S T A T E O F N E W Y O R K
________________________________________________________________________
1267--A
2009-2010 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 7, 2009
___________
Introduced by M. of A. COLTON, GOTTFRIED, CYMBROWITZ, PERRY, V. LOPEZ,
J. RIVERA, GIGLIO, GABRYSZAK, MILLMAN, JAFFEE, BURLING, PHEFFER,
DINOWITZ, FIELDS -- Multi-Sponsored by -- M. of A. ALFANO, BARRA,
BOYLAND, CALHOUN, CHRISTENSEN, CLARK, DESTITO, GLICK, GUNTHER, HAWLEY,
HOOPER, JOHN, LANCMAN, MARKEY, McENENY, MILLER, PAULIN, ROBINSON,
ROSENTHAL, SCARBOROUGH, SWEENEY, WALKER, WEISENBERG, WRIGHT -- read
once and referred 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. Subsection (i) of section 3216 of the insurance law is
amended by adding a new paragraph 26 to read as follows:
(26) NO POLICY WHICH PROVIDES COVERAGE FOR PRESCRIBED DRUGS SHALL
MANDATE THAT THE SAME BE PURCHASED BY THE INSURED FROM A MAIL ORDER
PHARMACY, NOR MAY SUCH POLICY IMPOSE A CO-PAYMENT FEE OR OTHER CONDITION
ON ANY INSURED WHO ELECTS TO PURCHASE DRUGS FROM OTHER THAN A MAIL ORDER
PHARMACY WHICH IS NOT ALSO IMPOSED ON INSUREDS ELECTING TO PURCHASE
DRUGS FROM A DESIGNATED MAIL ORDER 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. NOTHING IN THIS PARAGRAPH SHALL ALTER
ANY PROVISIONS OF SECTIONS THIRTEEN AND THIRTEEN-O OF THE WORKERS'
COMPENSATION LAW REGARDING THE PURCHASE OF PRESCRIPTION DRUGS AND THE
USE OF MAIL ORDER PHARMACY.
S 2. Subsection (1) of section 3221 of the insurance law is amended by
adding a new paragraph 18 to read as follows:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03965-04-9
A. 1267--A 2
(18) NO INSURER DELIVERING A GROUP OR BLANKET POLICY OR ISSUING A
GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE WHICH PROVIDES COVER-
AGE FOR PRESCRIBED DRUGS SHALL MANDATE THAT THE SAME BE PURCHASED BY THE
INSURED FROM A MAIL ORDER PHARMACY, NOR MAY SUCH POLICY IMPOSE A CO-PAY-
MENT FEE OR OTHER CONDITION ON ANY INSURED WHO ELECTS TO PURCHASE DRUGS
FROM OTHER THAN A MAIL ORDER PHARMACY WHICH IS NOT ALSO IMPOSED ON
INSUREDS ELECTING TO PURCHASE DRUGS FROM A DESIGNATED MAIL ORDER PHARMA-
CY; 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. NOTHING
IN THIS PARAGRAPH SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND
THIRTEEN-O OF THE WORKERS' COMPENSATION LAW REGARDING THE PURCHASE OF
PRESCRIPTION DRUGS AND THE USE OF MAIL ORDER PHARMACY.
S 3. Section 4303 of the insurance law is amended by adding a new
subsection (ff) to read as follows:
(FF) NO POLICY ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION, A
HOSPITAL SERVICE CORPORATION OR A HEALTH SERVICES CORPORATION WHICH
PROVIDES COVERAGE FOR PRESCRIBED DRUGS SHALL MANDATE THAT THE SAME BE
PURCHASED BY THE INSURED FROM A MAIL ORDER PHARMACY, NOR MAY SUCH POLICY
IMPOSE A CO-PAYMENT FEE OR OTHER CONDITION ON ANY INSURED WHO ELECTS TO
PURCHASE DRUGS FROM OTHER THAN A MAIL ORDER PHARMACY WHICH IS NOT ALSO
IMPOSED ON INSUREDS ELECTING TO PURCHASE DRUGS FROM A DESIGNATED MAIL
ORDER 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 AGREE-
MENT BETWEEN AN EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGAN-
IZATION. NOTHING IN THIS SUBSECTION SHALL ALTER ANY PROVISIONS OF
SECTIONS THIRTEEN AND THIRTEEN-O OF THE WORKERS' COMPENSATION LAW
REGARDING THE PURCHASE OF PRESCRIPTION DRUGS AND THE USE OF MAIL ORDER
PHARMACY.
S 4. The opening paragraph of paragraph 25 of subsection (b) of
section 4322 of the insurance law, as amended by chapter 554 of the laws
of 2002, is amended to read as follows:
Prescription drugs, including contraceptive drugs or devices approved
by the federal food and drug administration or generic equivalents
approved as substitutes by such food and drug administration and nutri-
tional supplements (formulas) for the therapeutic treatment of phenylke-
tonuria, branched-chain ketonuria, galactosemia and homocystinuria,
obtained at a participating pharmacy under a prescription written by an
in-plan or out-of-plan provider. Health maintenance organizations, in
addition to providing coverage for prescription drugs at a participating
pharmacy, may utilize a mail order prescription drug program. HOWEVER,
NO HEALTH MAINTENANCE ORGANIZATION SHALL MANDATE THAT PRESCRIPTION DRUGS
BE PURCHASED BY THE INSURED FROM A MAIL ORDER 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. NOTHING IN THIS PARAGRAPH
SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND THIRTEEN-O OF THE
WORKERS' COMPENSATION LAW REGARDING THE PURCHASE OF PRESCRIPTION DRUGS
AND THE USE OF MAIL ORDER PHARMACY. Health maintenance organizations may
provide prescription drugs pursuant to a drug formulary; however, health
maintenance organizations must implement an appeals process so that the
use of non-formulary prescription drugs may be requested by a physician
or other provider.
A. 1267--A 3
S 5. If any clause, subparagraph, subsection, section or other part of
this act, or the application thereof be held to be invalid, such hold-
ing shall not affect, impair or invalidate the remainder of this act, or
the application of such section or part of a section held invalid.
S 6. This act shall take effect on the thirtieth day after it shall
have become a law and shall apply to all policies and contracts issued,
renewed, modified, altered or amended on or after such effective date.