Senate Bill S6007

2009-2010 Legislative Session

Prohibits health insurers from requiring insureds purchase prescribed drugs from mail order pharmacy

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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

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 06, 2010	referred to insurance
Jun 19, 2009	referred to rules

co-Sponsors

2009-S6007 (ACTIVE) - Details

See Assembly Version of this Bill:: A1267
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221, 4303 & 4322, Ins L
Versions Introduced in 2011-2012 Legislative Session:: S3510, A5502

2009-S6007 (ACTIVE) - Summary

Prohibits health insurers from requiring that the insured purchase prescribed drugs from a mail order pharmacy or pay a co-payment fee when such purchases are not made from a mail order pharmacy if a similar fee is not charged for drugs from a mail order pharmacy.

2009-S6007 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S6007

 TITLE OF BILL :
An act to amend the insurance law, in relation to the purchase of
prescription drugs


 PURPOSE OR GENERAL IDEA OF BILL :
Prohibits health insurance policies from mandating their insured to
purchase prescribed drugs from a mail order pharmacy.

 SUMMARY OF PROVISIONS :
Subsection (i) of Section 3216 of the insurance law is amended to
preclude health insurance policies from mandating that their insured
purchase prescribed drugs from mail order pharmacies. Such policies
are also precluded from imposing a co-payment fee or other condition
on an insured who chooses not to purchase from a designated mail order
pharmacy.

A new paragraph 20 is also added to subsection (1) of Section 3221 of
such law and a new Subsection (aa) is likewise added to section 4303
to impose such a prohibition on all policies of health insurance in
the state including those issued by health services or medical expense
indemnity corporations issuing group contracts.

 JUSTIFICATION :

This legislation will provide freedom of choice to consumers who have
coverage for prescribed drugs as part of their health insurance. When
a policy mandates purchase from a specific mail order pharmacy the
consumer is forced to purchase an interim supply of the prescribed
drug from his or her neighborhood pharmacist who is familiar with his
or her medical history. The risk to the consumer in this situation is
obvious.

Furthermore, the neighborhood pharmacy in these situations is forced
to bear the burden of educating the patient as to the use and
potential effects of the prescribed drug. The inability of the
consumer to purchase the full prescription from the neighborhood
pharmacy imposes this burden inequitably, thereby providing the mail
order house with an economic advantage that the local provider cannot
over-come.

Finally, many consumers, especially senior citizens, rely on their
local pharmacist for the service that they provide with respect to
monitoring the regimen of drugs that they take. A mandate of purchase
by mail denies them of this important service and confidence.

 PRIOR LEGISLATIVE HISTORY :
A.2808/S.8775 (2007-2008)
A.6934 (2005-2006)

 FISCAL IMPLICATIONS :
None.

 EFFECTIVE DATE :
This act shall take effect on the thirtieth day after it shall have
become law and shall apply to all policies and contracts issued,
renewed, modified, altered or amended on or after such effective date.

2009-S6007 (ACTIVE) - Bill Text download pdf

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

                                  6007

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                              June 19, 2009
                               ___________

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

AN ACT to amend the insurance  law,  in  relation  to  the  purchase  of
  prescription 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)  NO  POLICY  WHICH  PROVIDES  COVERAGE FOR PRESCRIBED DRUGS SHALL
MANDATE THAT THE SAME BE PURCHASED BY THE  INSURED  FROM  A  MAIL  ORDER
PHARMACY, NOR MAY SUCH POLICY IMPOSE A CO-PAYMENT FEE OR OTHER CONDITION
ON ANY INSURED WHO ELECTS TO PURCHASE DRUGS FROM OTHER THAN A MAIL ORDER
PHARMACY  WHICH  IS  NOT  ALSO  IMPOSED ON INSUREDS ELECTING TO PURCHASE
DRUGS FROM A DESIGNATED MAIL ORDER PHARMACY; PROVIDED, HOWEVER, THAT THE
PROVISIONS OF THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF A COLLECTIVE
BARGAINING AGREEMENT OR APPLY TO A  POLICY  THAT  IS  THE  RESULT  OF  A
COLLECTIVE  BARGAINING AGREEMENT BETWEEN AN EMPLOYER AND A RECOGNIZED OR
CERTIFIED EMPLOYEE ORGANIZATION. NOTHING IN THIS PARAGRAPH  SHALL  ALTER
ANY  PROVISIONS  OF  SECTIONS  THIRTEEN  AND  THIRTEEN-O OF THE WORKERS'
COMPENSATION LAW REGARDING THE PURCHASE OF PRESCRIPTION  DRUGS  AND  THE
USE OF MAIL ORDER PHARMACY.
  S 2. Subsection (1) of section 3221 of the insurance law is amended by
adding a new paragraph 18 to read as follows:
  (18)  NO  INSURER  DELIVERING  A  GROUP OR BLANKET POLICY OR ISSUING A
GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE WHICH PROVIDES COVER-
AGE FOR PRESCRIBED DRUGS SHALL MANDATE THAT THE SAME BE PURCHASED BY THE
INSURED FROM A MAIL ORDER PHARMACY, NOR MAY SUCH POLICY IMPOSE A CO-PAY-
MENT FEE OR OTHER CONDITION ON ANY INSURED WHO ELECTS TO PURCHASE  DRUGS
FROM  OTHER  THAN  A  MAIL  ORDER  PHARMACY WHICH IS NOT ALSO IMPOSED ON
INSUREDS ELECTING TO PURCHASE DRUGS FROM A DESIGNATED MAIL ORDER PHARMA-
CY; PROVIDED, HOWEVER, THAT THE PROVISIONS OF  THIS  SECTION  SHALL  NOT

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03965-05-9

S. 6007                             2

SUPERSEDE  THE  TERMS OF A COLLECTIVE BARGAINING AGREEMENT OR APPLY TO A
POLICY THAT IS THE RESULT OF A COLLECTIVE BARGAINING  AGREEMENT  BETWEEN
AN EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGANIZATION. NOTHING
IN  THIS  PARAGRAPH  SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND
THIRTEEN-O OF THE WORKERS' COMPENSATION LAW REGARDING  THE  PURCHASE  OF
PRESCRIPTION DRUGS AND THE USE OF MAIL ORDER PHARMACY.
  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (ff) to read as follows:
  (FF) NO POLICY ISSUED BY A MEDICAL EXPENSE  INDEMNITY  CORPORATION,  A
HOSPITAL  SERVICE  CORPORATION  OR  A  HEALTH SERVICES CORPORATION WHICH
PROVIDES COVERAGE FOR PRESCRIBED DRUGS SHALL MANDATE THAT  THE  SAME  BE
PURCHASED BY THE INSURED FROM A MAIL ORDER PHARMACY, NOR MAY SUCH POLICY
IMPOSE  A CO-PAYMENT FEE OR OTHER CONDITION ON ANY INSURED WHO ELECTS TO
PURCHASE DRUGS FROM OTHER THAN A MAIL ORDER PHARMACY WHICH IS  NOT  ALSO
IMPOSED  ON  INSUREDS  ELECTING TO PURCHASE DRUGS FROM A DESIGNATED MAIL
ORDER PHARMACY; PROVIDED, HOWEVER, THAT THE PROVISIONS OF  THIS  SECTION
SHALL  NOT  SUPERSEDE  THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT OR
APPLY TO A POLICY THAT IS THE RESULT OF A COLLECTIVE  BARGAINING  AGREE-
MENT  BETWEEN  AN EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGAN-
IZATION. NOTHING IN  THIS  SUBSECTION  SHALL  ALTER  ANY  PROVISIONS  OF
SECTIONS  THIRTEEN  AND  THIRTEEN-O  OF  THE  WORKERS'  COMPENSATION LAW
REGARDING THE PURCHASE OF PRESCRIPTION DRUGS AND THE USE OF  MAIL  ORDER
PHARMACY.
  S  4.  The  opening  paragraph  of  paragraph  25 of subsection (b) of
section 4322 of the insurance law, as amended by chapter 554 of the laws
of 2002, is amended to read as follows:
  Prescription drugs, including contraceptive drugs or devices  approved
by  the  federal  food  and  drug  administration or generic equivalents
approved as substitutes by such food and drug administration and  nutri-
tional supplements (formulas) for the therapeutic treatment of phenylke-
tonuria,  branched-chain  ketonuria,  galactosemia  and  homocystinuria,
obtained at a participating pharmacy under a prescription written by  an
in-plan  or  out-of-plan  provider. Health maintenance organizations, in
addition to providing coverage for prescription drugs at a participating
pharmacy, may utilize a mail order prescription drug program.   HOWEVER,
NO HEALTH MAINTENANCE ORGANIZATION SHALL MANDATE THAT PRESCRIPTION DRUGS
BE PURCHASED BY THE INSURED FROM A MAIL ORDER PHARMACY; PROVIDED, HOWEV-
ER, THAT THE PROVISIONS OF THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF
A  COLLECTIVE  BARGAINING  AGREEMENT  OR  APPLY  TO A POLICY THAT IS THE
RESULT OF A COLLECTIVE BARGAINING AGREEMENT BETWEEN AN  EMPLOYER  AND  A
RECOGNIZED OR CERTIFIED EMPLOYEE ORGANIZATION. NOTHING IN THIS PARAGRAPH
SHALL  ALTER  ANY  PROVISIONS OF SECTIONS THIRTEEN AND THIRTEEN-O OF THE
WORKERS' COMPENSATION LAW REGARDING THE PURCHASE OF  PRESCRIPTION  DRUGS
AND THE USE OF MAIL ORDER PHARMACY. Health maintenance organizations may
provide prescription drugs pursuant to a drug formulary; however, health
maintenance  organizations must implement an appeals process so that the
use of non-formulary prescription drugs may be requested by a  physician
or other provider.
  S 5. If any clause, subparagraph, subsection, section or other part of
this  act, or the  application thereof be held to be invalid, such hold-
ing shall not affect, impair or invalidate the remainder of this act, or
the application of such section or part of a section held invalid.
  S 6. This act shall take effect on the thirtieth day  after  it  shall
have  become a law and shall apply to all policies and contracts issued,
renewed, modified, altered or amended on or after such effective date.

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Senate Bill S6007

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

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co-Sponsors

2009-S6007 (ACTIVE) - Details

2009-S6007 (ACTIVE) - Summary

2009-S6007 (ACTIVE) - Sponsor Memo

2009-S6007 (ACTIVE) - Bill Text download pdf

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Sponsored By

Neil D. Breslin

Archive: Last Bill Status - In Senate Committee Insurance Committee

Actions

co-Sponsors

George D. Maziarz

Antoine M. Thompson

2009-S6007 (ACTIVE) - Details

2009-S6007 (ACTIVE) - Summary

2009-S6007 (ACTIVE) - Sponsor Memo

2009-S6007 (ACTIVE) - Bill Text download pdf

Comments