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
                               ___________

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.