senate Bill S5799

Signed By Governor
2011-2012 Legislative Session

Requires insurance coverage for prescription fertility drugs purchased at non-mail order pharmacies to be the same as for prescription fertility drugs purchased at mail order pharmacies

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Archive: Last Bill Status Via A7779 - Signed by Governor


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

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Dec 12, 2011 approval memo.15
signed chap.598
Nov 30, 2011 delivered to governor
Jun 21, 2011 returned to assembly
passed senate
3rd reading cal.1489
substituted for s5799
Jun 21, 2011 substituted by a7779
ordered to third reading cal.1489
Jun 16, 2011 referred to rules

Votes

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S5799 - Bill Details

See Assembly Version of this Bill:
A7779
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221 & 4303, Ins L

S5799 - Bill Texts

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Requires insurance coverage for prescription fertility drugs purchased at non-mail order pharmacies to be the same as for prescription fertility drugs purchased at mail order pharmacies.

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BILL NUMBER:S5799

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

PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill is to ensure
that fertility drugs may be purchased locally without additional
financial burden to the insured person.

SUMMARY OF SPECIFIC PROVISIONS:
This bill would amend the insurance
law with respect to HMOs, and individual, group and not-for-profit
insurance policies by requiring all policies that provide coverage
for fertility drugs and require or permit a mail order pharmacy
benefit to cover prescription fertility drugs purchased at a non-mail
order pharmacy without any additional cost sharing to the covered
individual.

JUSTIFICATION:
In an effort to streamline the delivery of prescription
drugs while maintaining the affordability of coverage, many health
insurance policies require or incentivize the use of a mail order
pharmacy.
Nevertheless, the effectiveness of many fertility drugs relies on a
strict treatment regimen that is often difficult or impossible to
maintain when using a mail order pharmacy. Shipping and processing
delays may impair these drugs' ability to produce the desired effect
at a cost to both insureds and insurance companies themselves. This
bill would ensure that individuals with prescription drug coverage
have an equal opportunity to purchase fertility drugs from either a
mail order or non-mail order pharmacy.

PRIOR LEGISLATIVE HISTORY:
New Bill.

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
None.

EFFECTIVE DATE:
Thirty days following enactment and shall apply to all
policies and contracts issued, renewed, modified, altered or amended
on or after such effective date.

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

                                  5799

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                              June 16, 2011
                               ___________

Introduced  by  Sen.  SKELOS -- 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 13-a to read as follows:
  (13-A)  EVERY POLICY THAT PROVIDES COVERAGE FOR PRESCRIPTION FERTILITY
DRUGS AND REQUIRES OR PERMITS PRESCRIPTION DRUGS TO BE PURCHASED THROUGH
A MAIL ORDER PHARMACY SHALL PROVIDE THE SAME COVERAGE  FOR  PRESCRIPTION
FERTILITY  DRUGS  WHEN  SUCH DRUGS ARE PURCHASED FROM A PHARMACY THAT IS
NOT A MAIL ORDER PHARMACY. SUCH POLICY SHALL NOT IMPOSE  ANY  ADDITIONAL
FEE,  CO-PAYMENT,  CO-INSURANCE,  DEDUCTIBLE  OR  OTHER CONDITION ON ANY
INSURED WHO DOES NOT ELECT  TO  PURCHASE  PRESCRIPTION  FERTILITY  DRUGS
THROUGH A MAIL ORDER PHARMACY.
  S  2.  Paragraph  6 of subsection (k) of section 3221 of the insurance
law is amended by adding a new subparagraph (D) to read as follows:
  (D) EVERY POLICY THAT PROVIDES  COVERAGE  FOR  PRESCRIPTION  FERTILITY
DRUGS AND REQUIRES OR PERMITS PRESCRIPTION DRUGS TO BE PURCHASED THROUGH
A  MAIL  ORDER PHARMACY SHALL PROVIDE THE SAME COVERAGE FOR PRESCRIPTION
FERTILITY DRUGS WHEN SUCH DRUGS ARE PURCHASED FROM A  PHARMACY  THAT  IS
NOT  A  MAIL ORDER PHARMACY. SUCH POLICY SHALL NOT IMPOSE ANY ADDITIONAL
FEE, CO-PAYMENT, CO-INSURANCE, DEDUCTIBLE  OR  OTHER  CONDITION  ON  ANY
COVERED  PERSON  WHO  DOES  NOT ELECT TO PURCHASE PRESCRIPTION FERTILITY
DRUGS THROUGH A MAIL ORDER PHARMACY.
  S 3. Subsection (s) of section 4303 of the insurance law,  as  amended
by  section 2 of part K of chapter 82 of the laws of 2002, is amended by
adding a new paragraph 4 to read as follows:
  (4) EVERY POLICY ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION,  A
HOSPITAL  SERVICE  CORPORATION  OR  A  HEALTH  SERVICES CORPORATION THAT

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10740-02-1

S. 5799                             2

PROVIDES COVERAGE FOR  PRESCRIPTION  FERTILITY  DRUGS  AND  REQUIRES  OR
PERMITS PRESCRIPTION DRUGS TO BE PURCHASED THROUGH A MAIL ORDER PHARMACY
SHALL  PROVIDE  THE  SAME COVERAGE FOR PRESCRIPTION FERTILITY DRUGS WHEN
SUCH  DRUGS ARE PURCHASED FROM A PHARMACY THAT IS NOT A MAIL ORDER PHAR-
MACY. SUCH POLICY SHALL  NOT  IMPOSE  ANY  ADDITIONAL  FEE,  CO-PAYMENT,
CO-INSURANCE,  DEDUCTIBLE  OR  OTHER CONDITION ON ANY COVERED PERSON WHO
DOES NOT ELECT TO PURCHASE PRESCRIPTION FERTILITY DRUGS THROUGH  A  MAIL
ORDER PHARMACY.
  S  4.   If any clause, subparagraph, subsection, section or other part
of this act, or the application thereof be  held  to  be  invalid,  such
holding  shall  not  affect,  impair or invalidate the remainder of this
act, or the application of such section or part of a section held inval-
id.
  S 5. 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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