S T A T E   O F   N E W   Y O R K
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                                  7709

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                             April 22, 2009
                               ___________

Introduced by M. of A. P. RIVERA, COLTON, COOK, BRADLEY, MILLMAN, CLARK,
  PEOPLES,  POWELL,  PERALTA  -- Multi-Sponsored by -- M. of A. BRENNAN,
  CHRISTENSEN, CUSICK, DIAZ, FARRELL, GIANARIS, GLICK -- read  once  and
  referred to the Committee on Insurance

AN  ACT  to  amend the insurance law, in relation to coverage for single
  source 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) EVERY INDIVIDUAL POLICY WHICH PROVIDES COVERAGE FOR  PRESCRIPTION
DRUGS  SHALL ENSURE THAT THERE IS CONTINUOUS COVERAGE OF A SINGLE SOURCE
DRUG THAT IS PART OF A PRESCRIBED THERAPY UNTIL SUCH PRESCRIBED  THERAPY
IS NO LONGER MEDICALLY NECESSARY FOR ANY COVERED PERSON UNDER SUCH POLI-
CY.    FOR  THE  PURPOSES  OF  THIS  PARAGRAPH,  "DRUG"  SHALL  MEAN ANY
PRESCRIPTION DRUG THAT HAS BEEN APPROVED AS SAFE AND  EFFECTIVE  BY  THE
FEDERAL  FOOD  AND DRUG ADMINISTRATION, OR IS OTHERWISE LEGALLY MARKETED
IN THE UNITED STATES INCLUDING ANY MECHANICAL DEVICE THAT IS  NEEDED  TO
APPLY SUCH PRESCRIPTION DRUG SUCH AS INSULIN, SYRINGES AND NEEDLES.
  S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 15 to read as follows:
  (15) EVERY GROUP POLICY WHICH PROVIDES COVERAGE FOR PRESCRIPTION DRUGS
SHALL  ENSURE  THAT THERE IS CONTINUOUS COVERAGE OF A SINGLE SOURCE DRUG
THAT IS PART OF A PRESCRIBED THERAPY UNTIL SUCH PRESCRIBED THERAPY IS NO
LONGER MEDICALLY NECESSARY FOR ANY COVERED  PERSON  UNDER  SUCH  POLICY.
FOR  THE  PURPOSES OF THIS PARAGRAPH, "DRUG" SHALL MEAN ANY PRESCRIPTION
DRUG THAT HAS BEEN APPROVED AS SAFE AND EFFECTIVE BY  THE  FEDERAL  FOOD
AND  DRUG ADMINISTRATION, OR IS OTHERWISE LEGALLY MARKETED IN THE UNITED
STATES INCLUDING ANY MECHANICAL DEVICE THAT  IS  NEEDED  TO  APPLY  SUCH
PRESCRIPTION DRUG SUCH AS INSULIN, SYRINGES AND NEEDLES.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10356-01-9

              

A. 7709                             2

  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (ff) to read as follows:
  (FF)  EVERY  CONTRACT  ISSUED  BY  A  HEALTH  SERVICE CORPORATION OR A
MEDICAL  EXPENSE  INDEMNITY  CORPORATION  WHICH  PROVIDES  COVERAGE  FOR
PRESCRIPTION  DRUGS  SHALL ENSURE THAT THERE IS CONTINUOUS COVERAGE OF A
SINGLE SOURCE DRUG THAT IS PART  OF  A  PRESCRIBED  THERAPY  UNTIL  SUCH
PRESCRIBED  THERAPY  IS  NO  LONGER  MEDICALLY NECESSARY FOR ANY COVERED
PERSON UNDER SUCH POLICY.  FOR THE PURPOSES OF THIS  SUBSECTION,  "DRUG"
SHALL  MEAN  ANY  PRESCRIPTION  DRUG  THAT HAS BEEN APPROVED AS SAFE AND
EFFECTIVE BY THE FEDERAL FOOD AND DRUG ADMINISTRATION, OR  IS  OTHERWISE
LEGALLY  MARKETED  IN  THE UNITED STATES INCLUDING ANY MECHANICAL DEVICE
THAT IS NEEDED TO APPLY SUCH PRESCRIPTION DRUG SUCH AS INSULIN, SYRINGES
AND NEEDLES.
  S 4. This act shall take effect on the first  of  the  calendar  month
next  succeeding  the sixtieth day after it shall have become a law, and
shall apply only to policies and contracts issued, renewed or amended on
or after the effective date of this act.