Senate Bill S2938

2009-2010 Legislative Session

Discourages the practice by health plan insurers of changing brand name drugs to generic drugs which generic drugs are not the equivalent of brand name

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Archive: Last Bill Status - In Senate Committee Insurance 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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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 06, 2010	referred to insurance
Sep 14, 2009	print number 2938a
Sep 14, 2009	amend (t) and recommit to insurance
Mar 06, 2009	referred to insurance

Bill Amendments

Original

A (Active)

2009-S2938 - Details

See Assembly Version of this Bill:: A8863
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3221, 3216 & 4303, Ins L

2009-S2938 - Summary

Discourages the practice by health plan insurers of changing brand name drugs to generic drugs when generic drugs are not the equivalent of brand name.

2009-S2938 - Sponsor Memo

2009-S2938 - Bill Text download pdf

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

                                  2938

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                              March 6, 2009
                               ___________

Introduced  by  Sen.  KLEIN  -- 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 group health insurance
  policies and prescription drug coverage

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Section  3221  of  the insurance law is amended by adding
three new subsections (r), (s) and (t) to read as follows:
  (R)(1) NO INSURANCE SHALL PROVIDE INCENTIVES (MONEY OR OTHERWISE) TO A
PRESCRIBING PHYSICIAN OF DRUGS THAT DISCRIMINATE ON  THE  BASIS  OF  THE
DRUG PRESCRIBED.
  (2) AN INSURER SHALL BE LIABLE FOR ANY INJURIES OR DAMAGE SUSTAINED BY
A MEMBER INSURED BY A GROUP HEALTH POLICY ISSUED UNDER THIS SECTION AS A
RESULT OF A MEMBER'S DRUG SUBSTITUTION OCCASIONED BY CHANGES TO EXISTING
FORMULARY OR CO-PAYMENT OR CO-INSURANCE PAYMENT STRUCTURES.
  (3)  WHEN  AN  INSURER  HAS  CHANGED  THE  DRUG MEDICATION OF A MEMBER
INSURED BY A GROUP HEALTH POLICY ISSUED UNDER THIS SECTION TO A  GENERIC
ALTERNATIVE WHICH ALTERNATIVE AS ATTESTED TO BY THE MEMBER'S PRESCRIBING
PHYSICIAN  IS  NOT  THE  EQUIVALENT  OF THE ORIGINAL PRESCRIBED DRUG THE
INSURER SHALL CONTINUE TO COVER AND PAY FOR THE ORIGINAL DRUG  AND  MAKE
SAID DRUG AVAILABLE TO THE MEMBER AS ORIGINALLY PRESCRIBED.
  (S)(1) THE FOLLOWING SHALL APPLY TO DEDUCTIBLE CO-PAYMENT AND CO-INSU-
RANCE  AMOUNTS ESTABLISHED BY INSURERS OF HEALTH PLANS ISSUED UNDER THIS
SECTION.
  (2) THE CO-PAYMENT AND CO-INSURANCE AMOUNT WITH RESPECT TO ANY COVERED
DRUG SHALL NOT EXCEED THE COST OF THE DRUG TO THE HEALTH PLAN.
  (3) SHOULD A HEALTH PLAN INCLUDE AN OUT OF POCKET LIMIT ON NON-PHARMA-
CY BENEFITS IT SHALL ALSO  PROVIDE  THAT  OUT  OF  POCKET  EXPENSES  FOR
COVERED PRESCRIPTION DRUGS SHALL BE INCLUDED AS MEDICAL BENEFIT EXPENSES
UNDER THE PLAN'S GENERAL OUT OF POCKET EXPENSE CAP.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD08473-02-9

S. 2938                             2

  (4)  SHOULD  AN INSURER PROVIDE FOR TIERED CO-PAYMENT AND CO-INSURANCE
AMOUNTS, IT SHALL ALSO PROVIDE THAT THE MAXIMUM CO-PAYMENT AND  CO-INSU-
RANCE  AMOUNT  SHALL  NOT  EXCEED  THREE  HUNDRED  PERCENT OF THE LOWEST
CO-PAYMENT AND CO-INSURANCE AMOUNT.
  (T)  EVERY  GROUP  OR  BLANKET  POLICY  WHICH  PROVIDES  COVERAGE  FOR
PRESCRIPTION DRUGS SHALL BE SUBJECT TO THE FOLLOWING REQUIREMENTS:
  (1) IF LESS EXPENSIVE DRUGS ARE REQUIRED TO BE TAKEN  BY  THE  PATIENT
INITIALLY,  THE  SINGLE  SOURCE  MEDICATION  MUST BE AVAILABLE FOLLOWING
COMPLIANCE WITH THE STEP THERAPY AND A DETERMINATION  BY  THE  PATIENT'S
PHYSICIAN THAT THE DRUG REMAINS MEDICALLY NECESSARY.
  (2)  THE  INSURERS  MUST SUBMIT THEIR PRESCRIPTION DRUG FORMULARIES TO
THE DEPARTMENT ON AN ANNUAL BASIS AND WHENEVER  THEY  ARE  ALTERED.  THE
DEPARTMENT  SHALL  ISSUE  GUIDELINES  FOR  INSURERS  TO FOLLOW IN MAKING
DETERMINATIONS OF MEDICAL NECESSITY WITH RESPECT  TO  PRESCRIPTION  DRUG
COVERAGE.
  (3)  AN  INSURER CAN AMEND THE FORMULARY ONCE A YEAR OR WHEN AN AMEND-
MENT IS TO INCLUDE A NEW DRUG OR A NEW  GENERIC  VERSION  OF  A  CURRENT
DRUG.
  (4)  A  PATIENT RECEIVING COVERAGE FOR A DRUG ON AN INSURER'S EXISTING
FORMULARY SHALL NOT BE DENIED COVERAGE UPON A CHANGE IN THE FORMULARY IF
HIS OR HER PHYSICIAN DETERMINES THAT DRUG TO BE MEDICALLY NECESSARY.
  S 2. This act shall take effect immediately.

2009-S2938A (ACTIVE) - Details

See Assembly Version of this Bill:: A8863
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3221, 3216 & 4303, Ins L

2009-S2938A (ACTIVE) - Summary

Discourages the practice by health plan insurers of changing brand name drugs to generic drugs when generic drugs are not the equivalent of brand name.

2009-S2938A (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S2938A

 TITLE OF BILL :
An act to amend the insurance law, in relation to health insurance
policies and prescription drug coverage

 PURPOSE OR GENERAL IDEA OF BILL :
Discourages the practice by health insurers of creating co-payment and
co-insurance structures that effectively reduce coverage and raise
costs for policy-holders. Limits the ability of health insurers to
push patients toward generic drugs where the generic drugs are not the
equivalent of the brand name drug prescribed. Requires the State
Insurance Department to post online prescription drug formularies
issued by insurance companies. Prevents a change in an insurer's
formulary from discontinuing use of a prescribed drug by an existing
policy-holder whose doctor determines the drug to be medically
necessary.

 SUMMARY OF SPECIFIC PROVISIONS :
Amends section 3221 of the insurance law by adding new subsections (r)
and (s)providing that:

* Co-payment or co-insurance costs with respect to a prescribed drug
not exceed the cost of the drug to the insurance provider.

* An out-of-pocket cap be established for pharmacy benefits on covered

prescription drugs.

* Maximum co-payment and co-insurance amounts be limited so they shall
not exceed ten times the dollar value of the lowest co-payment and
co-insurance amount whose cost is above zero dollars.

* When an insurer has required that a member take a generic
alternative to a brand-name patented drug prescribed by their doctor,
and the alternative is not deemed as having an equivalent impact on
the member by the member's prescribing physician and is not deemed an
A-rated generically and therapeutically equivalent product as
determined by the FDA, the insurer shall pay for and make available
the brand-name patented drug originally prescribed by the member's
doctor.

* In cases where step therapy is required prior to a patient accessing
a brand name patented prescription drug, the patient can receive the
brand name patented prescription drug prescribed by their doctor if
the patient tries one alternative medication and the patient's doctor
determines that the single source therapy remains medically necessary.

* Insurers must submit their prescription drug formularies to the
State Insurance Department on an annual basis, which the State
Insurance Department shall publicly post on their Web site to enable
consumers to compare drug formularies during open enrollment periods.
Once submitted, plans may not remove or make changes to the drug
formulary mid-year except in instances where an A-rated generically
and therapeutically equivalent product as determined by the FDA
becomes available, the drug is recalled by the Food and Drug
Administration, or significant new safety information becomes
available.

* A patient receiving coverage for a drug on an insurer's existing
formulary shall not be denied coverage upon a change in the formulary
if his or her physician determines that drug to be medically
necessary.

Identical amendments are also made to section 3216 of the insurance
law by adding two new subsections (j-1) and (j-2) and to section 4303
of the insurance law by adding two new subsections (ff) and (gg).
 JUSTIFICATION :
Access to prescription drugs that best treat a particular illness or
condition are essential to the health and well-being of New Yorkers,
particularly the state's senior population. Too often, decisions about
the most appropriate prescription drug choices made by doctors and
patients are being trumped by insurance companies whose interest in
providing health coverage for their members are compromised by
concerns over costs.

This issue is most evident in relation to access to single-source
drugs. Single-source drugs are unique in their formulation, dosage,
and delivery-they have no generic equivalent because of current patent
laws and are often times more expensive. The higher prices of
single-source drugs cause insurance companies to create policies and
formularies that steer the insured toward prescription drugs that are
cheaper, rather than those that the doctor and patient may decide are
the best course of treatment. Insurance companies put restrictions in
place ranging from higher co-payments and coinsurance to bureaucratic
approval requirements like pre-authorization and step therapy that
hinder patient's access to brand name drugs that their doctor has
determined is the most suitable drug to treat their condition.

A 2008 study by my office showed that the most commonly prescribed
single-source prescription drugs, and those most frequently used to
treat ailments disproportionally impacting minorities like heart
disease, were the most likely to have restrictions on their use
imposed by the insurance companies. The findings included:

* All 15 health insurance companies surveyed imposed restrictions on
use of the twenty most prescribed single-source drugs.

* More than a third of health insurance companies surveyed imposed
restrictions on the use of the most commonly prescribed single-source
drugs treating mental health conditions.

* More than a third of health insurance companies surveyed imposed
restrictions on the use of the most commonly prescribed single-source
drugs treating high cholesterol and blood pressure.

A 2009 report by my office further examining this issue resulted in
additional conclusions, including:

* Single-source drugs treating HIV/AIDS routinely had the highest
co-payments, despite findings that costly co-payments on HIV/AIDS
drugs results in treatment interruption that can cause the virus to
become resistant to the prescribed drug and make treatment of the
patient more difficult.

* Insurance companies surveyed frequently require doctors to acquire
pre-authorization to prescribe single-source drugs treating cancer for
their patients.

* Single-source drugs treating chronic pain and cardiovascular
ailments are extensively restricted through prior authorization,
expensive co-payments, and quantity limitations. In several instances,
multiple limitations on use will be placed on one single-source drug.

 LEGISLATIVE HISTORY :
This is a new bill.

 FISCAL IMPLICATIONS :
No costs to the state.

 EFFECTIVE DATE :
This act shall take effect one year after it becomes law.

2009-S2938A (ACTIVE) - Bill Text download pdf

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

                                 2938--A

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                              March 6, 2009
                               ___________

Introduced by Sens. KLEIN, ADAMS, HASSELL-THOMPSON, C. JOHNSON, ONORATO,
  OPPENHEIMER,  STAVISKY  --  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 health insurance poli-
  cies and prescription drug coverage

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 3221 of the insurance law is amended by adding  two
new subsections (s) and (t) to read as follows:
  (S)  EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN
THIS STATE WHICH PROVIDES PRESCRIPTION DRUG COVERAGE SHALL:
  (1) LIMIT THE CO-PAYMENT AND CO-INSURANCE AMOUNTS WITH RESPECT TO  ANY
COVERED  DRUG  SO  THAT  IT SHALL NOT EXCEED THE COST OF THE DRUG TO THE
HEALTH PLAN.
  (2) PROVIDE AN OUT-OF-POCKET CAP  ON  PHARMACY  BENEFITS  FOR  COVERED
PRESCRIPTION DRUGS.
  (3)  LIMIT  THE  MAXIMUM  CO-PAYMENT  AND CO-INSURANCE AMOUNTS SO THEY
SHALL NOT EXCEED TEN TIMES THE DOLLAR VALUE OF THE LOWEST CO-PAYMENT AND
CO-INSURANCE AMOUNT WHOSE COST IS ABOVE ZERO DOLLARS.
  (T) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY  IN
THIS STATE WHICH PROVIDES PRESCRIPTION DRUG COVERAGE SHALL BE SUBJECT TO
THE FOLLOWING PROVISIONS:
  (1)  WHEN  AN  INSURER  HAS REQUIRED THAT A MEMBER INSURED BY A HEALTH
POLICY ISSUED UNDER THIS SECTION TAKE A GENERIC ALTERNATIVE TO A  BRAND-
NAME  PATENTED  DRUG  PRESCRIBED BY THEIR DOCTOR, AND THE ALTERNATIVE IS
NOT DEEMED AS HAVING AN EQUIVALENT IMPACT ON THE MEMBER BY THE  MEMBER'S
PRESCRIBING PHYSICIAN AND IS NOT DEEMED AN A-RATED GENERICALLY AND THER-
APEUTICALLY  EQUIVALENT  PRODUCT  AS  DETERMINED BY THE FDA, THE INSURER

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD08473-07-9

S. 2938--A                          2

SHALL PAY FOR AND MAKE AVAILABLE THE BRAND-NAME PATENTED DRUG ORIGINALLY
PRESCRIBED BY THE MEMBER'S DOCTOR.
  (2) IN CASES WHERE STEP THERAPY IS REQUIRED PRIOR TO A PATIENT ACCESS-
ING A BRAND-NAME PATENTED PRESCRIPTION DRUG, THE PATIENT CAN RECEIVE THE
BRAND-NAME  PATENTED PRESCRIPTION DRUG PRESCRIBED BY THEIR DOCTOR IF THE
PATIENT TRIES ONE ALTERNATIVE MEDICATION AND THE PATIENT'S DOCTOR DETER-
MINES THAT THE SINGLE SOURCE THERAPY REMAINS MEDICALLY NECESSARY.
  (3) INSURERS MUST SUBMIT THEIR PRESCRIPTION DRUG  FORMULARIES  TO  THE
DEPARTMENT AND ON AN ANNUAL  BASIS, WHICH THE  DEPARTMENT SHALL PUBLICLY
POST  ON  THEIR  WEBSITE TO ENABLE CONSUMERS TO COMPARE DRUG FORMULARIES
DURING OPEN ENROLLMENT PERIODS. ONCE SUBMITTED, PLANS MAY NOT REMOVE  OR
MAKE CHANGES TO THE DRUG FORMULARY MID-YEAR EXCEPT IN INSTANCES WHERE AN
A-RATED GENERICALLY AND THERAPEUTICALLY EQUIVALENT PRODUCT AS DETERMINED
BY  THE FDA BECOMES AVAILABLE, THE DRUG IS RECALLED BY THE FOOD AND DRUG
ADMINISTRATION, OR SIGNIFICANT NEW SAFETY INFORMATION BECOMES AVAILABLE.
  (4) A PATIENT RECEIVING COVERAGE FOR A DRUG ON AN  INSURER'S  EXISTING
FORMULARY SHALL NOT BE DENIED COVERAGE UPON A CHANGE IN THE FORMULARY IF
HIS OR HER PHYSICIAN DETERMINES THAT DRUG TO BE MEDICALLY NECESSARY.
  S  2.  Section  3216 of the insurance law is amended by adding two new
subsections (j-1) and (j-2) to read as follows:
  (J-1) EVERY POLICY OF  ACCIDENT  AND  HEALTH  INSURANCE  DELIVERED  OR
ISSUED  FOR  DELIVERY  TO  ANY  PERSON  IN  THIS  STATE  WHICH  PROVIDES
PRESCRIPTION DRUG COVERAGE SHALL:
  (1) LIMIT THE CO-PAYMENT AND CO-INSURANCE AMOUNTS WITH RESPECT TO  ANY
COVERED  DRUG  SO  THAT  IT SHALL NOT EXCEED THE COST OF THE DRUG TO THE
HEALTH PLAN.
  (2) PROVIDE AN OUT-OF-POCKET CAP  ON  PHARMACY  BENEFITS  FOR  COVERED
PRESCRIPTION DRUGS.
  (3)  LIMIT  THE  MAXIMUM  CO-PAYMENT  AND CO-INSURANCE AMOUNTS SO THEY
SHALL NOT EXCEED TEN TIMES THE DOLLAR VALUE OF THE LOWEST CO-PAYMENT AND
CO-INSURANCE AMOUNT WHOSE COST IS ABOVE ZERO DOLLARS.
  (J-2) EVERY POLICY OF  ACCIDENT  AND  HEALTH  INSURANCE  DELIVERED  OR
ISSUED  FOR  DELIVERY  TO  ANY  PERSON  IN  THIS  STATE  WHICH  PROVIDES
PRESCRIPTION DRUG COVERAGE SHALL BE SUBJECT TO THE FOLLOWING PROVISIONS:
  (1) WHEN AN INSURER HAS REQUIRED THAT A MEMBER  INSURED  BY  A  HEALTH
POLICY  ISSUED UNDER THIS SECTION TAKE A GENERIC ALTERNATIVE TO A BRAND-
NAME PATENTED DRUG PRESCRIBED BY THEIR DOCTOR, AND  THE  ALTERNATIVE  IS
NOT  DEEMED AS HAVING AN EQUIVALENT IMPACT ON THE MEMBER BY THE MEMBER'S
PRESCRIBING PHYSICIAN AND IS NOT DEEMED AN A-RATED GENERICALLY AND THER-
APEUTICALLY EQUIVALENT PRODUCT AS DETERMINED BY  THE  FDA,  THE  INSURER
SHALL PAY FOR AND MAKE AVAILABLE THE BRAND-NAME PATENTED DRUG ORIGINALLY
PRESCRIBED BY THE MEMBER'S DOCTOR.
  (2) IN CASES WHERE STEP THERAPY IS REQUIRED PRIOR TO A PATIENT ACCESS-
ING A BRAND-NAME PATENTED PRESCRIPTION DRUG, THE PATIENT CAN RECEIVE THE
BRAND-NAME  PATENTED PRESCRIPTION DRUG PRESCRIBED BY THEIR DOCTOR IF THE
PATIENT TRIES ONE ALTERNATIVE MEDICATION AND THE PATIENT'S DOCTOR DETER-
MINES THAT THE SINGLE SOURCE THERAPY REMAINS MEDICALLY NECESSARY.
  (3) INSURERS MUST SUBMIT THEIR PRESCRIPTION DRUG  FORMULARIES  TO  THE
DEPARTMENT  AND  ON AN ANNUAL BASIS, WHICH THE DEPARTMENT SHALL PUBLICLY
POST ON THEIR WEBSITE TO ENABLE CONSUMERS TO  COMPARE  DRUG  FORMULARIES
DURING  OPEN ENROLLMENT PERIODS. ONCE SUBMITTED, PLANS MAY NOT REMOVE OR
MAKE CHANGES TO THE DRUG FORMULARY MID-YEAR EXCEPT IN INSTANCES WHERE AN
A-RATED GENERICALLY AND THERAPEUTICALLY EQUIVALENT PRODUCT AS DETERMINED
BY THE FDA BECOMES AVAILABLE, THE DRUG IS RECALLED BY THE FOOD AND  DRUG
ADMINISTRATION, OR SIGNIFICANT NEW SAFETY INFORMATION BECOMES AVAILABLE.

S. 2938--A                          3

  (4)  A  PATIENT RECEIVING COVERAGE FOR A DRUG ON AN INSURER'S EXISTING
FORMULARY SHALL NOT BE DENIED COVERAGE UPON A CHANGE IN THE FORMULARY IF
HIS OR HER PHYSICIAN DETERMINES THAT DRUG TO BE MEDICALLY NECESSARY.
  S  3.  Section  4303 of the insurance law is amended by adding two new
subsections (gg) and (hh) to read as follows:
  (GG) EVERY CONTRACT ISSUED BY A HOSPITAL SERVICE CORPORATION OR HEALTH
SERVICE CORPORATION WHICH PROVIDES PRESCRIPTION DRUG COVERAGE SHALL:
  (1) LIMIT THE CO-PAYMENT AND CO-INSURANCE AMOUNTS WITH RESPECT TO  ANY
COVERED  DRUG  SO  THAT  IT SHALL NOT EXCEED THE COST OF THE DRUG TO THE
HEALTH CONTRACT.
  (2) PROVIDE AN OUT-OF-POCKET CAP  ON  PHARMACY  BENEFITS  FOR  COVERED
PRESCRIPTION DRUGS.
  (3)  LIMIT  THE  MAXIMUM  CO-PAYMENT  AND CO-INSURANCE AMOUNTS SO THEY
SHALL NOT EXCEED TEN TIMES THE DOLLAR VALUE OF THE LOWEST CO-PAYMENT AND
CO-INSURANCE AMOUNT WHOSE COST IS ABOVE ZERO DOLLARS.
  (HH) EVERY CONTRACT ISSUED BY A HOSPITAL SERVICE CORPORATION OR HEALTH
SERVICE CORPORATION WHICH PROVIDES PRESCRIPTION DRUG COVERAGE  SHALL  BE
SUBJECT TO THE FOLLOWING PROVISIONS:
  (1)  WHEN  AN  INSURER  HAS REQUIRED THAT A MEMBER INSURED BY A HEALTH
CONTRACT ISSUED UNDER THIS SECTION  TAKE  A  GENERIC  ALTERNATIVE  TO  A
BRAND-NAME PATENTED DRUG PRESCRIBED BY THEIR DOCTOR, AND THE ALTERNATIVE
IS  NOT  DEEMED  AS  HAVING  AN  EQUIVALENT  IMPACT ON THE MEMBER BY THE
MEMBER'S PRESCRIBING PHYSICIAN AND IS NOT DEEMED AN A-RATED  GENERICALLY
AND  THERAPEUTICALLY  EQUIVALENT  PRODUCT  AS DETERMINED BY THE FDA, THE
INSURER SHALL PAY FOR AND MAKE AVAILABLE THE  BRAND-NAME  PATENTED  DRUG
ORIGINALLY PRESCRIBED BY THE MEMBER'S DOCTOR.
  (2) IN CASES WHERE STEP THERAPY IS REQUIRED PRIOR TO A PATIENT ACCESS-
ING A BRAND-NAME PATENTED PRESCRIPTION DRUG, THE PATIENT CAN RECEIVE THE
BRAND-NAME  PATENTED PRESCRIPTION DRUG PRESCRIBED BY THEIR DOCTOR IF THE
PATIENT TRIES ONE ALTERNATIVE MEDICATION AND THE PATIENT'S DOCTOR DETER-
MINES THAT THE SINGLE SOURCE THERAPY REMAINS MEDICALLY NECESSARY.
  (3) INSURERS MUST SUBMIT THEIR PRESCRIPTION DRUG  FORMULARIES  TO  THE
DEPARTMENT  AND  ON AN ANNUAL BASIS, WHICH THE DEPARTMENT SHALL PUBLICLY
POST ON THEIR WEBSITE TO ENABLE CONSUMERS TO  COMPARE  DRUG  FORMULARIES
DURING  OPEN ENROLLMENT PERIODS. ONCE SUBMITTED, PLANS MAY NOT REMOVE OR
MAKE CHANGES TO THE DRUG FORMULARY MID-YEAR EXCEPT IN INSTANCES WHERE AN
A-RATED GENERICALLY AND THERAPEUTICALLY EQUIVALENT PRODUCT AS DETERMINED
BY THE FDA BECOMES AVAILABLE, THE DRUG IS RECALLED BY THE FOOD AND  DRUG
ADMINISTRATION, OR SIGNIFICANT NEW SAFETY INFORMATION BECOMES AVAILABLE.
  (4)  A  PATIENT RECEIVING COVERAGE FOR A DRUG ON AN INSURER'S EXISTING
FORMULARY SHALL NOT BE DENIED COVERAGE UPON A CHANGE IN THE FORMULARY IF
HIS OR HER PHYSICIAN DETERMINES THAT DRUG TO BE MEDICALLY NECESSARY.
  S 4. This act shall take effect one year after the date on which  this
act shall have become a law.

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Senate Bill S2938

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Archive: Last Bill Status - In Senate Committee Insurance Committee

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Bill Amendments

2009-S2938 - Details

2009-S2938 - Summary

2009-S2938 - Sponsor Memo

2009-S2938 - Bill Text download pdf

2009-S2938A (ACTIVE) - Details

2009-S2938A (ACTIVE) - Summary

2009-S2938A (ACTIVE) - Sponsor Memo

2009-S2938A (ACTIVE) - Bill Text download pdf

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Sponsored By

Jeffrey D. Klein

Archive: Last Bill Status - In Senate Committee Insurance Committee

Actions

Bill Amendments

2009-S2938 - Details

2009-S2938 - Summary

2009-S2938 - Sponsor Memo

2009-S2938 - Bill Text download pdf

2009-S2938A (ACTIVE) - Details

2009-S2938A (ACTIVE) - Summary

2009-S2938A (ACTIVE) - Sponsor Memo

2009-S2938A (ACTIVE) - Bill Text download pdf

Comments