NY State Senate Bill 2009-S5510

Senate Bill S5510

2009-2010 Legislative Session

Requires health insurance policies covering prescription drugs to provide continuous coverage for single source drugs until the prescribed therapy therefor is not required

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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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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 06, 2010	referred to insurance
May 13, 2009	referred to insurance

co-Sponsors

2009-S5510 (ACTIVE) - Details

See Assembly Version of this Bill:: A7709
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2011-2012 Legislative Session:: A3718

2009-S5510 (ACTIVE) - Summary

Provides that every insurance 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 the enrollee of such policy.

2009-S5510 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S5510

 TITLE OF BILL :
An act to amend the insurance law, in relation to coverage for single
source drugs


 PURPOSE OR GENERAL IDEA OF BILL :
This bill requires continued coverage of a prescription drug if a
patient was on such drug prior to a policy change.

 SUMMARY OF PROVISIONS :
Section 1: amends section 3216(i) by adding a new paragraph 25 which
provides that every individual policy which has coverage for
prescription drugs shall ensure that there is continuous coverage of a
single source drug that is part of a prescribed therapy until the
therapy is no longer medically necessary.

Section 2: amends section 3221(k) of the insurance law by adding a new
paragraph 13 providing that every group policy which provides
prescription drug coverage ensures that there is continuous coverage
of a single source drug that is part of a prescribed therapy until the
prescribed therapy is no longer medically necessary.

Section 3: amends section 4303 of the insurance law by adding a new
subsection (bb). This section provides that every contract issued by a

health service corporation or a medical expense indemnity corporation
which provides prescription drug coverage shall ensure continuous
coverage for single source drugs where the drug is part of a
prescribed therapy which is medically necessary.

Section 4: 60 days after it shall become law, but applied only to
policies and contracts issued, renewed or amended on or after the
effective date of this act.

 JUSTIFICATION :
This legislation was modeled after a 1998 law in California. This bill
would require an insurance plan to continue their coverage of
prescription medication for patients currently taking the medication
when no generic equivalent is available. When a patient is on a
prescribed therapy it is very important for the patient to maintain
that therapy to the end. When a drug is dropped from a plan, the
consequences can be dire and/or costly for the patients that are in
various stages of therapy with that drug. If the patient were to
maintain the prescribed therapy, the out of pocket cost to the patient
could be so exorbitant that the patient would eventually stop taking
the prescription prior to the completion of the therapy.

In another circumstance, the patient may be forced to change to a
simi- lar brand name drug that is covered under the plan in the midst
of the prescribed therapy. That new drug may not be as suitable or may
cause adverse reactions. The new drug may not react well with other
medication the patient is taking. Also, the new drug may not achieve
the desired effect that the other drug accomplished.

The physician should have the final say in which prescription a
patient takes. Although one drug may seem to have the same effect as
another it may not be as compatible with other medications a patient
is taking. One drug may be more effective under certain conditions.
In any event, health care cannot be directed by the bottom dollar in
every instance.

 FISCAL IMPLICATIONS :
To be determined.

 EFFECTIVE DATE :
This act shall take effect 60 days after it shall become law, but
shall apply to policies and contracts issued, renewed or amended on or
after the effective date of this act.

2009-S5510 (ACTIVE) - Bill Text download pdf

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

                                  5510

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                              May 13, 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  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.
  S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (ff) to read as follows:

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

S. 5510                             2

  (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.

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Senate Bill S5510

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Sponsored By

Jeffrey D. Klein