Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|
---|---|
Jan 06, 2010 |
referred to insurance |
Jun 11, 2009 |
referred to insurance |
Assembly Bill A8863
2009-2010 Legislative Session
Sponsored By
ESPAILLAT
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
Actions
2009-A8863 (ACTIVE) - Details
- Current Committee:
- Assembly Insurance
- Law Section:
- Insurance Law
- Laws Affected:
- Amd §3221, Ins L
2009-A8863 (ACTIVE) - Sponsor Memo
BILL NUMBER:A8863 TITLE OF BILL: An act to amend the insurance law, in relation to group health insurance policies and prescription drug coverage PURPOSE OR GENERAL IDEA OF BILL: Discourages the practice by health insurers of changing brand name drugs to generic drugs where the generic drugs are not the equivalent of the brand name. SUMMARY OF SPECIFIC PROVISIONS: Amends section 3221 of the insurance law by adding new subsections (r) and (s) providing that: * Insurers shall not provide incentives to physicians based on the drugs they prescribe. * Insurers shall not require their policy holders to change to a drug that is not equivalent to their original prescribed medication. * Prescription co-pays shall not exceed the actual cost of the drug to the health plan. * In a system of tiered prescription co-pays, the maximum co-pay shall not exceeds 300% of the minimum co-pay. * Out-of-pocket expenses for prescription drugs shall be included in any applicable health plan cap on out-of-pocket medical expenses.
2009-A8863 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 8863 2009-2010 Regular Sessions I N A S S E M B L Y June 11, 2009 ___________ Introduced by M. of A. ESPAILLAT -- read once and referred 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
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