S T A T E O F N E W Y O R K
________________________________________________________________________
6054
I N S E N A T E
(PREFILED)
January 4, 2012
___________
Introduced by Sen. MAZIARZ -- 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 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. Paragraph 28 of subsection (i) of section 3216 of the
insurance law, as added by a chapter of the laws of 2011, amending the
insurance law relating to the purchase of prescription drugs, as
proposed in legislative bills numbers S. 3510-B and A. 5502-B, is
amended to read as follows:
(28) Any policy [which] THAT provides coverage for prescription drugs
shall permit each [participant] INSURED to fill any [mail order] covered
prescription THAT MAY BE OBTAINED AT A NETWORK PARTICIPATING MAIL ORDER
OR OTHER NON-RETAIL PHARMACY, at [his or her] THE INSURED'S option, at
[any mail order pharmacy or] A network participating non-mail order
retail pharmacy [if the network participating non-mail order retail
pharmacy offers to accept a price that is comparable to that of the mail
order pharmacy] PROVIDED THAT THE NETWORK PARTICIPATING NON-MAIL ORDER
RETAIL PHARMACY AGREES IN ADVANCE, THROUGH A CONTRACTUAL NETWORK AGREE-
MENT, TO THE SAME REIMBURSEMENT AMOUNT, AS WELL AS THE SAME APPLICABLE
TERMS AND CONDITIONS, THAT THE INSURER HAS ESTABLISHED FOR THE NETWORK
PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY. [Any policy
which provides coverage for prescription drugs] IN SUCH A CASE, THE
POLICY shall not impose a co-payment fee or other condition on any
insured who elects to purchase PRESCRIPTION drugs from a network partic-
ipating non-mail order retail pharmacy which is not also imposed on
insureds electing to purchase drugs from a [designated] NETWORK PARTIC-
IPATING mail order OR OTHER NON-RETAIL 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 recog-
nized or certified employee organization].
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09145-08-1
S. 6054 2
S 2. Paragraph 18 of subsection (1) of section 3221 of the insurance
law, as added by a chapter of the laws of 2011, amending the insurance
law relating to the purchase of prescription drugs, as proposed in
legislative bills numbers S. 3510-B and A. 5502-B, is amended to read as
follows:
(18) Any insurer delivering a group or blanket policy or issuing a
group or blanket policy for delivery in this state [which] THAT provides
coverage for prescription drugs shall permit each [participant] INSURED
to fill any [mail order] covered prescription THAT MAY BE OBTAINED AT A
NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY, at [his
or her] THE INSURED'S option, at [any mail order pharmacy or] A network
participating non-mail order retail pharmacy [if the network participat-
ing non-mail order retail pharmacy offers to accept a price that is
comparable to that of the mail order pharmacy] PROVIDED THAT THE NETWORK
PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY AGREES IN ADVANCE, THROUGH
A CONTRACTUAL NETWORK AGREEMENT, TO THE SAME REIMBURSEMENT AMOUNT, AS
WELL AS THE SAME APPLICABLE TERMS AND CONDITIONS, THAT THE INSURER HAS
ESTABLISHED FOR THE NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL
PHARMACY. [Any policy which provides coverage for prescription drugs]
IN SUCH A CASE, THE POLICY shall not impose a co-payment fee or other
condition on any insured who elects to purchase drugs from a network
participating non-mail order retail pharmacy which is not also imposed
on insureds electing to purchase drugs from a [designated] NETWORK
PARTICIPATING mail order OR OTHER NON-RETAIL 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.
S 3. Subsection (hh) of section 4303 of the insurance law, as added by
a chapter of the laws of 2011, amending the insurance law relating to
the purchase of prescription drugs, as proposed in legislative bills
numbers S. 3510-B and A. 5502-B, is amended to read as follows:
(hh) Any [policy] CONTRACT issued by a medical expense indemnity
corporation, a hospital service corporation or a health services corpo-
ration [which] THAT provides coverage for prescription drugs shall
permit each [participant] COVERED PERSON to fill any [mail order]
covered prescription THAT MAY BE OBTAINED AT A NETWORK PARTICIPATING
MAIL ORDER OR OTHER NON-RETAIL PHARMACY, at [his or her] THE COVERED
PERSON'S option, at [any mail order pharmacy or] A network participating
non-mail order retail pharmacy [if the network participating non-mail
order retail pharmacy offers to accept a price that is comparable to
that of the mail order pharmacy] PROVIDED THAT THE NETWORK PARTICIPATING
NON-MAIL ORDER RETAIL PHARMACY AGREES IN ADVANCE, THROUGH A CONTRACTUAL
NETWORK AGREEMENT, TO THE SAME REIMBURSEMENT AMOUNT, AS WELL AS THE SAME
APPLICABLE TERMS AND CONDITIONS, THAT THE CORPORATION HAS ESTABLISHED
FOR THE NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY.
[Any policy which provides coverage for prescription drugs] IN SUCH A
CASE, THE CONTRACT shall not impose a copayment fee or other condition
on any [insured] COVERED PERSON who elects to purchase drugs from a
network participating non-mail order retail pharmacy which is not also
imposed on [insureds] COVERED PERSONS electing to purchase drugs from a
[designated] NETWORK PARTICIPATING mail order OR OTHER NON-RETAIL phar-
macy; provided, however, that the provisions of this section shall not
supersede the terms of a collective bargaining agreement or apply to a
[policy] CONTRACT that is the result of a collective bargaining agree-
S. 6054 3
ment between an employer and a recognized or certified employee organ-
ization.
S 4. This act shall take effect on the same date and in the same
manner as a chapter of the laws of 2011, amending the insurance law
relating to the purchase of prescription drugs, as proposed in legisla-
tive bills numbers S. 3510-B and A. 5502-B, takes effect.
