NY State Senate Bill 2011-S2202

Archive: Last Bill Status - In Senate Committee Aging 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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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 04, 2012	referred to aging
Jan 18, 2011	referred to aging

2011-S2202 (ACTIVE) - Details

Current Committee:: Senate Aging
Law Section:: Elder Law
Laws Affected:: Add Art 2 Title 4 §270, Eld L
Versions Introduced in 2009-2010 Legislative Session:: S1577

2011-S2202 (ACTIVE) - Summary

Creates the state pharmaceutical local choice program to require that prescription drug plans within health insurance policies permit insureds to purchase pharmaceuticals from local pharmacies.

2011-S2202 (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S2202

TITLE OF BILL:

An act
to amend the elder law, in relation to creating the state pharmaceutical
local choice program

PURPOSE OR GENERAL IDEA OF THE BILL:

To assure that any health care plan that includes pharmaceutical
benefits and which includes an option or requirement for mail order
purchase of drugs also provide that an insured can purchase the
required drugs locally, at a community pharmacy.

SUMMARY OF PROVISIONS:

The bill makes the following changes:

Section 1. Creates a new Title 4, Miscellaneous Provisions in the
Elder Law, with a new section 300, Pharmaceutical Local Choice Program.
Section 300, the Pharmaceutical Local Choice Program, requires that:

1. A health insurance policy which provides coverage for prescribed
drugs that includes an option or a requirement that insureds purchase
prescription drugs from a mail order pharmacy (i.e., a non-resident

establishment, as defined in section 6808-b of the education law),
shall additionally provide that an insured may purchase such drugs
from a community pharmacy (i.e., one registered with the education
department pursuant to section 6808 of the education law) which,
insofar as reasonable, shall be located and accessible in the local
community of the insured.

The subdivision defines the term "health insurance policy" to mean and
include any policy of accident and health insurance delivered or
issued for delivery in this state,
and any group or blanket policy delivered or issued for delivery in
this state, as described in appropriate sections of the insurance law.

2. This subdivision creates the consumer pharmaceutical insurance
coverage panel, whose membership is the same as the EPIC panel, and
whose purpose is to oversee the program for providing consumer choice
in purchase of prescription pharmaceuticals within their own
communities. The panel, and each member is authorized to and shall
promulgate regulations to effect the purposes of this section,
including requiring adherence to the provisions of this section by
health insurance policies, and appropriate notification of insureds
of the option to purchase prescription drugs at a pharmacy rather
than a non-resident establishments; and to develop and implement, in
cooperation with area offices for the aging or other units of local
government and not for profit organizations, an outreach program to
inform the elderly and others of the option to purchase prescription
drugs at a pharmacy rather than a non-resident establishment.

3. This subdivision requires an annual report submitted to the
governor and the legislature by January 1 of each year concerning the
effect of any disparity in copayments or other fees or charges to


consumers for purchase of the same or similar drugs through local
pharmacies and mail order, by or pursuant to health insurance
policies, including those provided under Medicare Part D. The report
is to include annual statistical information derived by data
collection by the panel, or from sampling, regarding the number of
persons and plans affected, the amount of any such disparities, the
required use of such non-resident establishments and pharmacies, and
any recommendations by the panel concerning the need to prohibit or
ameliorate such disparities.

4. This subdivision requires a l2-member advisory committee to the
panel, with four members appointed by the governor, three by the
temporary president of the senate, one by the minority leader of the
senate, three members by the speaker of the assembly, and one member
by the minority leader of the assembly. The advisory committee
members shall be representatives of consumers and pharmacists, with
no less than 50% representing consumers (including three
representatives of statewide organizations representing the elderly
and consumers), and two representatives of statewide organizations
representing pharmacies.

JUSTIFICATION:

There has been an explosion in the number of health insurance plans
requiring mail order purchase of pharmaceuticals. This may make some
sense on a cost basis, the insureds lose access to community
pharmacies, with the protections afforded them.
This bill simply tracks the requirements of the Medicare Part D plan,
which allows mail-order, but also requires community pharmacy
participation.
In order to determine the possible effect of disparate fees, the bill
also requires a study by the consumer pharmaceutical insurance
coverage panel by January 1 of each year. The data from the study
will give the legislature necessary information to determine whether
steps need to be taken in this area also.

LEGISLATIVE HISTORY:
S.7506 of 2006, Aging
S.1776 of 2008, Aging
S.1577 of 2010, Aging

FISCAL IMPLICATIONS:
To be determined.

EFFECTIVE DATE:
July 1, 2011.

2011-S2202 (ACTIVE) - Bill Text download pdf

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

                                  2202

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                            January 18, 2011
                               ___________

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

AN ACT to amend the elder law, in relation to creating the state pharma-
  ceutical local choice program

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

  Section 1. Article 2 of the elder law is amended by adding a new title
4 to read as follows:
                                  TITLE 4
                        MISCELLANEOUS PROVISIONS

SECTION 270. PHARMACEUTICAL LOCAL CHOICE PROGRAM.
  S 270. PHARMACEUTICAL  LOCAL CHOICE PROGRAM. 1. ANY OTHER PROVISION OF
ANY OTHER LAW TO THE CONTRARY NOTWITHSTANDING,  EVERY  HEALTH  INSURANCE
POLICY  WHICH  PROVIDES  COVERAGE  FOR PRESCRIBED DRUGS THAT INCLUDES AN
OPTION OR A REQUIREMENT THAT INSUREDS PURCHASE PRESCRIPTION DRUGS FROM A
NON-RESIDENT ESTABLISHMENT, AS DEFINED IN  SECTION  SIXTY-EIGHT  HUNDRED
EIGHT-B OF THE EDUCATION LAW, SHALL ADDITIONALLY PROVIDE THAT AN INSURED
MAY PURCHASE SUCH PRESCRIPTION DRUGS FROM A PHARMACY REGISTERED WITH THE
STATE  DEPARTMENT  OF  EDUCATION PURSUANT TO SECTION SIXTY-EIGHT HUNDRED
EIGHT OF THE EDUCATION  LAW  WHICH,  INSOFAR  AS  REASONABLE,  SHALL  BE
LOCATED  AND  ACCESSIBLE  IN  THE  LOCAL COMMUNITY OF THE INSURED.   FOR
PURPOSES OF THIS SECTION, THE TERM "HEALTH INSURANCE POLICY" SHALL  MEAN
AND  INCLUDE  ANY  POLICY  OF ACCIDENT AND HEALTH INSURANCE DELIVERED OR
ISSUED FOR DELIVERY IN THIS STATE, AS DESCRIBED  IN  SUBSECTION  (I)  OF
SECTION THREE THOUSAND TWO HUNDRED SIXTEEN OF THE INSURANCE LAW, AND ANY
GROUP  OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE,
AS DESCRIBED IN SECTION THREE THOUSAND TWO  HUNDRED  TWENTY-ONE  OF  THE
INSURANCE LAW.
  2.  THERE  IS  HEREBY  CREATED  THE  CONSUMER PHARMACEUTICAL INSURANCE
COVERAGE PANEL, WHOSE PURPOSE  SHALL  BE  TO  OVERSEE  THE  PROGRAM  FOR

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06121-01-1

S. 2202                             2

PROVIDING  CONSUMER  CHOICE  IN PURCHASE OF PRESCRIPTION PHARMACEUTICALS
WITHIN THEIR OWN COMMUNITIES, AND WHOSE MEMBERSHIP, CHAIRS, AND MEETINGS
SHALL BE THE SAME AS THE MEMBERS AND CHAIRS OF  THE  ELDERLY  PHARMACEU-
TICAL  INSURANCE  COVERAGE  PANEL,  AS  SUCH  MEMBERSHIP IS DESCRIBED IN
SECTION TWO HUNDRED FORTY-FOUR OF  THIS  ARTICLE.  PANEL  MEMBERS  SHALL
RECEIVE  NO  COMPENSATION  FOR  THEIR  SERVICES AS PANEL MEMBERS.   SUCH
PANEL, AND EACH MEMBER THEREOF, AS APPROPRIATE, IS HEREBY AUTHORIZED  TO
AND SHALL:
  (A) PROMULGATE REGULATIONS AS SHALL BE NECESSARY AND IN KEEPING WITHIN
THE  SCOPE OF POWERS OF THE PANEL AND OF EACH SUCH MEMBER, TO EFFECT THE
PURPOSES OF THIS SECTION.   SUCH  REGULATIONS  SHALL  INCLUDE  REQUIRING
ADHERENCE  TO  THE  PROVISIONS OF THIS SECTION BY HEALTH INSURANCE POLI-
CIES, AND APPROPRIATE NOTIFICATION OF INSUREDS OF THE OPTION TO PURCHASE
PRESCRIPTION DRUGS AT A PHARMACY RATHER THAN A  NON-RESIDENT  ESTABLISH-
MENT; AND
  (B)  DEVELOP  AND  IMPLEMENT, IN COOPERATION WITH AREA OFFICES FOR THE
AGING OR OTHER UNITS OF LOCAL GOVERNMENT AND NOT  FOR  PROFIT  ORGANIZA-
TIONS,  AN  OUTREACH  PROGRAM  TO  INFORM  THE ELDERLY AND OTHERS OF THE
OPTION TO PURCHASE PRESCRIPTION  DRUGS  AT  A  PHARMACY  RATHER  THAN  A
NON-RESIDENT ESTABLISHMENT.
  3.  THE PANEL SHALL PREPARE AN ANNUAL REPORT AND SUBMIT SUCH REPORT TO
THE GOVERNOR AND THE LEGISLATURE NO LATER THAN THE FIRST DAY OF  JANUARY
OF  EACH  YEAR  CONCERNING THE EFFECT OF ANY DISPARITY IN CO-PAYMENTS OR
OTHER FEES OR CHARGES TO CONSUMERS FOR PURCHASE OF THE SAME  OR  SIMILAR
DRUGS  BY  OR  PURSUANT  TO  HEALTH  INSURANCE POLICIES, INCLUDING THOSE
PROVIDING BENEFITS PURSUANT TO TITLE XVIII OF THE FEDERAL SOCIAL SECURI-
TY ACT (PART D), RELATING TO THE USE OF NON-RESIDENT ESTABLISHMENTS  AND
PHARMACIES,  AS  SUCH  TERMS  ARE  DESCRIBED  IN SUBDIVISION ONE OF THIS
SECTION.  SUCH  REPORT  SHALL  INCLUDE  ANNUAL  STATISTICAL  INFORMATION
DERIVED BY DATA COLLECTION BY THE PANEL, OR FROM SAMPLING, REGARDING THE
NUMBER  OF  PERSONS  AND PLANS AFFECTED, THE AMOUNT OF ANY SUCH DISPARI-
TIES, THE REQUIRED USE OF SUCH NON-RESIDENT ESTABLISHMENTS  AND  PHARMA-
CIES,  AND  ANY  RECOMMENDATIONS  BY  THE  PANEL  CONCERNING THE NEED TO
PROHIBIT OR AMELIORATE SUCH DISPARITIES.
  4. THERE SHALL BE AN ADVISORY COMMITTEE  TO  THE  PANEL  COMPRISED  OF
TWELVE  PERSONS.  FOUR MEMBERS SHALL BE APPOINTED BY THE GOVERNOR, THREE
MEMBERS SHALL BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE, ONE
MEMBER SHALL BE APPOINTED BY THE MINORITY LEADER OF  THE  SENATE,  THREE
MEMBERS SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY AND ONE MEMBER
SHALL  BE APPOINTED BY THE MINORITY LEADER OF THE ASSEMBLY. THE ADVISORY
COMMITTEE MEMBERS SHALL BE REPRESENTATIVES OF CONSUMERS AND PHARMACISTS,
WITH NO LESS THAN FIFTY PERCENT REPRESENTING CONSUMERS, PROVIDED THAT OF
THE MEMBERS APPOINTED,  THREE  SHALL  BE  REPRESENTATIVES  OF  STATEWIDE
ORGANIZATIONS  REPRESENTING  THE ELDERLY AND CONSUMERS, AND TWO SHALL BE
REPRESENTATIVES OF STATEWIDE ORGANIZATIONS REPRESENTING PHARMACIES.  THE
PANEL  SHALL CONSULT THE ADVISORY COMMITTEE AND CONSIDER ITS RECOMMENDA-
TIONS CONCERNING THE IMPLEMENTATION OF THIS  PROGRAM  AND  THE  POLICIES
GOVERNING  ITS  CONTINUED  OPERATION. COMMITTEE MEMBERS SHALL RECEIVE NO
COMPENSATION FOR THEIR SERVICES BUT SHALL BE ALLOWED  THEIR  ACTUAL  AND
NECESSARY EXPENSES INCURRED IN THE PERFORMANCE OF THEIR DUTIES.
  5.  THE  FOREGOING PROVISIONS OF THIS SECTION TO THE CONTRARY NOTWITH-
STANDING, SUBDIVISION ONE OF THIS SECTION (A) SHALL NOT APPLY TO  HEALTH
INSURANCE  POLICIES  THE  PROVISIONS  OF WHICH ARE SUBJECT TO COLLECTIVE
BARGAINING AGREEMENTS WHICH ARE IN CONTRADICTION TO THE REQUIREMENTS  OF
SUCH  SECTION;  (B)  SHALL  ONLY APPLY TO POLICIES AND CONTRACTS ISSUED,
RENEWED, MODIFIED, ALTERED OR AMENDED ON OR AFTER THE EFFECTIVE DATE  OF

S. 2202                             3

THIS  SECTION;  AND  (C)  MAY  BE APPLIED IN A MANNER WHICH REQUIRES THE
INSURED TO PAY A REASONABLE FEE OR CHARGE THAT REFLECTS THE DIFFERENTIAL
IN COST, IF ANY, FOR USE OF A PHARMACY LOCATED  AND  ACCESSIBLE  IN  THE
LOCAL  COMMUNITY  OF  THE  INSURED, PROVIDED THAT SUCH REASONABLE FEE OR
CHARGE SHALL BE SUBJECT TO AUDIT BY THE  CONSUMER  PHARMACEUTICAL  PANEL
FOR  REASONABLENESS,  AND  FURTHER  PROVIDED  THAT SUCH HEALTH INSURANCE
POLICY SHALL NOT IMPOSE OR REQUIRE ANY OTHER  DIFFERENCES  IN  TREATMENT
FOR  THE USE OF SUCH LOCAL PHARMACY WITH RESPECT TO CO-PAYMENTS OR QUAN-
TITY LIMITATIONS OR OTHER SIMILAR PAYMENTS OR LIMITATIONS.
  S 2. This act shall take effect July 1, 2011.

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Senate Bill S2202

Sponsored By

Archive: Last Bill Status - In Senate Committee Aging Committee

Actions

2011-S2202 (ACTIVE) - Details

2011-S2202 (ACTIVE) - Summary

2011-S2202 (ACTIVE) - Sponsor Memo

2011-S2202 (ACTIVE) - Bill Text download pdf

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Sponsored By

Martin J. Golden

Archive: Last Bill Status - In Senate Committee Aging Committee

Actions

2011-S2202 (ACTIVE) - Details

2011-S2202 (ACTIVE) - Summary

2011-S2202 (ACTIVE) - Sponsor Memo

2011-S2202 (ACTIVE) - Bill Text download pdf

Comments