or permits prescription drugs to be purchased through
a  NETWORK  PARTICIPATING  mail order OR OTHER NON-RETAIL pharmacy shall
provide the same coverage for prescription  fertility  drugs  when  such
drugs  are  purchased from a NETWORK PARTICIPATING NON-MAIL ORDER RETAIL
pharmacy [that is not a 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 ESTAB-
LISHED  FOR A NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHAR-
MACY.  [Such] IN SUCH CASE, THE policy shall not impose any [additional]
fee, co-payment, co-insurance, deductible  or  other  condition  on  any
insured  who  [does not elect] ELECTS to purchase prescription fertility
drugs through a [mail order] NETWORK PARTICIPATING NON-MAIL ORDER RETAIL
pharmacy  THAT  IT  DOES  NOT  IMPOSE  ON  ANY  INSURED  WHO   PURCHASES
PRESCRIPTION  FERTILITY DRUGS THROUGH A NETWORK PARTICIPATING MAIL ORDER
OR OTHER NON-RETAIL PHARMACY.
  S 2. Subparagraph (D) of paragraph 6 of subsection (k) of section 3221
of the insurance law, as added by Chapter 598 of the laws  of  2011,  is
amended to read as follows:
  (D)  Every  policy  that  provides coverage for prescription fertility
drugs and requires or permits prescription drugs to be purchased through
a NETWORK PARTICIPATING mail order OR OTHER  NON-RETAIL  pharmacy  shall
provide  the  same  coverage  for prescription fertility drugs when such

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10740-06-2

S. 6126                             2

drugs are purchased from a NETWORK PARTICIPATING NON-MAIL  ORDER  RETAIL
pharmacy  [that  is not a 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 ESTAB-
LISHED  FOR A NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHAR-
MACY.  [Such] IN SUCH CASE, THE policy shall not impose any [additional]
fee, co-payment, co-insurance, deductible  or  other  condition  on  any
covered  person  who  [does  not  elect] ELECTS to purchase prescription
fertility drugs through a [mail order]  NETWORK  PARTICIPATING  NON-MAIL
ORDER  RETAIL pharmacy THAT IT DOES NOT IMPOSE ON ANY COVERED PERSON WHO
PURCHASES PRESCRIPTION FERTILITY DRUGS THROUGH A  NETWORK  PARTICIPATING
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 RECOGNIZED OR
CERTIFIED EMPLOYEE ORGANIZATION.
  S 3. Paragraph 4 of subsection (s) of section 4303  of  the  insurance
law,  as added by Chapter 598 of the laws of 2011, is amended to read as
follows:
  (4) Every [policy] CONTRACT issued  by  a  medical  expense  indemnity
corporation,  a hospital service corporation or a health services corpo-
ration that provides  coverage  for  prescription  fertility  drugs  and
requires or permits prescription drugs to be purchased through a NETWORK
PARTICIPATING  mail order OR OTHER NON-RETAIL pharmacy shall provide the
same coverage for prescription  fertility  drugs  when  such  drugs  are
purchased  from  a  NETWORK PARTICIPATING NON-MAIL ORDER RETAIL pharmacy
[that is not a mail order pharmacy] PROVIDED THAT  THE  NETWORK  PARTIC-
IPATING  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.  [Such policy] IN SUCH CASE, THE CONTRACT shall not impose any
[additional]  fee,  co-payment, co-insurance, deductible or other condi-
tion on any covered person who does not elect to  purchase  prescription
fertility  drugs  through  a  NETWORK  PARTICIPATING mail order OR OTHER
NON-RETAIL pharmacy; PROVIDED, HOWEVER,  THAT  THE  PROVISIONS  OF  THIS
SECTION  SHALL NOT SUPERSEDE THE TERMS OF A COLLECTIVE BARGAINING AGREE-
MENT OR APPLY TO A CONTRACT THAT IS THE RESULT OF A COLLECTIVE  BARGAIN-
ING AGREEMENT BETWEEN AN EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE
ORGANIZATION.
  S  4.  This  act  shall  take  effect on the same date and in the same
manner as section 5 of chapter 598 of the laws of 2011, takes effect.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.