S T A T E O F N E W Y O R K
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2011-2012 Regular Sessions
I N A S S E M B L Y
March 31, 2011
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Introduced by M. of A. ZEBROWSKI, COLTON, COOK, DINOWITZ, GUNTHER,
JAFFEE, KELLNER, LANCMAN, ORTIZ, PEOPLES-STOKES, PHEFFER -- Multi-
Sponsored by -- M. of A. BROOK-KRASNY, MAISEL, MAYERSOHN, REILLY,
ROBINSON, TITONE, TOWNS, WEISENBERG -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to insurance coverage for
prescribed drugs
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 27 of subsection (i) of section 3216 of the
insurance law, as added by chapter 457 of the laws of 2010, is renum-
bered paragraph 28 and a new paragraph 29 is added to read as follows:
(29)(A) EVERY POLICY WHICH PROVIDES COVERAGE FOR PRESCRIBED DRUGS
APPROVED BY THE FOOD AND DRUG ADMINISTRATION OF THE UNITED STATES
GOVERNMENT SHALL PROVIDE COVERAGE TO ANY NAMED SUBSCRIBER OR OTHER
PERSON COVERED THEREUNDER FOR ANY DRUG PRESCRIBED BY A PHYSICIAN OR
OTHER LICENSED HEALTH CARE PROVIDER, LEGALLY AUTHORIZED TO PRESCRIBE
UNDER TITLE EIGHT OF THE EDUCATION LAW, AS THE DRUG MOST LIKELY TO
PROVIDE RELIEF TO SUCH PERSON. PROVIDED, HOWEVER, THAT SUCH DRUG MUST BE
RECOGNIZED FOR TREATMENT OF THE SPECIFIC TYPE OF ILLNESS OR INJURY FOR
WHICH THE DRUG HAS BEEN PRESCRIBED IN ONE OF THE FOLLOWING ESTABLISHED
REFERENCE COMPENDIA:
(I) THE AMERICAN MEDICAL ASSOCIATION DRUG EVALUATIONS;
(II) THE AMERICAN HOSPITAL FORMULARY SERVICE DRUG INFORMATION; OR
(III) THE UNITED STATES PHARMACOPEIA DRUG INFORMATION; OR RECOMMENDED
BY REVIEW ARTICLE OR EDITORIAL COMMENT IN A MAJOR PEER REVIEWED PROFES-
SIONAL JOURNAL.
(B) NOTWITHSTANDING THE PROVISIONS OF THIS PARAGRAPH, COVERAGE SHALL
NOT BE REQUIRED FOR ANY EXPERIMENTAL OR INVESTIGATIONAL DRUGS OR ANY
DRUG WHICH THE FOOD AND DRUG ADMINISTRATION HAS DETERMINED TO BE
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10304-01-1
A. 6789 2
CONTRAINDICATED FOR TREATMENT OF THE SPECIFIC TYPE OF ILLNESS OR INJURY
FOR WHICH THE DRUG HAS BEEN PRESCRIBED.
S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 17 to read as follows:
(17)(A) EVERY POLICY WHICH PROVIDES COVERAGE FOR PRESCRIBED DRUGS
APPROVED BY THE FOOD AND DRUG ADMINISTRATION OF THE UNITED STATES
GOVERNMENT SHALL PROVIDE COVERAGE TO ANY NAMED SUBSCRIBER OR OTHER
PERSON COVERED THEREUNDER FOR ANY DRUG PRESCRIBED BY A PHYSICIAN OR
OTHER LICENSED HEALTH CARE PROVIDER, LEGALLY AUTHORIZED TO PRESCRIBE
UNDER TITLE EIGHT OF THE EDUCATION LAW, AS THE DRUG MOST LIKELY TO
PROVIDE RELIEF TO SUCH PERSON. PROVIDED, HOWEVER, THAT SUCH DRUG MUST BE
RECOGNIZED FOR TREATMENT OF THE SPECIFIC TYPE OF ILLNESS OR INJURY FOR
WHICH THE DRUG HAS BEEN PRESCRIBED IN ONE OF THE FOLLOWING ESTABLISHED
REFERENCE COMPENDIA:
(I) THE AMERICAN MEDICAL ASSOCIATION DRUG EVALUATIONS;
(II) THE AMERICAN HOSPITAL FORMULARY SERVICE DRUG INFORMATION; OR
(III) THE UNITED STATES PHARMACOPEIA DRUG INFORMATION; OR RECOMMENDED
BY REVIEW ARTICLE OR EDITORIAL COMMENT IN A MAJOR PEER REVIEWED PROFES-
SIONAL JOURNAL.
(B) NOTWITHSTANDING THE PROVISIONS OF THIS PARAGRAPH, COVERAGE SHALL
NOT BE REQUIRED FOR ANY EXPERIMENTAL OR INVESTIGATIONAL DRUGS OR ANY
DRUG WHICH THE FOOD AND DRUG ADMINISTRATION HAS DETERMINED TO BE
CONTRAINDICATED FOR TREATMENT OF THE SPECIFIC TYPE OF ILLNESS OR INJURY
FOR WHICH THE DRUG HAS BEEN PRESCRIBED.
S 3. Subsection (gg) of section 4303 of the insurance law, as added by
chapter 536 of the laws of 2010, is relettered subsection (hh) and a new
subsection (ii) is added to read as follows:
(II) (1) EVERY POLICY WHICH PROVIDES COVERAGE FOR PRESCRIBED DRUGS
APPROVED BY THE FOOD AND DRUG ADMINISTRATION OF THE UNITED STATES
GOVERNMENT SHALL PROVIDE COVERAGE TO ANY NAMED SUBSCRIBER OR OTHER
PERSON COVERED THEREUNDER FOR ANY DRUG PRESCRIBED BY A PHYSICIAN OR
OTHER LICENSED HEALTH CARE PROVIDER, LEGALLY AUTHORIZED TO PRESCRIBE
UNDER TITLE EIGHT OF THE EDUCATION LAW, AS THE DRUG MOST LIKELY TO
PROVIDE RELIEF TO SUCH PERSON. PROVIDED, HOWEVER, THAT SUCH DRUG MUST BE
RECOGNIZED FOR TREATMENT OF THE SPECIFIC TYPE OF ILLNESS OR INJURY FOR
WHICH THE DRUG HAS BEEN PRESCRIBED IN ONE OF THE FOLLOWING ESTABLISHED
REFERENCE COMPENDIA:
(A) THE AMERICAN MEDICAL ASSOCIATION DRUG EVALUATIONS;
(B) THE AMERICAN HOSPITAL FORMULARY SERVICE DRUG INFORMATION; OR
(C) THE UNITED STATES PHARMACOPEIA DRUG INFORMATION; OR RECOMMENDED BY
REVIEW ARTICLE OR EDITORIAL COMMENT IN A MAJOR PEER REVIEWED PROFES-
SIONAL JOURNAL.
(2) NOTWITHSTANDING THE PROVISIONS OF THIS SUBSECTION, COVERAGE SHALL
NOT BE REQUIRED FOR ANY EXPERIMENTAL OR INVESTIGATIONAL DRUGS OR ANY
DRUG WHICH THE FOOD AND DRUG ADMINISTRATION HAS DETERMINED TO BE
CONTRAINDICATED FOR TREATMENT OF THE SPECIFIC TYPE OF ILLNESS OR INJURY
FOR WHICH THE DRUG HAS BEEN PRESCRIBED.
S 4. This act shall take effect on the first of January next succeed-
ing the date on which 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; provided that any rule or regulation
necessary for the timely implementation of this act on its effective
date is authorized and directed to be promulgated on or before such
date.