NY State Senate Bill S5000B

Archive: Last Bill Status - Signed by Governor

Introduced
In Committee
On Floor Calendar
- Passed Senate
- Passed Assembly
Delivered to Governor
Signed by Governor

Your Voice

Please enter your contact information

First Name *

Last Name *

Email Address *

A valid email address is required.

Home address search or enter your address manually *

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Leave this field blank

Actions

view actions (24)

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Oct 08, 2010	approval memo.29
Oct 01, 2010	signed chap.536
Sep 20, 2010	delivered to governor
Jun 23, 2010	returned to senate passed assembly ordered to third reading rules cal.291 substituted for a8278b
Jun 03, 2010	referred to insurance delivered to assembly passed senate
May 17, 2010	amended on third reading 5000b
Apr 26, 2010	advanced to third reading
Apr 21, 2010	2nd report cal.
Apr 20, 2010	1st report cal.418
Jan 20, 2010	reported and committed to codes
Jan 13, 2010	print number 5000a
Jan 13, 2010	amend and recommit to health
Jan 06, 2010	referred to health
Jul 16, 2009	committed to rules
Jun 04, 2009	advanced to third reading
Jun 03, 2009	2nd report cal.
Jun 02, 2009	1st report cal.576
May 19, 2009	reported and committed to codes
Apr 27, 2009	referred to health

Votes

view votes

Jun 3, 2010 - floor Vote

S5000B

floor

Aye

Nay

Absent

Excused

Abstained

Apr 20, 2010 - Codes committee Vote

S5000A

committee

Aye

Nay

Aye with Reservations

Absent

Excused

Abstained

Jan 20, 2010 - Health committee Vote

S5000A

committee

Aye

Nay

Aye with Reservations

Absent

Excused

Abstained

Jun 2, 2009 - Codes committee Vote

S5000

committee

Aye

Nay

Aye with Reservations

Absent

Excused

Abstained

Bill Amendments

Original

B (Active)

Original

B (Active)

Co-Sponsors

S5000 - Details

See Assembly Version of this Bill:: A8278
Law Section:: Public Health Law
Laws Affected:: Amd §4406-c, Pub Health L; amd §§3216, 3221 & 4303, Ins L; amd §296, Exec L

S5000 - Summary

Provides that no health care plan or health insurance policy which provides coverage for prescription drugs and for which cost-sharing, deductibles or co-insurance obligations are determined by category of prescription drugs including, but not limited to, generic drugs, preferred brand drugs and non-preferred brand drugs, shall impose cost-sharing, deductibles or co-insurance obligations for any prescription drug that exceeds the dollar amount of cost-sharing, deductibles or co-insurance obligations for any other prescription drug provided under such coverage in the category of non-preferred brand drugs or their equivalents.

S5000 - Sponsor Memo

 BILL NUMBER:  S5000

 TITLE OF BILL :
An act to amend the public health law and the insurance law, in
relation to cost-sharing, deductible or co-insurance for tier IV
prescription drugs; and to amend the executive law, in relation to
unlawful discriminatory practice in relation to tier IV prescription
drugs


 PURPOSE :
This bill would would prohibit commercial health insurance plans from
creating specialty tiers within their prescription drug formularies.

 SUMMARY OF PROVISIONS :
Section 1: Legislative findings

Section 2: Amends Section 4406-c of the public health law to prohibit
the creation of specialty tiers.

Sections 3, 4, 5 and 6: Conforming amendments to insurance law to
prohibit the creation of specialty tiers.

Section 7: Amends executive law to provide that creation of specialty
tiers is unlawful discriminatory practice.

Section 8: Severability clause.

Section 9: Provides for effective date of 30 days after enactment.

 JUSTIFICATION :
As drug prices continue to climb, other states have seen commercial
health insurance plans address this increase by creating a new cost
sharing mechanism within their drug plans. This mechanism, called
"specialty tiers," dramatically increases the amount that consumers
pay for their medications. Instead of the three tiered drug formulary
structure used by most plans where tier one is for generic drugs, tier
two is for brand-name preferred drugs and tier three is for brand-name
non-preferred drugs, some plans have started to introduce fourth tiers
or "specialty tiers" that are reserved for the most expensive
medications. The medications in this tier are assigned a coinsurance,
a percentage of the cost of the medication, as opposed to a set dollar
amount used in the other three tiers ($10 for generic, $25 for
preferred, $50 for non-preferred).

The medications placed in this tier are assigned a co-insurance of
between 20-35% and can cost upwards of $3,000 per month. This means
that consumers are asked to pay between $250 to over $1,000 for one
month's supply of one medication. If subject to a 25-33% co-insurance,
a monthly supply of the medications used to treat MS would cost
between $500 and $775.

Paying $500 to $775 for one month's supply of medication would be a
strain on anyone. However, people living with chronic illnesses are
most likely to be among those impacted by this new formulary tier and
are also the most likely to be taking several other medications in
addition to all of their other medical expenditures. Attaching this
kind of cost sharing burden to these crucial medications used to slow
down the progression of chronic, disabling conditions like MS and
Rheumatoid Arthritis, or saving lives like in the treatment of HI V,
breast and colorectal cancers, leukemia and non-Hodgkins lymphoma,
will in many cases lead to discontinuation of use.

 LEGISLATIVE HISTORY :
This is a new bill.

 FISCAL IMPLICATIONS :
None.

 LOCAL FISCAL IMPLICATIONS :
None.

 EFFECTIVE DATE :
Effective date 30 days after enactment.

S5000 - Bill Text download pdf

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

                                  5000

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                             April 27, 2009
                               ___________

Introduced  by  Sen.  DUANE  -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT to amend the public health law and the insurance law, in relation
  to cost-sharing, deductible or co-insurance for tier  IV  prescription
  drugs; and to amend the executive law, in relation to unlawful discri-
  minatory practice in relation to tier IV prescription drugs

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

  Section 1. Legislative findings.  The  cost-sharing,  deductibles  and
co-insurance  obligations for certain drugs have become cost prohibitive
for persons trying to overcome serious diseases such as cancer, multiple
sclerosis, rheumatoid arthritis,  hepatitis  C,  and  hemophilia.  These
drugs are typically new, produced in lesser quantities than other drugs,
and  not  available as less expensive brand name or generic prescription
drugs. Some health insurance plans and policies have established  unique
categories  or specialty tiers for these drugs, sometimes referred to as
Tier IV or Tier V. Patients under these plans  are  required  to  pay  a
percentage  of  the  cost  of  these  high-priced drugs, rather than the
traditional co-payment amounts for generic, preferred  brand,  and  non-
preferred  brand  prescription  drugs, often covered by Tier I, Tier II,
and Tier III plans and policies, respectively.  As  a  result,  patients
covered  under Tier IV or Tier V plans or policies must pay thousands of
dollars in out-of-pocket costs for drugs critical for their treatment.
  It is in the public interest to  help  patients  to  afford  necessary
prescription drugs by prohibiting cost-sharing, deductibles and co-insu-
rance  obligations  by  patients  that exceed payments for non-preferred
brand prescription drugs or the equivalent thereof. It is not the intent
of this legislation to preclude  plans  or  policies  from  categorizing
drugs  used  in  the  treatment  of  these common diseases as brand name
prescription drugs or generic prescription drug equivalents.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11409-01-9

S. 5000                             2

  The extraordinary disparity in cost-sharing, deductible  and  co-insu-
rance  burdens imposed on patients whose life and health depend on these
drugs constitutes serious and unjustified discrimination based on  their
disease or disability.
  This  legislation  is  intended  to  provide  patients more affordable
access to prescription drugs essential for their  treatment  of  cancer,
multiple  sclerosis,  rheumatoid  arthritis, hepatitis C, hemophilia and
other diseases.
  S 2. Section 4406-c of the public health law is amended  by  adding  a
new subdivision 7 to read as follows:
  7.  NO HEALTH CARE PLAN WHICH PROVIDES COVERAGE FOR PRESCRIPTION DRUGS
AND FOR WHICH COST-SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS  ARE
DETERMINED  BY CATEGORY OF PRESCRIPTION DRUGS INCLUDING, BUT NOT LIMITED
TO, GENERIC DRUGS, PREFERRED BRAND DRUGS AND NON-PREFERRED BRAND  DRUGS,
SHALL  IMPOSE  COST-SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS FOR
ANY PRESCRIPTION DRUG THAT EXCEEDS THE DOLLAR  AMOUNT  OF  COST-SHARING,
DEDUCTIBLES  OR CO-INSURANCE OBLIGATIONS FOR ANY OTHER PRESCRIPTION DRUG
PROVIDED UNDER SUCH COVERAGE IN  THE  CATEGORY  OF  NON-PREFERRED  BRAND
DRUGS OR ITS EQUIVALENT.
  S 3. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 26 to read as follows:
  (26)  NO  POLICY  DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH
PROVIDES COVERAGE FOR PRESCRIPTION DRUGS  AND  FOR  WHICH  COST-SHARING,
DEDUCTIBLES  OR  CO-INSURANCE  OBLIGATIONS ARE DETERMINED BY CATEGORY OF
PRESCRIPTION  DRUGS  INCLUDING,  BUT  NOT  LIMITED  TO,  GENERIC  DRUGS,
PREFERRED  BRAND DRUGS AND NON-PREFERRED BRAND DRUGS, SHALL IMPOSE COST-
SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS  FOR  ANY  PRESCRIPTION
DRUG  THAT  EXCEEDS  THE  DOLLAR  AMOUNT OF COST-SHARING, DEDUCTIBLES OR
CO-INSURANCE OBLIGATIONS FOR ANY OTHER PRESCRIPTION DRUG PROVIDED  UNDER
SUCH COVERAGE IN THE CATEGORY OF NON-PREFERRED BRAND DRUGS OR ITS EQUIV-
ALENT.
  S 4. Subsection (a) of section 3221 of the insurance law is amended by
adding a new paragraph 16 to read as follows:
  (16)  NO  POLICY  DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH
PROVIDES COVERAGE FOR PRESCRIPTION DRUGS  AND  FOR  WHICH  COST-SHARING,
DEDUCTIBLES  OR  CO-INSURANCE  OBLIGATIONS ARE DETERMINED BY CATEGORY OF
PRESCRIPTION  DRUGS  INCLUDING,  BUT  NOT  LIMITED  TO,  GENERIC  DRUGS,
PREFERRED  BRAND DRUGS AND NON-PREFERRED BRAND DRUGS, SHALL IMPOSE COST-
SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS  FOR  ANY  PRESCRIPTION
DRUG  THAT  EXCEEDS  THE  DOLLAR  AMOUNT OF COST-SHARING, DEDUCTIBLES OR
CO-INSURANCE OBLIGATIONS FOR ANY OTHER PRESCRIPTION DRUG PROVIDED  UNDER
SUCH COVERAGE IN THE CATEGORY OF NON-PREFERRED BRAND DRUGS OR ITS EQUIV-
ALENT.
  S  5.  Section  4303  of  the insurance law is amended by adding a new
subsection (ff) to read as follows:
  (FF) NO MEDICAL EXPENSE  INDEMNITY  CORPORATION,  A  HOSPITAL  SERVICE
CORPORATION  OR A HEALTH SERVICE CORPORATION WHICH PROVIDES COVERAGE FOR
PRESCRIPTION DRUGS AND FOR WHICH COST-SHARING, DEDUCTIBLES  OR  CO-INSU-
RANCE  OBLIGATIONS  ARE  DETERMINED  BY  CATEGORY  OF PRESCRIPTION DRUGS
INCLUDING, BUT NOT LIMITED TO, GENERIC DRUGS, PREFERRED BRAND DRUGS  AND
NON-PREFERRED  BRAND  DRUGS,  SHALL  IMPOSE COST-SHARING, DEDUCTIBLES OR
CO-INSURANCE OBLIGATIONS FOR ANY  PRESCRIPTION  DRUG  THAT  EXCEEDS  THE
DOLLAR  AMOUNT  OF COST-SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS
FOR ANY OTHER PRESCRIPTION DRUG PROVIDED  UNDER  SUCH  COVERAGE  IN  THE
CATEGORY OF NON-PREFERRED BRAND DRUGS OR ITS EQUIVALENT.

S. 5000                             3

  S  6.  Section  4321  of  the insurance law is amended by adding a new
subsection (g) to read as follows:
  (G)  NO  POLICY  DELIVERED  OR ISSUED FOR DELIVERY IN THIS STATE WHICH
PROVIDES COVERAGE FOR PRESCRIPTION DRUGS  AND  FOR  WHICH  COST-SHARING,
DEDUCTIBLES  OR  CO-INSURANCE  OBLIGATIONS ARE DETERMINED BY CATEGORY OF
PRESCRIPTION  DRUGS  INCLUDING,  BUT  NOT  LIMITED  TO,  GENERIC  DRUGS,
PREFERRED  BRAND DRUGS AND NON-PREFERRED BRAND DRUGS, SHALL IMPOSE COST-
SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS  FOR  ANY  PRESCRIPTION
DRUG  THAT  EXCEEDS  THE  DOLLAR  AMOUNT OF COST-SHARING, DEDUCTIBLES OR
CO-INSURANCE OBLIGATIONS FOR ANY OTHER PRESCRIPTION DRUG PROVIDED  UNDER
SUCH COVERAGE IN THE CATEGORY OF NON-PREFERRED BRAND DRUGS OR ITS EQUIV-
ALENT.
  S 7. Subdivision 20 of section 296 of the executive law, as renumbered
by  chapter  204 of the laws of 1996, is renumbered subdivision 21 and a
new subdivision 20 is added to read as follows:
  20. IT SHALL BE AN UNLAWFUL DISCRIMINATORY PRACTICE FOR ANY  EMPLOYER,
LABOR  ORGANIZATION,  INSURER,  HEALTH MAINTENANCE ORGANIZATION OR OTHER
ENTITY TO LIMIT HEALTH CARE COVERAGE SUCH THAT COST-SHARING, DEDUCTIBLES
OR CO-INSURANCE OBLIGATIONS FOR ANY PRESCRIPTION DRUG EXCEEDS THE DOLLAR
AMOUNT OF COST-SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS FOR  ANY
OTHER  PRESCRIPTION DRUG PROVIDED UNDER SUCH HEALTH CARE COVERAGE IN THE
CATEGORY OF NON-PREFERRED BRAND DRUGS OR ITS EQUIVALENT.
  S 8. Severability. If any provision of this act, or any application of
any provision of this act, is held to be invalid, or ruled by any feder-
al agency to violate or be inconsistent with any applicable federal  law
or  regulation,  that  shall not affect the validity or effectiveness of
any other provision of this act, or of  any  other  application  of  any
provision of this act.
  S  9.  This  act shall take effect on the thirtieth day after it shall
have become a law.

Co-Sponsors

S5000A - Details

See Assembly Version of this Bill:: A8278
Law Section:: Public Health Law
Laws Affected:: Amd §4406-c, Pub Health L; amd §§3216, 3221 & 4303, Ins L; amd §296, Exec L

S5000A - Summary

S5000A - Sponsor Memo

 BILL NUMBER:  S5000A

 TITLE OF BILL :

An act to amend the public health law and the insurance law, in
relation to cost-sharing, deductible or co-insurance for tier IV
prescription drugs; and to amend the executive law, in relation to
unlawful discriminatory practice in relation to tier IV prescription
drugs


 PURPOSE :

This bill would prohibit commercial health insurance plans from
creating specialty tiers within their prescription drug formularies.

 SUMMARY OF PROVISIONS :

Section 1: Legislative findings

Section 2: Amends Section 4406-c of the public health law to prohibit
the creation of specialty tiers.

Sections 3, 4, 5 and 6: Conforming amendments to insurance law to
prohibit the creation of specialty tiers.

Section 7: Amends executive law to provide that creation of specialty
tiers is unlawful discriminatory practice.

Section 8: Severability clause.

Section 9: Provides for effective date of 30 days after enactment.

 JUSTIFICATION :

As drug prices continue to climb, other states have seen commercial
health insurance plans address this increase by creating a new cost
sharing mechanism within their drug plans. This mechanism, called
"specialty tiers," dramatically increases the amount that consumers
pay for their medications. Instead of the three tiered drug formulary
structure used by most plans where tier one is for generic drugs, tier
two is for brand-name preferred drugs and tier three is for brand-name
non-preferred drugs, some plans have started to introduce fourth tiers
or "specialty tiers" that are reserved for the most expensive
medications. The medications in this tier are assigned a coinsurance,
a percentage of the cost of the medication, as opposed to a set dollar
amount used in the other three tiers ($10 for generic, $25 for
preferred, $50 for non-preferred).

The medications placed in this tier are assigned a co-insurance of
between 20-35% and can cost upwards of $3,000 per month. This means
that consumers are asked to pay between $250 to over $1,000 for one
month's supply of one medication. If subject to a 25-33% co-insurance,
a monthly supply of the medications used to treat MS would cost
between $500 and $775.

Paying $500 to $775 for one month's supply of medication would be a
strain on anyone.  However, people living with chronic illnesses are
most likely to be among those impacted by this new formulary tier and
are also the most likely to be taking several other medications in
addition to all of their other medical expenditures. Attaching this
kind of cost sharing burden to these crucial medications used to slow
down the progression of chronic, disabling conditions like MS and
Rheumatoid Arthritis, or saving lives like in the treatment of HIV,
breast and colorectal cancers, leukemia and non-Hodgkin's lymphoma,
will in many cases lead to discontinuation of use.
 LEGISLATIVE HISTORY :

This is a new bill.

 FISCAL IMPLICATIONS :

None.

 LOCAL FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
Effective date 30 days after enactment.

S5000A - Bill Text download pdf

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

                                 5000--A

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                             April 27, 2009
                               ___________

Introduced  by  Sens.  DUANE,  ESPADA,  KRUEGER, MONSERRATE, MONTGOMERY,
  VALESKY -- read twice and ordered printed,  and  when  printed  to  be
  committed  to  the Committee on Health -- recommitted to the Committee
  on Health in accordance with  Senate  Rule  6,  sec.  8  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN ACT to amend the public health law and the insurance law, in relation
  to  cost-sharing,  deductible or co-insurance for tier IV prescription
  drugs; and to amend the executive law, in relation to unlawful discri-
  minatory practice in relation to tier IV prescription drugs

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

  Section  1.  Legislative  findings.  The cost-sharing, deductibles and
co-insurance obligations for certain drugs have become cost  prohibitive
for persons trying to overcome serious diseases such as cancer, multiple
sclerosis,  rheumatoid  arthritis,  hepatitis  C,  and hemophilia. These
drugs are typically new, produced in lesser quantities than other drugs,
and not available as less expensive brand name or  generic  prescription
drugs.  Some health insurance plans and policies have established unique
categories or specialty tiers for these drugs, sometimes referred to  as
Tier  IV  or  Tier  V.  Patients under these plans are required to pay a
percentage of the cost of  these  high-priced  drugs,  rather  than  the
traditional  co-payment  amounts  for generic, preferred brand, and non-
preferred brand prescription drugs, often covered by Tier  I,  Tier  II,
and  Tier  III  plans  and policies, respectively. As a result, patients
covered under Tier IV or Tier V plans or policies must pay thousands  of
dollars in out-of-pocket costs for drugs critical for their treatment.
  It  is  in  the  public  interest to help patients to afford necessary
prescription drugs by prohibiting cost-sharing, deductibles and co-insu-
rance obligations by patients that  exceed  payments  for  non-preferred
brand prescription drugs or the equivalent thereof. It is not the intent

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11409-02-0

S. 5000--A                          2

of  this  legislation  to  preclude  plans or policies from categorizing
drugs used in the treatment of  these  common  diseases  as  brand  name
prescription drugs or generic prescription drug equivalents.
  The  extraordinary  disparity in cost-sharing, deductible and co-insu-
rance burdens imposed on patients whose life and health depend on  these
drugs  constitutes serious and unjustified discrimination based on their
disease or disability.
  This legislation is  intended  to  provide  patients  more  affordable
access  to  prescription  drugs essential for their treatment of cancer,
multiple sclerosis, rheumatoid arthritis, hepatitis  C,  hemophilia  and
other diseases.
  S  2.  Section  4406-c of the public health law is amended by adding a
new subdivision 7 to read as follows:
  7. NO HEALTH CARE PLAN WHICH PROVIDES COVERAGE FOR PRESCRIPTION  DRUGS
AND  FOR WHICH COST-SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS ARE
DETERMINED BY CATEGORY OF PRESCRIPTION DRUGS INCLUDING, BUT NOT  LIMITED
TO,  GENERIC DRUGS, PREFERRED BRAND DRUGS AND NON-PREFERRED BRAND DRUGS,
SHALL IMPOSE COST-SHARING, DEDUCTIBLES OR CO-INSURANCE  OBLIGATIONS  FOR
ANY  PRESCRIPTION  DRUG  THAT EXCEEDS THE DOLLAR AMOUNT OF COST-SHARING,
DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS FOR ANY OTHER PRESCRIPTION  DRUG
PROVIDED  UNDER  SUCH  COVERAGE  IN  THE CATEGORY OF NON-PREFERRED BRAND
DRUGS OR ITS EQUIVALENT.
  S 3. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 27 to read as follows:
  (27) NO POLICY DELIVERED OR ISSUED FOR DELIVERY IN  THIS  STATE  WHICH
PROVIDES  COVERAGE  FOR  PRESCRIPTION  DRUGS AND FOR WHICH COST-SHARING,
DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS ARE DETERMINED  BY  CATEGORY  OF
PRESCRIPTION  DRUGS  INCLUDING,  BUT  NOT  LIMITED  TO,  GENERIC  DRUGS,
PREFERRED BRAND DRUGS AND NON-PREFERRED BRAND DRUGS, SHALL IMPOSE  COST-
SHARING,  DEDUCTIBLES  OR  CO-INSURANCE OBLIGATIONS FOR ANY PRESCRIPTION
DRUG THAT EXCEEDS THE DOLLAR  AMOUNT  OF  COST-SHARING,  DEDUCTIBLES  OR
CO-INSURANCE  OBLIGATIONS FOR ANY OTHER PRESCRIPTION DRUG PROVIDED UNDER
SUCH COVERAGE IN THE CATEGORY OF NON-PREFERRED BRAND DRUGS OR ITS EQUIV-
ALENT.
  S 4. Subsection (a) of section 3221 of the insurance law is amended by
adding a new paragraph 16 to read as follows:
  (16) NO POLICY DELIVERED OR ISSUED FOR DELIVERY IN  THIS  STATE  WHICH
PROVIDES  COVERAGE  FOR  PRESCRIPTION  DRUGS AND FOR WHICH COST-SHARING,
DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS ARE DETERMINED  BY  CATEGORY  OF
PRESCRIPTION  DRUGS  INCLUDING,  BUT  NOT  LIMITED  TO,  GENERIC  DRUGS,
PREFERRED BRAND DRUGS AND NON-PREFERRED BRAND DRUGS, SHALL IMPOSE  COST-
SHARING,  DEDUCTIBLES  OR  CO-INSURANCE OBLIGATIONS FOR ANY PRESCRIPTION
DRUG THAT EXCEEDS THE DOLLAR  AMOUNT  OF  COST-SHARING,  DEDUCTIBLES  OR
CO-INSURANCE  OBLIGATIONS FOR ANY OTHER PRESCRIPTION DRUG PROVIDED UNDER
SUCH COVERAGE IN THE CATEGORY OF NON-PREFERRED BRAND DRUGS OR ITS EQUIV-
ALENT.
  S 5. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (gg) to read as follows:
  (GG)  NO  MEDICAL  EXPENSE  INDEMNITY  CORPORATION, A HOSPITAL SERVICE
CORPORATION OR A HEALTH SERVICE CORPORATION WHICH PROVIDES COVERAGE  FOR
PRESCRIPTION  DRUGS  AND FOR WHICH COST-SHARING, DEDUCTIBLES OR CO-INSU-
RANCE OBLIGATIONS ARE  DETERMINED  BY  CATEGORY  OF  PRESCRIPTION  DRUGS
INCLUDING,  BUT NOT LIMITED TO, GENERIC DRUGS, PREFERRED BRAND DRUGS AND
NON-PREFERRED BRAND DRUGS, SHALL  IMPOSE  COST-SHARING,  DEDUCTIBLES  OR
CO-INSURANCE  OBLIGATIONS  FOR  ANY  PRESCRIPTION  DRUG THAT EXCEEDS THE
DOLLAR AMOUNT OF COST-SHARING, DEDUCTIBLES OR  CO-INSURANCE  OBLIGATIONS

S. 5000--A                          3

FOR  ANY  OTHER  PRESCRIPTION  DRUG  PROVIDED UNDER SUCH COVERAGE IN THE
CATEGORY OF NON-PREFERRED BRAND DRUGS OR ITS EQUIVALENT.
  S  6.  Section  4321  of  the insurance law is amended by adding a new
subsection (g) to read as follows:
  (G) NO POLICY DELIVERED OR ISSUED FOR DELIVERY  IN  THIS  STATE  WHICH
PROVIDES  COVERAGE  FOR  PRESCRIPTION  DRUGS AND FOR WHICH COST-SHARING,
DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS ARE DETERMINED  BY  CATEGORY  OF
PRESCRIPTION  DRUGS  INCLUDING,  BUT  NOT  LIMITED  TO,  GENERIC  DRUGS,
PREFERRED BRAND DRUGS AND NON-PREFERRED BRAND DRUGS, SHALL IMPOSE  COST-
SHARING,  DEDUCTIBLES  OR  CO-INSURANCE OBLIGATIONS FOR ANY PRESCRIPTION
DRUG THAT EXCEEDS THE DOLLAR  AMOUNT  OF  COST-SHARING,  DEDUCTIBLES  OR
CO-INSURANCE  OBLIGATIONS FOR ANY OTHER PRESCRIPTION DRUG PROVIDED UNDER
SUCH COVERAGE IN THE CATEGORY OF NON-PREFERRED BRAND DRUGS OR ITS EQUIV-
ALENT.
  S 7. Subdivision 20 of section 296 of the executive law, as renumbered
by chapter 204 of the laws of 1996, is renumbered subdivision 21  and  a
new subdivision 20 is added to read as follows:
  20.  IT SHALL BE AN UNLAWFUL DISCRIMINATORY PRACTICE FOR ANY EMPLOYER,
LABOR ORGANIZATION, INSURER, HEALTH MAINTENANCE  ORGANIZATION  OR  OTHER
ENTITY TO LIMIT HEALTH CARE COVERAGE SUCH THAT COST-SHARING, DEDUCTIBLES
OR CO-INSURANCE OBLIGATIONS FOR ANY PRESCRIPTION DRUG EXCEEDS THE DOLLAR
AMOUNT  OF COST-SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS FOR ANY
OTHER PRESCRIPTION DRUG PROVIDED UNDER SUCH HEALTH CARE COVERAGE IN  THE
CATEGORY OF NON-PREFERRED BRAND DRUGS OR ITS EQUIVALENT.
  S 8. Severability. If any provision of this act, or any application of
any provision of this act, is held to be invalid, or ruled by any feder-
al  agency to violate or be inconsistent with any applicable federal law
or regulation, that shall not affect the validity  or  effectiveness  of
any  other  provision  of  this  act, or of any other application of any
provision of this act.
  S 9. This act shall take effect on the thirtieth day  after  it  shall
have become a law.

Co-Sponsors

S5000B (ACTIVE) - Details

See Assembly Version of this Bill:: A8278
Law Section:: Public Health Law
Laws Affected:: Amd §4406-c, Pub Health L; amd §§3216, 3221 & 4303, Ins L; amd §296, Exec L

S5000B (ACTIVE) - Summary

S5000B (ACTIVE) - Sponsor Memo

BILL NUMBER:S5000B

TITLE OF BILL:

An act to amend the public health law and the insurance law, in relation
to cost-sharing, deductible or co-insurance for tier IV prescription
drugs; and to amend the executive law, in relation to unlawful discrimi-
natory practice in relation to tier IV prescription drugs

PURPOSE:

This bill would prohibit commercial health insurance plans from creating
specialty tiers within their prescription drug formularies.

SUMMARY OF PROVISIONS:

Section 1: Legislative findings.

Section 2: Amends Section 4406-c of the public health law to prohibit
the creation of specialty tiers.

Sections 3, 4, and 5: Conforming amendments to insurance law to prohibit
the creation of specialty tiers.

Section 6: Amends executive law to provide that creation of specialty
tiers is unlawful discriminatory practice.

Section 7: Severability clause.

Section 8: Provides for effective dates of 30 days after enactment.

JUSTIFICATION:

As the cost of prescription drugs continues to climb, states like Cali-
fornia, Minnesota, Maryland, and Alabama have seen commercial health
insurance plans create new "specialty tiers" to dramatically increase
the co-payments that consumers pay.

Instead of a three-tiered drug formulary structure used by most plans
(where Tier 1 is for generics, Tier 2 is for brand-name preferred drugs,
and Tier 3 is for brand-name non-preferred drugs), some plans have begun
to add fourth and even fifth tiers for the most expensive medications.
These additional tiers assign a percentage cost of the medication as
co-insurance, as opposed to a set dollar amount used in the other three
tiers. An example of this might be a $10 co-pay for Tier 1 generics, a
$25 co-pay for Tier 2 brand-name preferred drugs, and a $50 co-pay for
Tier 3 brand-name non-preferred drugs.

In the states where this is happening, medications placed in these
specialty tiers are typically assigned a co-insurance between 20-35% of
the actual cost of the medication. If someone is living with multiple

sclerosis, for example, that individual's monthly co-payment could reach
$775.

People living with chronic illnesses like multiple sclerosis, rheumatoid
arthritis, and hemophilia, or people with a life-threatening condition
like HIV, breast or colorectal cancers, leukemia and non-Hodgkins
lymphoma (to name a few examples), are the populations that are most
affected.

Paying hundreds or even thousands of dollars each month for prescription
drugs would be a strain for anyone, but for people with chronic
illnesses and life-threatening conditions, this unfortunate social poli-
cy has the potential to destroy a family's financial solvency or even
end their ability to take a necessary medication.

Specialty tiering is contrary to the original purpose of insurance, the
spreading of costs; instead it creates a structure where those who are
most sick pay more, and the healthy pay less.

LEGISLATIVE HISTORY:

None.

FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:

This act shall take effect on the thirtieth day after it shall have
become law.

S5000B (ACTIVE) - Bill Text download pdf

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

                                 5000--B
    Cal. No. 418

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                             April 27, 2009
                               ___________

Introduced  by Sens. DUANE, DILAN, ESPADA, KRUEGER, MONTGOMERY, PERKINS,
  THOMPSON, VALESKY -- read twice and ordered printed, and when  printed
  to  be  committed  to  the  Committee  on Health -- recommitted to the
  Committee on Health in accordance  with  Senate  Rule  6,  sec.  8  --
  committee  discharged,  bill amended, ordered reprinted as amended and
  recommitted to said committee -- reported favorably from said  commit-
  tee and committed to the Committee on Codes -- reported favorably from
  said committee, ordered to first and second report, ordered to a third
  reading,  amended  and  ordered  reprinted, retaining its place in the
  order of third reading

AN ACT to amend the public health law and the insurance law, in relation
  to cost-sharing, deductible or co-insurance for tier  IV  prescription
  drugs; and to amend the executive law, in relation to unlawful discri-
  minatory practice in relation to tier IV prescription drugs

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

  Section 1. Legislative findings.  The  cost-sharing,  deductibles  and
co-insurance obligations for certain drugs are becoming cost prohibitive
for  persons  trying  to  overcome  serious  and  often life-threatening
diseases and conditions such as cancer, multiple  sclerosis,  rheumatoid
arthritis, hepatitis C, hemophilia and psoriasis.  These drugs are typi-
cally  new,  produced  in  lesser  quantities  than other drugs, and not
available as less expensive brand name or  generic  prescription  drugs.
Some health insurance plans and policies in other states as well as some
self-insured  plans  in  New  York have established unique categories or
specialty tiers for these drugs, sometimes referred to  as  Tier  IV  or
Tier  V.  Patients under these plans are required to pay a percentage of
the cost of these high-priced drugs, rather than the traditional co-pay-
ment amounts for  generic,  preferred  brand,  and  non-preferred  brand
prescription drugs, often covered by Tier I, Tier II, and Tier III plans
and  policies,  respectively.  As a result, patients covered under plans

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

                                                           LBD11409-05-0

S. 5000--B                          2

with specialty tiers must pay  thousands  of  dollars  in  out-of-pocket
costs for drugs critical for their treatment.
  It  is  in  the  public  interest to help patients to afford necessary
prescription drugs by prohibiting cost-sharing, deductibles and co-insu-
rance obligations by patients that  exceed  payments  for  non-preferred
brand prescription drugs or the equivalent thereof. It is not the intent
of  this  legislation  to  preclude  plans or policies from categorizing
drugs used in the treatment of  these  common  diseases  as  brand  name
prescription drugs or generic prescription drug equivalents.
  The  extraordinary  disparity in cost-sharing, deductible and co-insu-
rance burdens imposed on patients whose life and health depend on  these
drugs  constitutes serious and unjustified discrimination based on their
disease or disability.
  This legislation is  intended  to  provide  patients  more  affordable
access  to  prescription  drugs essential for their treatment of cancer,
multiple  sclerosis,  rheumatoid  arthritis,  hepatitis  C,  hemophilia,
psoriasis, and other diseases.
  S  2.  Section  4406-c of the public health law is amended by adding a
new subdivision 7 to read as follows:
  7. NO HEALTH MAINTENANCE  ORGANIZATION  WHICH  PROVIDES  COVERAGE  FOR
PRESCRIPTION  DRUGS  AND FOR WHICH COST-SHARING, DEDUCTIBLES OR CO-INSU-
RANCE OBLIGATIONS ARE DETERMINED BY CATEGORY OF PRESCRIPTION DRUGS SHALL
IMPOSE COST-SHARING, DEDUCTIBLES OR  CO-INSURANCE  OBLIGATIONS  FOR  ANY
PRESCRIPTION DRUG THAT EXCEEDS THE DOLLAR AMOUNT OF COST-SHARING, DEDUC-
TIBLES  OR CO-INSURANCE OBLIGATIONS FOR NON-PREFERRED BRAND DRUGS OR ITS
EQUIVALENT (OR BRAND DRUGS IF THERE IS NO NON-PREFERRED BRAND DRUG CATE-
GORY).
  S 3. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 27 to read as follows:
  (27) NO POLICY DELIVERED OR ISSUED FOR DELIVERY IN  THIS  STATE  WHICH
PROVIDES  COVERAGE  FOR  PRESCRIPTION  DRUGS AND FOR WHICH COST-SHARING,
DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS ARE DETERMINED  BY  CATEGORY  OF
PRESCRIPTION  DRUGS  SHALL  IMPOSE COST-SHARING, DEDUCTIBLES OR CO-INSU-
RANCE OBLIGATIONS FOR ANY PRESCRIPTION  DRUG  THAT  EXCEEDS  THE  DOLLAR
AMOUNT  OF  COST-SHARING,  DEDUCTIBLES  OR  CO-INSURANCE OBLIGATIONS FOR
NON-PREFERRED BRAND DRUGS OR ITS EQUIVALENT (OR BRAND DRUGS IF THERE  IS
NO NON-PREFERRED BRAND DRUG CATEGORY).
  S 4. Subsection (a) of section 3221 of the insurance law is amended by
adding a new paragraph 16 to read as follows:
  (16)  NO  POLICY  DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH
PROVIDES COVERAGE FOR PRESCRIPTION DRUGS  AND  FOR  WHICH  COST-SHARING,
DEDUCTIBLES  OR  CO-INSURANCE  OBLIGATIONS ARE DETERMINED BY CATEGORY OF
PRESCRIPTION DRUGS SHALL IMPOSE COST-SHARING,  DEDUCTIBLES  OR  CO-INSU-
RANCE  OBLIGATIONS  FOR  ANY  PRESCRIPTION  DRUG THAT EXCEEDS THE DOLLAR
AMOUNT OF COST-SHARING,  DEDUCTIBLES  OR  CO-INSURANCE  OBLIGATIONS  FOR
NON-PREFERRED  BRAND DRUGS OR ITS EQUIVALENT (OR BRAND DRUGS IF THERE IS
NO NON-PREFERRED BRAND DRUG CATEGORY).
  S 5. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (gg) to read as follows:
  (GG)  NO  MEDICAL  EXPENSE  INDEMNITY  CORPORATION, A HOSPITAL SERVICE
CORPORATION OR A HEALTH SERVICE CORPORATION WHICH PROVIDES COVERAGE  FOR
PRESCRIPTION  DRUGS  AND FOR WHICH COST-SHARING, DEDUCTIBLES OR CO-INSU-
RANCE OBLIGATIONS ARE DETERMINED BY CATEGORY OF PRESCRIPTION DRUGS SHALL
IMPOSE COST-SHARING, DEDUCTIBLES OR  CO-INSURANCE  OBLIGATIONS  FOR  ANY
PRESCRIPTION DRUG THAT EXCEEDS THE DOLLAR AMOUNT OF COST-SHARING, DEDUC-
TIBLES  OR CO-INSURANCE OBLIGATIONS FOR NON-PREFERRED BRAND DRUGS OR ITS

S. 5000--B                          3

EQUIVALENT (OR BRAND DRUGS IF THERE IS NO NON-PREFERRED BRAND DRUG CATE-
GORY).
  S  6.    Subdivision 20 of section 296 of the executive law, as renum-
bered by chapter 204 of the laws of 1996, is renumbered  subdivision  21
and a new subdivision 20 is added to read as follows:
  20.  IT SHALL BE AN UNLAWFUL DISCRIMINATORY PRACTICE FOR ANY EMPLOYER,
LABOR ORGANIZATION, INSURER, HEALTH MAINTENANCE  ORGANIZATION  OR  OTHER
ENTITY TO LIMIT HEALTH CARE COVERAGE SUCH THAT COST-SHARING, DEDUCTIBLES
OR CO-INSURANCE OBLIGATIONS FOR ANY PRESCRIPTION DRUG EXCEEDS THE DOLLAR
AMOUNT  OF COST-SHARING, DEDUCTIBLES OR CO-INSURANCE OBLIGATIONS FOR ANY
OTHER PRESCRIPTION DRUG PROVIDED UNDER SUCH HEALTH CARE COVERAGE IN  THE
CATEGORY  OF NON-PREFERRED BRAND DRUGS OR ITS EQUIVALENT (OR BRAND DRUGS
IF THERE IS NO NON-PREFERRED BRAND  DRUG  CATEGORY);  PROVIDED  HOWEVER,
THIS  SUBDIVISION  SHALL  NOT APPLY TO ANY SELF-INSURED EMPLOYEE WELFARE
BENEFIT PLAN, AS DEFINED IN THE EMPLOYEE RETIREMENT INCOME SECURITY  ACT
OF 1974, AS AMENDED.
  S 7. Severability. If any provision of this act, or any application of
any provision of this act, is held to be invalid, or ruled by any feder-
al  agency to violate or be inconsistent with any applicable federal law
or regulation, that shall not affect the validity  or  effectiveness  of
any  other  provision  of  this  act, or of any other application of any
provision of this act.
  S 8. This act shall take effect on the thirtieth day  after  it  shall
have become a law.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

The New York State Senate

senate Bill S5000B

Sponsored By

Archive: Last Bill Status - Signed by Governor

Your Voice

Actions

Votes

Jun 3, 2010 - floor Vote

Floor Vote: Jun 3, 2010

Apr 20, 2010 - Codes committee Vote

Committee Vote: Apr 20, 2010

Jan 20, 2010 - Health committee Vote

Committee Vote: Jan 20, 2010

Jun 2, 2009 - Codes committee Vote

Committee Vote: Jun 2, 2009

Bill Amendments

Co-Sponsors

S5000 - Details

S5000 - Summary

S5000 - Sponsor Memo

S5000 - Bill Text download pdf

Co-Sponsors

S5000A - Details

S5000A - Summary

S5000A - Sponsor Memo

S5000A - Bill Text download pdf

Co-Sponsors

S5000B (ACTIVE) - Details

S5000B (ACTIVE) - Summary

S5000B (ACTIVE) - Sponsor Memo

S5000B (ACTIVE) - Bill Text download pdf

Comments

senate Bill S5000B

Share this bill

Sponsored By

Archive: Last Bill Status - Signed by Governor

Your Voice

Actions

Votes

Jun 3, 2010 - floor Vote

Floor Vote: Jun 3, 2010

Apr 20, 2010 - Codes committee Vote

Committee Vote: Apr 20, 2010

Jan 20, 2010 - Health committee Vote

Committee Vote: Jan 20, 2010

Jun 2, 2009 - Codes committee Vote

Committee Vote: Jun 2, 2009

Bill Amendments

Co-Sponsors

S5000 - Details

S5000 - Summary

S5000 - Sponsor Memo

S5000 - Bill Text download pdf

Co-Sponsors

S5000A - Details

S5000A - Summary

S5000A - Sponsor Memo

S5000A - Bill Text download pdf

Co-Sponsors

S5000B (ACTIVE) - Details

S5000B (ACTIVE) - Summary

S5000B (ACTIVE) - Sponsor Memo

S5000B (ACTIVE) - Bill Text download pdf

Comments