Assembly Bill A4521

2019-2020 Legislative Session

Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals

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Archive: Last Bill Status - In Assembly Committee


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2019-A4521 (ACTIVE) - Details

See Senate Version of this Bill:
S6244
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Add §§4806, 3224-d & 4303-a, amd §§4903, 4910, 4914, 3216, 3221, 4303, 4325 & 3231, Ins L; add §4406-h, amd §§4903, 4910 & 4914, Pub Health L; amd §§367-a & 364-j, Soc Serv L; amd §§6810 & 6826-a, Ed L
Versions Introduced in Other Legislative Sessions:
2017-2018: A10215, S8651
2021-2022: A5046
2023-2024: A8067

2019-A4521 (ACTIVE) - Summary

Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals; to access to retail pharmacies, prescription synchronization, limits on patient drug costs, explanations of benefits and rebates; to prescription drug synchronization; to pharmacy benefit management

2019-A4521 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4521
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 4, 2019
                                ___________
 
 Introduced  by  M. of A. SOLAGES, TAYLOR, DICKENS, L. ROSENTHAL, D'URSO,
   RAMOS, SIMON,  GUNTHER,  ARROYO,  JAFFEE,  GLICK,  GOTTFRIED,  BARRON,
   BLAKE, LAWRENCE, MONTESANO, SEAWRIGHT, WRIGHT -- Multi-Sponsored by --
   M. of A. COOK -- read once and referred to the Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to  access  to  appropriate  drugs  at  reasonable  prices,  formulary
   exceptions, standing prior authorizations  and  external  appeals;  to
   amend  the  insurance law, in relation to access to retail pharmacies,
   prescription synchronization, limits on patient drug  costs,  explana-
   tions  of  benefits  and rebates; to amend the social services law, in
   relation to prescription drug synchronization; and to amend the educa-
   tion law, in relation to limits on copayments and drug substitutions
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  The insurance law is amended by adding a new section 4806
 to read as follows:
   § 4806. ACCESS TO APPROPRIATE DRUGS AT  REASONABLE  PRICES;  FORMULARY
 EXCEPTIONS;  STANDING  PRIOR  AUTHORIZATION  REQUIREMENT. (A) AN INSURER
 OFFERING A PRESCRIPTION DRUG BENEFIT WITH A  FORMULARY  OF  APPROVED  OR
 PREFERRED  DRUGS  SHALL  ESTABLISH  A  PROCEDURE  BY WHICH IT DETERMINES
 WHETHER A FORMULARY DRUG PROVIDES APPROPRIATE  THERAPEUTIC  BENEFITS  TO
 MEET  THE  PARTICULAR  HEALTH  CARE  NEEDS OF AN INSURED. IF THE INSURER
 DETERMINES THAT NO FORMULARY DRUG PROVIDES APPROPRIATE THERAPEUTIC BENE-
 FITS TO MEET THE PARTICULAR HEALTH CARE NEEDS OF AN INSURED, THE INSURER
 SHALL COVER THE COST OF AN OFF-FORMULARY DRUG FOR THAT  INSURED,  AT  NO
 ADDITIONAL  COST  TO THE INSURED BEYOND WHAT THE INSURED WOULD OTHERWISE
 PAY FOR A PREFERRED BRAND NAME DRUG ON THE FORMULARY. THE DETERMINATIONS
 WHETHER A DRUG PROVIDES APPROPRIATE THERAPEUTIC BENEFITS AND  WHETHER  A
 NON-FORMULARY DRUG IS NECESSARY TO MEET THE PARTICULAR HEALTH CARE NEEDS
 OF  THE  INSURED  ARE UTILIZATION REVIEW DECISIONS AND ARE REVIEWABLE IN
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07324-01-9
              

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