NY State Assembly Bill 2009-A10411

Archive: Last Bill Status - In Assembly Committee

Introduced
- In Committee Assembly
- In Committee Senate
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Delivered to Governor
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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Mar 25, 2010	referred to insurance

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2009-A10411 (ACTIVE) - Details

Current Committee:: Assembly Insurance
Law Section:: Insurance Law
Laws Affected:: Add Art 33 §§3301 - 3306, Ins L
Versions Introduced in Other Legislative Sessions:: 2011-2012: A6049, A8609
2013-2014: A4285
2015-2016: A3142
2017-2018: A7018

2009-A10411 (ACTIVE) - Summary

Prohibits first fail accident and/or health insurance policies; enacts penalties and defines terms.

2009-A10411 (ACTIVE) - Sponsor Memo

                                BILL NUMBER:A10411

TITLE OF BILL:  An act to amend the insurance law, in relation to the
prohibition on first fail policies

PURPOSE OR GENERAL IDEA OF BILL: This bill would amend the insurance law
by adding Article 33 which would Prohibit fail first accident/or health
insurance policies that require a patient to exhaust the least expensive
drug Options before insurers will cover more expensive treatment
options. The bill would provide consumers with safeguards, transparency,
and medical oversight that is necessary to ensure their health and safe-
ty.

SUMMARY OF SPECIFIC PROVISIONS: This bill would amend the insurance law
by adding a new article 33 which would prohibit tail first accident/or
health insurance policies.

Section 3301 defines key terms.

Section 3302 establishes duties and prohibits certain action taken by
the pharmacy benefits manager (PBM), who functions as an administrator
in connection with pharmacy benefits. The legislation requires the PBM
to disclose to the insured information pertaining to individual claims,
along with an itemized invoice of the actual amounts paid to each phar-
macist and pharmacy. Additionally, the legislation prohibits PMBs from
enrolling pharmacies in contracts without a signed affirmation from the

pharmacy or pharmacist, conditioning participation of a contract, and
from discriminating between pharmacies on the basis, of co-payments or
days of supply.  The legislation requires PMBs to use the same National
Drug Code price when calculating the reimbursement to the pharmacy and
requires modifications to a prescription to remain with the original
pharmacy.

Section 3303 prohibits health benefit plans that provide prescription
coverage from reducing, limiting, or denying coverage when the insured
was taking the medication or was currently covered by a policy that
covered the drug. The legislation specifies that an insurer is allowed
to make uniform changes in its benefit design that apply to all covered
drugs or increase cost-sharing obligations' only due to an increase in
the underlying drug prices.

Section 3304 requires that any time a change to a patient's medication
is recommended, that all "switch communications" clearly inform the
insured of the originally prescribed medication, advise the insured of
their rights, any cost-sharing changes they will assume, and disclose
any financial interest involved in the decision to switch medications.

Section 3305 establishes penalties in the event that a "switch communi-
cation" is non-compliant or contains a false statement. These penalties
include fines that shall not exceed $25,000.

Section 3306 authorizes the prescribing physician to override
restrictions placed on a patient's medication by a PBM or insurer
through fail first protocol in situations including when the treatment
has been or is expected to be ineffective in treating the patient's
disease or medical condition or is likely to cause an adverse reaction
or other harm. Additionally, for medications with no generic equivalent
and for which the prescribing physician feels there is no appropriate
therapeutic alternative, the insurer or PMB is required to provide
access to medications labeled by the United States Food and Drug Admin-
istration without restriction.

JUSTIFICATION: Fail first, is an approach to prescribing drugs used by
health insurers to control costs. Fail first, also called step therapy,
insists that the least expensive drug in any class be proscribed to a
patient first. If the treatment is ineffective, insurers will cover more
expensive treatment options. This practice has serious negative conse-
quences for consumers and the public health system. By limiting the
array of medication options, both physicians and consumers are forced to
compromise their treatment decisions in a way that is dangerous, time
consuming and more expensive from a direct and indirect out-of-pocket
cost perspective.

Under fail first, a consumer will often have to fail on one or more
medications before they are allowed access to the medication that his or
her physician would have tried as an initial treatment. It is poor clin-
ical care to delay the start of effective treatment and expose a person
to unnecessary risk. In this way, fail first denies patients the drugs
they need when they need them, and effectively allows insurers co prac-
tice medicine without a license. There are significant administrative
costs associated with these types of policies and most importantly,
consumers can relapse and require more expensive medical interventions
such as hospitalization.

This bill provides safeguards for consumers and pharmacies by regulating
the duties and actions that can be taken by the PBM, who functions as an
administrator in connection with pharmacy benefits.

The bill prohibits insurers that provide prescription coverage under a
health benefit plan from reducing, limiting, or denying coverage when
the insured was taking the medication or was currently covered by a
policy that covered the drug. The legislation provides transparency by
requiring that all "switch communications" clearly inform the insured of
the originally prescribed medication. Further, "switch communications"
must advise the insured of their rights, any cost-sharing changes they
will incur, and disclose any financial interest involved in the decision
to switch the medication of the insured.

Most significantly, this bill allows the prescribing physician to over-
ride any step therapy or fail first protocol. This medical veto is
essential to ensure patient safety when the suggested change in medica-
tion has been ineffective in treating the patient's disease or medical

condition, is expected to be ineffective, or is likely to cause an
adverse reaction or other harm.

PRIOR LEGISLATIVE HISTORY: None

FISCAL IMPLICATIONS: This bill should save taxpayers of New York a
considerable amount in administrative costs and unnecessary medical
treatment.

EFFECTIVE DATE: This bill would effective 120 days after it shall have
become law.

2009-A10411 (ACTIVE) - Bill Text download pdf

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

                                  10411

                          I N  A S S E M B L Y

                             March 25, 2010
                               ___________

Introduced  by  M.  of  A. BING, BENEDETTO, ESPAILLAT, TITONE, DINOWITZ,
  MILLMAN,  PHEFFER,  COOK,  GIBSON,  JACOBS,  SPANO,  MARKEY,   BARRON,
  N. RIVERA,  MAISEL,  CHRISTENSEN, JAFFEE, HOOPER -- Multi-Sponsored by
  -- M. of A. BOYLAND, GLICK, McENENY -- read once and referred  to  the
  Committee on Insurance

AN  ACT  to  amend  the insurance law, in relation to the prohibition on
  first fail policies

  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 article 33 to
read as follows:
                                ARTICLE 33
                   PROHIBITION ON FIRST FAIL POLICIES
SECTION 3301. DEFINITIONS.
        3302. PHARMACY BENEFITS MANAGER DUTIES.
        3303. PRESCRIPTION DRUG DENIALS.
        3304. SWITCH COMMUNICATIONS.
        3305. PENALTIES.
        3306. PRESCRIPTION DRUG RESTRICTION OVERRIDES.
  S 3301. DEFINITIONS. AS USED IN THIS ARTICLE:
  (A) "INSURER" SHALL MEAN ANY PERSON OR ENTITY WHO OFFERS A  POLICY  OF
ACCIDENT  AND/OR HEALTH INSURANCE PURSUANT TO SECTION THREE THOUSAND TWO
HUNDRED SIXTEEN, THREE THOUSAND TWO HUNDRED TWENTY-ONE, OR FOUR THOUSAND
THREE HUNDRED THREE OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE  PUBLIC
HEALTH  LAW;  EXCEPT WHEN SUCH HEALTH CARE SERVICES ARE PROVIDED, DELIV-
ERED, ARRANGED FOR, PAID FOR, OR REIMBURSED BY ANY STATE, DEPARTMENT  OR
AGENCY;
  (B)  "PHARMACY  BENEFITS  MANAGER"  OR "PBM", MEANS A PERSON OR ENTITY
OTHER THAN A PHARMACY  OR  PHARMACIST  ACTING  AS  AN  ADMINISTRATOR  IN
CONNECTION WITH PHARMACY BENEFITS;
  (C)  "SWITCH COMMUNICATION", MEANS A COMMUNICATION FROM ANY INSURER OR
PBM TO A PATIENT OR THE PATIENT'S PHYSICIAN THAT RECOMMENDS A  PATIENT'S
MEDICATION  BE  SWITCHED BY THE ORIGINAL PRESCRIBING HEALTH CARE PROFES-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD15501-02-0

A. 10411                            2

SIONAL  TO  A  DIFFERENT  MEDICATION  THAN  THE  MEDICATION   ORIGINALLY
PRESCRIBED BY THE PRESCRIBING HEALTH CARE PROFESSIONAL.
  S  3302.  PHARMACY  BENEFITS  MANAGER  DUTIES. (A) A PHARMACY BENEFITS
MANAGER SHALL:
  (1)  REMIT  TO  THE  COVERED  ENTITY  EACH   INDIVIDUAL   CLAIM,   THE
PRESCRIPTION  NUMBER,  THE ELEVEN-DIGIT NATIONAL DRUG CODE (NDC) NUMBER,
THE QUANTITY AND THE AMOUNT THE PHARMACY BENEFITS MANAGER ACTUALLY  PAID
EACH PHARMACY OR PHARMACIST, AND THE AMOUNT CHARGED TO THE PERSON, BUSI-
NESS,  OR  OTHER ENTITY THAT IS PURCHASING PHARMACIST'S SERVICES THROUGH
THE PHARMACY BENEFITS MANAGER; AND
  (2) ITEMIZE BY INDIVIDUAL CLAIM  THE  AMOUNTS  THE  PHARMACY  BENEFITS
MANAGER  ACTUALLY  PAID  EACH  PHARMACY  OR  PHARMACIST FOR PHARMACIST'S
SERVICES ON ANY INVOICE, STATEMENT, OR REMITTANCE.
  (B) A PHARMACY BENEFITS MANAGER SHALL NOT:
  (1) AUTOMATICALLY  ENROLL  OR  PASSIVELY  ENROLL  THE  PHARMACY  IN  A
CONTRACT,  OR  MODIFY  AN EXISTING CONTRACT WITHOUT AFFIRMATION FROM THE
PHARMACY OR PHARMACIST. THE PHARMACY SHALL SIGN A CONTRACT BEFORE ASSUM-
ING RESPONSIBILITY TO FILL PRESCRIPTIONS;
  (2) REQUIRE THAT A PHARMACY OR PHARMACIST PARTICIPATE IN ONE  PHARMACY
BENEFITS  MANAGER  CONTRACT IN ORDER TO PARTICIPATE IN ANOTHER CONTRACT;
OR
  (3) DISCRIMINATE BETWEEN PHARMACIES OR PHARMACISTS  ON  THE  BASIS  OF
COPAYMENTS OR DAYS OF SUPPLY.
  (C)  WHEN  A  PHARMACY  BENEFITS  MANAGER  CALCULATES THE CHARGE FOR A
PRESCRIPTION TO THE RECIPIENT OF THE DRUG AND THE  COVERED  ENTITY,  THE
PHARMACY  BENEFITS MANAGER SHALL USE THE SAME NDC PRICE USED WHEN CALCU-
LATING THE REIMBURSEMENT TO THE DISPENSING PHARMACY.
  (D) WHEN AN INSURED PRESENTS A PRESCRIPTION TO A PHARMACY IN THE PHAR-
MACY BENEFITS MANAGER'S NETWORK, THE PHARMACY BENEFITS MANAGER SHALL NOT
REASSIGN SUCH PRESCRIPTION TO BE FILLED BY ANY OTHER PHARMACY. WHEN  THE
PHARMACY  BENEFITS  MANAGER CONTACTS THE PRESCRIBING HEALTH CARE PRACTI-
TIONER TO AFFIRM OR MODIFY THE  ORIGINAL  PRESCRIPTION  WHICH  HAS  BEEN
DELIVERED   TO  A  PARTICIPATING  PHARMACY,  THE  AFFIRMED  OR  MODIFIED
PRESCRIPTION SHALL BE FILLED  AT  THE  PHARMACY  TO  WHICH  THE  INSURED
PRESENTED THE ORIGINAL PRESCRIPTION.
  S  3303.  PRESCRIPTION  DRUG  DENIALS. (A) A POLICY OF ACCIDENT AND/OR
HEALTH INSURANCE THAT COVERS PRESCRIPTION DRUGS SHALL NOT LIMIT, REDUCE,
OR DENY COVERAGE FOR ANY DRUG IF, PRIOR TO THE LIMITATION, REDUCTION, OR
DENIAL OF COVERAGE:
  (1) ANY INSURED WAS USING THE DRUG;
  (2) SUCH INSURED OR INSUREDS WERE COVERED UNDER THE POLICY; AND
  (3) THE DRUG WAS COVERED UNDER THE POLICY FOR SUCH INSURED  INDIVIDUAL
OR INDIVIDUALS.
  (B) A LIMITATION, REDUCTION, OR DENIAL OF COVERAGE INCLUDES REMOVING A
DRUG  FROM THE FORMULARY OR OTHER DRUG LIST, IMPOSING NEW PRIOR AUTHORI-
ZATION OR OTHER UTILIZATION MANAGEMENT TOOLS, OR PLACING THE DRUG  ON  A
FORMULARY  TIER THAT INCREASES THE PATIENT'S COST-SHARING OBLIGATIONS OR
OTHERWISE INCREASES THE PATIENT'S COST-SHARING OBLIGATIONS.
  (C) NOTHING IN THIS SECTION SHALL  PROHIBIT  AN  INSURER  FROM  MAKING
UNIFORM  CHANGES  IN ITS BENEFIT DESIGN THAT APPLY TO ALL COVERED DRUGS,
UNIFORMLY REMOVING A DRUG FROM THE FORMULARY LIST FOR ALL  INSUREDS,  OR
INCREASING  COST-SHARING  OBLIGATIONS MERELY DUE TO A PERCENTAGE COINSU-
RANCE PAYMENT THAT NECESSARILY INCREASES WITH AN INCREASE IN THE  UNDER-
LYING DRUG PRICES.
  S  3304.  SWITCH  COMMUNICATIONS.  (A) ANY TIME A PATIENT'S PRESCRIBED
MEDICATION IS RECOMMENDED TO BE SWITCHED TO A MEDICATION OTHER THAN THAT

A. 10411                            3

ORIGINALLY PRESCRIBED BY THE PRESCRIBING PRACTITIONER, A SWITCH COMMUNI-
CATION SHALL BE SENT TO:
  (1)  THE PATIENT AND SHALL PROVIDE INFORMATION ABOUT WHY THE SWITCH IS
PROPOSED AND THE PATIENT'S RIGHTS FOR REFUSING THE RECOMMENDED CHANGE IN
TREATMENT; AND
  (2) THE POLICY SPONSOR AND SHALL INFORM  SUCH  SPONSOR  OF  THE  COST,
SHOWN  IN  CURRENCY  FORM,  OF  THE RECOMMENDED MEDICATION AND THE COST,
SHOWN IN CURRENCY FORM, OF THE ORIGINALLY PRESCRIBED MEDICATION.
  (B) SUCH SWITCH COMMUNICATION SHALL:
  (1) CLEARLY IDENTIFY THE  ORIGINALLY  PRESCRIBED  MEDICATION  AND  THE
MEDICATION  TO  WHICH  IT  HAS  BEEN PROPOSED THAT THE PATIENT SHOULD BE
SWITCHED;
  (2) EXPLAIN ANY FINANCIAL INCENTIVES THAT MAY BE PROVIDED TO, OR  HAVE
BEEN OFFERED TO, THE PRESCRIBING HEALTH CARE PROFESSIONAL BY THE INSURER
OR PBM THAT COULD RESULT IN THE SWITCH TO THE DIFFERENT DRUG. IN PARTIC-
ULAR,  CASH  OR  IN-KIND  COMPENSATION  PAYABLE  TO PRESCRIBERS OR THEIR
PROFESSIONAL PRACTICES  FOR  SWITCHING  PATIENTS  FROM  THEIR  CURRENTLY
PRESCRIBED  MEDICATION  TO  A DIFFERENT MEDICATION SHALL BE DISCLOSED TO
THE PATIENT AS WELL AS INCENTIVES THAT MAY BE PROVIDED  THROUGH  GENERAL
HEALTH  CARE  PROFESSIONAL  COMPENSATION PROGRAMS USED BY THE INSURER OR
PBM;
  (3) EXPLAIN ANY FINANCIAL INCENTIVE THAT AN INSURER OR PBM MAY HAVE TO
ENCOURAGE THE SWITCH TO A DIFFERENT DRUG;
  (4) ADVISE THE PATIENT OF HIS OR HER RIGHTS TO  DISCUSS  THE  PROPOSED
CHANGE  IN  TREATMENT  BEFORE  SUCH  A  SWITCH  TAKES PLACE, INCLUDING A
DISCUSSION WITH THE PATIENT'S PRESCRIBING PRACTITIONER, THE FILING OF  A
GRIEVANCE  WITH  THE  INSURER  TO PREVENT THE SWITCH IF SUCH A SWITCH IS
BASED ON A FINANCIAL INCENTIVE AND THE FILING OF A  GRIEVANCE  WITH  THE
DEPARTMENT; AND
  (5)  EXPLAIN ANY COST-SHARING CHANGES FOR WHICH THE PATIENT IS RESPON-
SIBLE.
  (C) SWITCH COMMUNICATIONS TO  HEALTH  CARE  PROVIDERS  SHALL  DISCLOSE
FINANCIAL  INCENTIVES OR BENEFITS THAT MAY BE RECEIVED BY THE INSURER OR
PBM.
  (D) SWITCH COMMUNICATIONS TO HEALTH CARE PROVIDERS  SHALL  DIRECT  THE
PRESCRIBER  TO  ADVISE  THE PATIENT THAT IS SUBJECTED TO A SWITCH BY THE
PRESCRIBER OF ANY FINANCIAL INCENTIVES RECEIVED  BY  THE  PRESCRIBER  OR
OTHER  INDUCEMENTS  FROM THE INSURER OR PBM THAT MAY INFLUENCE THE DECI-
SION TO SWITCH.
  (E) A COPY OF ANY SWITCH COMMUNICATION SENT TO A PATIENT SHALL ALSO BE
SENT TO THE PRESCRIBING PRACTITIONER.
  (F) HEALTH INSURANCE PAYERS, INCLUDING EMPLOYERS, SHALL BE NOTIFIED OF
MEDICATION SWITCHES AMONG POLICY PARTICIPANTS. SUCH  NOTIFICATION  SHALL
INCLUDE  ANY  FINANCIAL INCENTIVE THE INSURER OR PBM MAY BE UTILIZING TO
ENCOURAGE OR INDUCE THE SWITCH. INFORMATION CONTAINED IN  THE  NOTIFICA-
TION SHALL BE IN THE AGGREGATE AND MUST NOT CONTAIN ANY PERSONALLY IDEN-
TIFIABLE INFORMATION.
  (G)  THE  DEPARTMENT  SHALL  CREATE ONE FORM FOR INSURERS AND PHARMACY
BENEFIT MANAGERS TO USE IN SWITCH COMMUNICATIONS TO PATIENTS,  PRESCRIB-
ING PRACTITIONERS, AND HEALTH INSURANCE PAYERS INCLUDING EMPLOYERS.
  (H)  THE  DEPARTMENT  SHALL PROMULGATE RULES GOVERNING SWITCH COMMUNI-
CATIONS. SUCH RULES SHALL INCLUDE, BUT NOT BE LIMITED TO THE FOLLOWING:
  (1) PROCEDURES FOR VERIFYING THE ACCURACY OF ANY SWITCH COMMUNICATIONS
FROM POLICIES OF ACCIDENT AND/OR HEALTH INSURANCE AND  PHARMACY  BENEFIT
MANAGERS  TO  ENSURE THAT SUCH SWITCH COMMUNICATIONS ARE TRUTHFUL, ACCU-
RATE, AND NOT MISLEADING BASED ON COST TO THE PATIENT AND  POLICY  SPON-

A. 10411                            4

SOR,  THE  PRODUCT PACKAGE LABELING, MEDICAL COMPENDIA RECOGNIZED BY THE
DRUG UTILIZATION REVIEW BOARD,  AND  PEER-REVIEWED  MEDICAL  LITERATURE,
WITH APPROPRIATE REFERENCES PROVIDED;
  (2)  EXCEPT  FOR  A  SUBSTITUTION  DUE  TO  THE FOOD AND DRUG ADMINIS-
TRATION'S WITHDRAWAL OF A DRUG FOR PRESCRIPTION, A REQUIREMENT THAT  ALL
SWITCH  COMMUNICATIONS  BEAR  A  PROMINENT LEGEND ON THE FIRST PAGE THAT
STATES:  "THIS IS NOT A PRODUCT SAFETY NOTICE.  THIS  IS  A  PROMOTIONAL
ANNOUNCEMENT  FROM YOUR HEALTH CARE INSURER OR PHARMACY BENEFITS MANAGER
ABOUT ONE OF YOUR CURRENT PRESCRIBED MEDICATIONS.";
  (3) A REQUIREMENT THAT, IF THE SWITCH COMMUNICATION CONTAINS  INFORMA-
TION  REGARDING A POTENTIAL THERAPEUTIC SUBSTITUTION, SUCH COMMUNICATION
SHALL EXPLAIN THAT MEDICATIONS IN THE SAME THERAPEUTIC CLASS ARE ASSOCI-
ATED WITH DIFFERENT RISKS AND  BENEFITS  AND  MAY  WORK  DIFFERENTLY  IN
DIFFERENT PATIENTS.
  S  3305.  PENALTIES. (A) ISSUING OR DELIVERING OR CAUSING TO BE ISSUED
OR DELIVERED A SWITCH COMMUNICATION THAT HAS NOT BEEN  APPROVED  AND  IS
NOT  IN COMPLIANCE WITH THE REQUIREMENTS OF SECTION THREE THOUSAND THREE
HUNDRED FOUR OF THIS ARTICLE IS PUNISHABLE BY A FINE NOT TO EXCEED TWEN-
TY-FIVE THOUSAND DOLLARS.
  (B) PROVIDING A MISREPRESENTATION  OR  FALSE  STATEMENT  IN  A  SWITCH
COMMUNICATION  UNDER  SECTION  THREE THOUSAND THREE HUNDRED FOUR OF THIS
ARTICLE IS PUNISHABLE BY A  FINE  NOT  TO  EXCEED  TWENTY-FIVE  THOUSAND
DOLLARS.
  (C)  ANY  OTHER  MATERIAL  VIOLATION  OF  SECTION THREE THOUSAND THREE
HUNDRED FOUR OF THIS ARTICLE IS PUNISHABLE BY A FINE NOT TO EXCEED TWEN-
TY-FIVE THOUSAND DOLLARS.
  S 3306. PRESCRIPTION DRUG RESTRICTION OVERRIDES. (A) WHEN  MEDICATIONS
FOR  THE TREATMENT OF ANY MEDICAL CONDITION ARE RESTRICTED FOR USE BY AN
INSURER OR PBM BY A STEP THERAPY OR FAIL FIRST  PROTOCOL,  A  PRESCRIBER
MAY OVERRIDE SUCH RESTRICTION IF:
  (1)  THE  PREFERRED TREATMENT BY THE INSURER OR THE PBM HAS BEEN INEF-
FECTIVE IN THE TREATMENT OF THE  COVERED  PERSON'S  DISEASE  OR  MEDICAL
CONDITION; OR
  (2)  BASED  ON  SOUND  CLINICAL  EVIDENCE  AND  MEDICAL AND SCIENTIFIC
EVIDENCE:
  (A) THE PREFERRED TREATMENT IS EXPECTED TO BE INEFFECTIVE BASED ON THE
KNOWN RELEVANT PHYSICAL OR MENTAL CHARACTERISTICS OF THE COVERED  PERSON
AND KNOWN CHARACTERISTICS OF THE DRUG REGIMEN, AND IS LIKELY TO BE INEF-
FECTIVE  OR ADVERSELY AFFECT THE DRUG'S EFFECTIVENESS OR PATIENT COMPLI-
ANCE; OR
  (B) THE PREFERRED TREATMENT HAS  CAUSED  OR  IS  LIKELY  TO  CAUSE  AN
ADVERSE REACTION OR OTHER HARM TO THE COVERED PERSON.
  (B)  THE DURATION OF ANY STEP THERAPY OR FAIL FIRST PROTOCOL SHALL NOT
BE LONGER THAN A PERIOD OF FOURTEEN DAYS WHEN SUCH TREATMENT  IS  DEEMED
CLINICALLY INEFFECTIVE BY THE PRESCRIBING PHYSICIAN.
  (C)  FOR  MEDICATIONS  WITH  NO  GENERIC  EQUIVALENT AND FOR WHICH THE
PRESCRIBING PHYSICIAN IN THEIR CLINICAL JUDGMENT FEELS THAT NO APPROPRI-
ATE THERAPEUTIC ALTERNATIVE IS AVAILABLE AN INSURER OR PBM SHALL PROVIDE
ACCESS TO UNITED STATES FOOD AND DRUG ADMINISTRATION (FDA) LABELED MEDI-
CATIONS WITHOUT RESTRICTION TO TREAT SUCH MEDICAL CONDITIONS  FOR  WHICH
AN FDA LABELED MEDICATION IS AVAILABLE.
  (D)  NOTHING  IN  THIS  SECTION SHALL REQUIRE COVERAGE FOR A CONDITION
SPECIFICALLY EXCLUDED BY THE POLICY WHICH IS NOT  OTHERWISE  COVERED  BY
LAW.
  S 2. This act shall take effect immediately.

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Assembly Bill A10411

Sponsored By

Archive: Last Bill Status - In Assembly Committee

co-Sponsors

multi-Sponsors

2009-A10411 (ACTIVE) - Details

2009-A10411 (ACTIVE) - Summary

2009-A10411 (ACTIVE) - Sponsor Memo

2009-A10411 (ACTIVE) - Bill Text download pdf

Comments

Assembly Bill A10411

Share this bill

Sponsored By

BING

Archive: Last Bill Status - In Assembly Committee

co-Sponsors

Michael Benedetto

Adriano Espaillat

Matthew Titone

Jeffrey Dinowitz

multi-Sponsors

William Boyland

Deborah Glick

John McEneny

2009-A10411 (ACTIVE) - Details

2009-A10411 (ACTIVE) - Summary

2009-A10411 (ACTIVE) - Sponsor Memo

2009-A10411 (ACTIVE) - Bill Text download pdf

Comments