Senate Bill S3510B

Signed By Governor

2011-2012 Legislative Session

Prohibits health insurers from requiring that the insured purchase prescribed drugs from mail order pharmacy

download bill text pdf

Archive: Last Bill Status Via A5502 - Signed by Governor

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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Actions

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Dec 12, 2011	approval memo.14 signed chap.597
Nov 30, 2011	delivered to governor
Jun 20, 2011	returned to assembly passed senate 3rd reading cal.1383 substituted for s3510b
Jun 20, 2011	substituted by a5502b ordered to third reading cal.1383 committee discharged and committed to rules
May 17, 2011	print number 3510b
May 17, 2011	amend and recommit to insurance
Apr 25, 2011	print number 3510a
Apr 25, 2011	amend and recommit to insurance
Feb 24, 2011	referred to insurance

Votes

- Jun 20, 2011 - Floor Vote
  A5502
  
  Aye
  
  60
  
  Nay
  
  2
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  
  0
  - - Floor Vote: Jun 20, 2011
      
      aye (60)
      
      Adams
      
      Addabbo Jr.
      
      Alesi
      
      Avella
      
      Ball
      
      Bonacic
      
      Breslin
      
      Carlucci
      
      DeFrancisco
      
      Diaz
      
      Dilan
      
      Duane
      
      Espaillat
      
      Farley
      
      Flanagan
      
      Fuschillo
      
      Gallivan
      
      Gianaris
      
      Golden
      
      Griffo
      
      Grisanti
      
      Hannon
      
      Hassell-Thompson
      
      Huntley
      
      Johnson
      
      Kennedy
      
      Klein
      
      Krueger
      
      Kruger
      
      LaValle
      
      Lanza
      
      Larkin
      
      Libous
      
      Little
      
      Marcellino
      
      Martins
      
      Maziarz
      
      Montgomery
      
      Nozzolio
      
      O'Mara
      
      Oppenheimer
      
      Parker
      
      Peralta
      
      Perkins
      
      Ranzenhofer
      
      Ritchie
      
      Rivera
      
      Robach
      
      Saland
      
      Sampson
      
      Savino
      
      Serrano
      
      Skelos
      
      Smith
      
      Squadron
      
      Stavisky
      
      Stewart-Cousins
      
      Valesky
      
      Young
      
      Zeldin
      
      nay (2)
      
      McDonald
      
      Seward
  Jun 20, 2011 - Rules Committee Vote
  S3510B
  
  Aye
  
  22
  
  Nay
  
  0
  
  Aye with Reservations
  
  1
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  
  1
  - - Rules Committee Vote: Jun 20, 2011
      
      aye (22)
      
      Alesi
      
      Breslin
      
      Dilan
      
      Duane
      
      Farley
      
      Hannon
      
      Hassell-Thompson
      
      Johnson
      
      Krueger
      
      LaValle
      
      Larkin
      
      Libous
      
      Marcellino
      
      Maziarz
      
      Nozzolio
      
      Parker
      
      Perkins
      
      Saland
      
      Sampson
      
      Skelos
      
      Smith
      
      Stewart-Cousins
      
      aye wr (1)
      
      Seward
      
      abstained (1)
      
      Montgomery

Bill Amendments

Original

B (Active)

co-Sponsors

View additional co-sponsors

2011-S3510 - Details

See Assembly Version of this Bill:: A5502
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2009-2010 Legislative Session:: S6007, A1267

2011-S3510 - Summary

Prohibits health insurers from requiring that the insured purchase prescribed drugs from a mail order pharmacy or pay a co-payment fee when such purchases are not made from a mail order pharmacy if a similar fee is not charged for drugs from a mail order pharmacy.

2011-S3510 - Sponsor Memo

                                BILL NUMBER:S3510

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

PURPOSE OR GENERAL IDEA OF BILL:
Prohibits health insurance policies from mandating their insured to
purchase prescribed drugs from a mail order pharmacy.

SUMMARY OF PROVISIONS:
Subsection (i) of Section 3216 of the insurance law is amended to
preclude health insurance policies from mandating that their insured
purchase prescribed drugs from mail order pharmacies. Such policies
are also precluded from imposing a co-payment fee or other condition
on an insured who chooses not to purchase from a designated mail
order pharmacy.

A new paragraph 18 is also added to subsection (1) of Section 3221 of
such law and a new Subsection (hh) is likewise added to section 4303 to
impose such a prohibition on all policies of health insurance in the
state including those issued by health services or medical expense
indemnity corporations issuing group contracts.

JUSTIFICATION:
This legislation will provide freedom of choice to consumers who have
coverage for prescribed drugs as part of their health insurance. When
a policy mandates purchase from a specific mail order pharmacy the
consumer is forced to purchase an interim supply of the prescribed
drug from his or her neighborhood pharmacist who is familiar with his
or her medical history. The risk to the consumer in this situation is
obvious.

Furthermore, the neighborhood pharmacy in these situations is forced
to bear the burden of educating the patient as to the use and
potential effects of the prescribed drug. The inability of the
consumer to purchase the full prescription from the neighborhood
pharmacy imposes this burden inequitably, thereby providing the mail
order house with an economic advantage that the local provider cannot
overcome.

Finally, many consumers, especially senior citizens, rely on their
local pharmacist for the service that they provide with respect to
monitoring the regimen of drugs that they take. A mandate of purchase
by mail denies them of this important service and confidence.

PRIOR LEGISLATIVE HISTORY:

S.6007 (2009-2010), Referred to Insurance
A.2808/S.8775 (2007-2008)
A.6934 (2005-2006)

FISCAL IMPLICATIONS:
None.


EFFECTIVE DATE:
This act shall take effect on the thirtieth day after it shall have
become law and shall apply to all policies and contracts issued,
renewed, modified, altered or amended on or after such effective date.

2011-S3510 - Bill Text download pdf

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

                                  3510

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                            February 24, 2011
                               ___________

Introduced  by  Sens. MAZIARZ, BRESLIN, BONACIC, GOLDEN, GRIFFO, HANNON,
  KLEIN, LANZA, MARCELLINO, MONTGOMERY -- read twice and ordered  print-
  ed, 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.  Subsection  (i)  of  section 3216 of the insurance law is
amended by adding a new paragraph 28 to read as follows:
  (28) NO POLICY WHICH PROVIDES  COVERAGE  FOR  PRESCRIBED  DRUGS  SHALL
MANDATE  THAT  THE  SAME  BE  PURCHASED BY THE INSURED FROM A MAIL ORDER
PHARMACY, NOR MAY SUCH POLICY IMPOSE A CO-PAYMENT FEE OR OTHER CONDITION
ON ANY INSURED WHO ELECTS TO PURCHASE DRUGS FROM OTHER THAN A MAIL ORDER
PHARMACY WHICH IS NOT ALSO IMPOSED  ON  INSUREDS  ELECTING  TO  PURCHASE
DRUGS FROM A DESIGNATED MAIL ORDER 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 RECOGNIZED  OR
CERTIFIED  EMPLOYEE  ORGANIZATION. NOTHING IN THIS PARAGRAPH SHALL ALTER
ANY PROVISIONS OF SECTIONS  THIRTEEN  AND  THIRTEEN-O  OF  THE  WORKERS'
COMPENSATION  LAW  REGARDING  THE PURCHASE OF PRESCRIPTION DRUGS AND THE
USE OF MAIL ORDER PHARMACY.
  S 2. Subsection (1) of section 3221 of the insurance law is amended by
adding a new paragraph 18 to read as follows:
  (18) NO INSURER DELIVERING A GROUP OR  BLANKET  POLICY  OR  ISSUING  A
GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE WHICH PROVIDES COVER-
AGE FOR PRESCRIBED DRUGS SHALL MANDATE THAT THE SAME BE PURCHASED BY THE
INSURED FROM A MAIL ORDER PHARMACY, NOR MAY SUCH POLICY IMPOSE A CO-PAY-
MENT  FEE OR OTHER CONDITION ON ANY INSURED WHO ELECTS TO PURCHASE DRUGS
FROM OTHER THAN A MAIL ORDER PHARMACY  WHICH  IS  NOT  ALSO  IMPOSED  ON
INSUREDS ELECTING TO PURCHASE DRUGS FROM A DESIGNATED MAIL ORDER PHARMA-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09145-01-1

S. 3510                             2

CY;  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 RECOGNIZED OR CERTIFIED EMPLOYEE ORGANIZATION. NOTHING
IN  THIS  PARAGRAPH  SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND
THIRTEEN-O OF THE WORKERS' COMPENSATION LAW REGARDING  THE  PURCHASE  OF
PRESCRIPTION DRUGS AND THE USE OF MAIL ORDER PHARMACY.
  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (hh) to read as follows:
  (HH) NO POLICY ISSUED BY A MEDICAL EXPENSE  INDEMNITY  CORPORATION,  A
HOSPITAL  SERVICE  CORPORATION  OR  A  HEALTH SERVICES CORPORATION WHICH
PROVIDES COVERAGE FOR PRESCRIBED DRUGS SHALL MANDATE THAT  THE  SAME  BE
PURCHASED BY THE INSURED FROM A MAIL ORDER PHARMACY, NOR MAY SUCH POLICY
IMPOSE  A CO-PAYMENT FEE OR OTHER CONDITION ON ANY INSURED WHO ELECTS TO
PURCHASE DRUGS FROM OTHER THAN A MAIL ORDER PHARMACY WHICH IS  NOT  ALSO
IMPOSED  ON  INSUREDS  ELECTING TO PURCHASE DRUGS FROM A DESIGNATED MAIL
ORDER 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  AGREE-
MENT  BETWEEN  AN EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGAN-
IZATION. NOTHING IN  THIS  SUBSECTION  SHALL  ALTER  ANY  PROVISIONS  OF
SECTIONS  THIRTEEN  AND  THIRTEEN-O  OF  THE  WORKERS'  COMPENSATION LAW
REGARDING THE PURCHASE OF PRESCRIPTION DRUGS AND THE USE OF  MAIL  ORDER
PHARMACY.
  S  4.  The  opening  paragraph  of  paragraph  25 of subsection (b) of
section 4322 of the insurance law, as amended by chapter 554 of the laws
of 2002, is amended to read as follows:
  Prescription drugs, including contraceptive drugs or devices  approved
by  the  federal  food  and  drug  administration or generic equivalents
approved as substitutes by such food and drug administration and  nutri-
tional supplements (formulas) for the therapeutic treatment of phenylke-
tonuria,  branched-chain  ketonuria,  galactosemia  and  homocystinuria,
obtained at a participating pharmacy under a prescription written by  an
in-plan  or  out-of-plan  provider. Health maintenance organizations, in
addition to providing coverage for prescription drugs at a participating
pharmacy, may utilize a mail order prescription drug program.   HOWEVER,
NO HEALTH MAINTENANCE ORGANIZATION SHALL MANDATE THAT PRESCRIPTION DRUGS
BE PURCHASED BY THE INSURED FROM A MAIL ORDER 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. NOTHING IN THIS PARAGRAPH
SHALL  ALTER  ANY  PROVISIONS OF SECTIONS THIRTEEN AND THIRTEEN-O OF THE
WORKERS' COMPENSATION LAW REGARDING THE PURCHASE OF  PRESCRIPTION  DRUGS
AND THE USE OF MAIL ORDER PHARMACY. Health maintenance organizations may
provide prescription drugs pursuant to a drug formulary; however, health
maintenance  organizations must implement an appeals process so that the
use of non-formulary prescription drugs may be requested by a  physician
or other provider.
  S 5. If any clause, subparagraph, subsection, section or other part of
this  act, or the  application thereof be held to be invalid, such hold-
ing shall not affect, impair or invalidate the remainder of this act, or
the application of such section or part of a section held invalid.
  S 6. 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.

co-Sponsors

View additional co-sponsors

2011-S3510A - Details

See Assembly Version of this Bill:: A5502
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2009-2010 Legislative Session:: S6007, A1267

2011-S3510A - Summary

2011-S3510A - Sponsor Memo

                                BILL NUMBER:S3510A

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

PURPOSE OR GENERAL IDEA OF BILL:
Prohibits health insurance policies from mandating their insured to
purchase prescribed drugs from a mail order pharmacy.

SUMMARY OF PROVISIONS:
Subsection (i) of Section 3216 of the insurance law is amended to
preclude health insurance policies from mandating that their insured
purchase prescribed drugs from mail order pharmacies, provided that
the non mail order pharmacy offers to accept a comparable price. Such
policies are also precluded from imposing a co-payment fee or other
condition on an insured who chooses not to purchase from a designated
mail order pharmacy.

A new paragraph 18 is also added to subsection (1) of Section 3221 of
such law and a new Subsection (hh) is likewise added to section 4303
to impose such a prohibition on all policies of health insurance in
the state including those issued by health services or medical
expense indemnity corporations issuing group contracts.

JUSTIFICATION:
This legislation will provide freedom of choice to consumers who have
coverage for prescribed drugs as part of their health insurance. When
a policy mandates purchase from a specific mail order pharmacy the
consumer is forced to purchase an interim supply of the prescribed
drug from his or her neighborhood pharmacist who is familiar with his
or her medical history. The risk to the consumer in this situation is
obvious. This bill also offers cost protections for consumers and
insurance carriers by ensuring that the protections offered in this
bill are only applied when a non-mail order pharmacy offers a
comparable price.

Furthermore, the neighborhood pharmacy in these situations is forced
to bear the burden of educating the patient as to the use and
potential effects of the prescribed drug. The inability of the
consumer to purchase the full prescription from the neighborhood
pharmacy imposes this burden inequitably, thereby providing the mail
order house with an economic advantage that the local provider cannot
overcome.

Finally, many consumers, especially senior citizens, rely on their
local pharmacist for the service that they provide with respect to
monitoring
the regimen of drugs that they take. A mandate of purchase by mail
denies them of this important service and confidence.

PRIOR LEGISLATIVE HISTORY:


S.6007 (2009-2010), Referred to Insurance
A.2808/S.8775 (2007-2008)
A.6934 (2005-2006)

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect on the thirtieth day after it shall have
become law and shall apply to all policies and contracts issued,
renewed, modified, altered or amended on or after such effective date

2011-S3510A - Bill Text download pdf

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

                                 3510--A

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                            February 24, 2011
                               ___________

Introduced  by  Sens.  MAZIARZ, BRESLIN, ADDABBO, AVELLA, BALL, BONACIC,
  DUANE, GALLIVAN, GOLDEN,  GRIFFO,  HANNON,  HUNTLEY,  JOHNSON,  KLEIN,
  KRUEGER,  KRUGER, LANZA, LARKIN, LAVALLE, LIBOUS, MARCELLINO, MARTINS,
  MONTGOMERY,  OPPENHEIMER,  PERALTA,  PERKINS,  RANZENHOFER,  STAVISKY,
  ZELDIN  --  read  twice  and  ordered  printed, and when printed to be
  committed to the Committee on Insurance -- committee discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee

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 28 to read as follows:
  (28)  ANY  POLICY WHICH PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL
PERMIT EACH PARTICIPANT TO FILL ANY MAIL ORDER COVERED PRESCRIPTION,  AT
HIS  OR  HER OPTION, AT ANY MAIL ORDER PHARMACY OR 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. ANY POLICY WHICH PROVIDES COVERAGE  FOR
PRESCRIPTION  DRUGS 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  MAIL ORDER PHARMACY;
PROVIDED, HOWEVER, THAT THE PROVISIONS OF THIS SECTION SHALL NOT  SUPER-
SEDE 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. NOTHING IN
THIS PARAGRAPH SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND THIR-
TEEN-O OF THE  WORKERS'  COMPENSATION  LAW  REGARDING  THE  PURCHASE  OF
PRESCRIPTION DRUGS AND THE USE OF MAIL ORDER PHARMACY.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09145-05-1

S. 3510--A                          2

  S 2. Subsection (1) of section 3221 of the insurance law is amended by
adding a new paragraph 18 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 PROVIDES COVER-
AGE FOR PRESCRIPTION DRUGS SHALL PERMIT EACH  PARTICIPANT  TO  FILL  ANY
MAIL ORDER COVERED PRESCRIPTION, AT HIS OR HER OPTION, AT ANY MAIL ORDER
PHARMACY  OR 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. ANY POLICY
WHICH PROVIDES COVERAGE  FOR  PRESCRIPTION  DRUGS  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 DESIG-
NATED  MAIL  ORDER  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 RECOGNIZED  OR  CERTIFIED
EMPLOYEE  ORGANIZATION.  NOTHING  IN  THIS  PARAGRAPH  SHALL  ALTER  ANY
PROVISIONS OF SECTIONS THIRTEEN AND THIRTEEN-O OF THE  WORKERS'  COMPEN-
SATION  LAW  REGARDING THE PURCHASE OF PRESCRIPTION DRUGS AND THE USE OF
MAIL ORDER PHARMACY.
  S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (hh) to read as follows:
  (HH)  ANY  POLICY ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION, A
HOSPITAL SERVICE CORPORATION OR  A  HEALTH  SERVICES  CORPORATION  WHICH
PROVIDES  COVERAGE  FOR PRESCRIPTION DRUGS SHALL PERMIT EACH PARTICIPANT
TO FILL ANY MAIL ORDER COVERED PRESCRIPTION, AT HIS OR  HER  OPTION,  AT
ANY  MAIL  ORDER PHARMACY OR 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. ANY POLICY WHICH  PROVIDES  COVERAGE  FOR  PRESCRIPTION  DRUGS
SHALL  NOT  IMPOSE A COPAYMENT 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 MAIL ORDER 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. NOTHING IN THIS SUBSECTION
SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND  THIRTEEN-O  OF  THE
WORKERS'  COMPENSATION  LAW REGARDING THE PURCHASE OF PRESCRIPTION DRUGS
AND THE USE OF MAIL ORDER PHARMACY.
  S 4. The opening paragraph  of  paragraph  25  of  subsection  (b)  of
section 4322 of the insurance law, as amended by chapter 554 of the laws
of 2002, is amended to read as follows:
  Prescription  drugs, including contraceptive drugs or devices approved
by the federal food  and  drug  administration  or  generic  equivalents
approved  as substitutes by such food and drug administration and nutri-
tional supplements (formulas) for the therapeutic treatment of phenylke-
tonuria,  branched-chain  ketonuria,  galactosemia  and  homocystinuria,
obtained  at a participating pharmacy under a prescription written by an
in-plan or out-of-plan provider. Health  maintenance  organizations,  in
addition to providing coverage for prescription drugs at a participating
pharmacy,  may utilize a mail order prescription drug program.  HOWEVER,
NO HEALTH MAINTENANCE ORGANIZATION SHALL MANDATE THAT PRESCRIPTION DRUGS
BE PURCHASED BY THE INSURED FROM A MAIL  ORDER  PHARMACY  IF  A  NETWORK

S. 3510--A                          3

PARTICIPATING  NON-MAIL  ORDER  RETAIL PHARMACY OFFERS TO ACCEPT A PRICE
THAT IS COMPARABLE TO THAT OF THE MAIL ORDER PHARMACY.  NO HEALTH  MAIN-
TENANCE ORGANIZATION SHALL 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.  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. NOTHING
IN  THIS  PARAGRAPH  SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND
THIRTEEN-O OF THE WORKERS' COMPENSATION LAW REGARDING  THE  PURCHASE  OF
PRESCRIPTION  DRUGS  AND  THE USE OF MAIL ORDER PHARMACY. Health mainte-
nance organizations may provide prescription drugs pursuant  to  a  drug
formulary;  however,  health maintenance organizations must implement an
appeals process so that the use of non-formulary prescription drugs  may
be requested by a physician or other provider.
  S 5. If any clause, subparagraph, subsection, section or other part of
this  act, or the  application thereof be held to be invalid, such hold-
ing shall not affect, impair or invalidate the remainder of this act, or
the application of such section or part of a section held invalid.
  S 6. 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.

co-Sponsors

View additional co-sponsors

2011-S3510B (ACTIVE) - Details

See Assembly Version of this Bill:: A5502
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2009-2010 Legislative Session:: S6007, A1267

2011-S3510B (ACTIVE) - Summary

2011-S3510B (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S3510B

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

PURPOSE OR GENERAL IDEA OF BILL:
Prohibits health insurance policies from mandating their insured to
purchase prescribed drugs from a mail order pharmacy.

SUMMARY OF PROVISIONS:
Subsection (i) of Section 3216 of the insurance law is amended to
preclude health insurance policies from mandating that their insured
purchase prescribed drugs from mail order pharmacies, provided that
the non mail order pharmacy offers to accept a comparable price. Such
policies are also precluded from imposing a co-payment fee or other
condition on an insured who chooses not to purchase from a designated
mail order pharmacy.

A new paragraph 18 is also added to subsection (1) of Section 3221 of
such law and a new Subsection (hh) is likewise added to section 4303
to impose such a prohibition on all policies of health insurance in
the state including those issued by health services or medical
expense indemnity corporations issuing group contracts.

JUSTIFICATION:
This legislation will provide freedom of choice to consumers who have
coverage for prescribed drugs as part of their health insurance. When
a policy mandates purchase from a specific mail order pharmacy the
consumer is forced to purchase an interim supply of the prescribed
drug from his or her neighborhood pharmacist who is familiar with his
or her medical history. The risk to the consumer in this situation is
obvious.
This bill also offers cost protections for consumers and insurance
carriers by ensuring that the protections offered in this bill are
only applied when a non-mail order pharmacy offers a comparable price.

Furthermore, the neighborhood pharmacy in these situations is forced
to bear the burden of educating the patient as to the use and
potential effects of the prescribed drug. The inability of the
consumer to purchase the full prescription from the neighborhood
pharmacy imposes this burden inequitably, thereby providing the mail
order house with an economic advantage that the local provider cannot
overcome.

Finally, many consumers, especially senior citizens, rely on their
local pharmacist for the service that they provide with respect to
monitoring
the regimen of drugs that they take. A mandate of purchase by mail
denies them of this important service and confidence.

PRIOR LEGISLATIVE HISTORY:


S.6007 (2009-2010), Referred to Insurance
A.2808/S.8775 (2007-2008)
A.6934 (2005-2006)

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect on the thirtieth day after it shall have
become law and shall apply to all policies and contracts issued,
renewed, modified, altered or amended on or after such effective date.

2011-S3510B (ACTIVE) - Bill Text download pdf

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

                                 3510--B

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                            February 24, 2011
                               ___________

Introduced  by  Sens.  MAZIARZ, BRESLIN, ADDABBO, AVELLA, BALL, BONACIC,
  DUANE, GALLIVAN, GOLDEN,  GRIFFO,  HANNON,  HUNTLEY,  JOHNSON,  KLEIN,
  KRUEGER,  KRUGER, LANZA, LARKIN, LAVALLE, LIBOUS, MARCELLINO, MARTINS,
  MONTGOMERY,  OPPENHEIMER,  PERALTA,  PERKINS,  RANZENHOFER,  STAVISKY,
  ZELDIN  --  read  twice  and  ordered  printed, and when printed to be
  committed to the Committee on Insurance -- committee discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee --  committee  discharged,  bill  amended,  ordered  reprinted  as
  amended and recommitted to said committee

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 28 to read as follows:
  (28) ANY POLICY WHICH PROVIDES COVERAGE FOR PRESCRIPTION  DRUGS  SHALL
PERMIT  EACH PARTICIPANT TO FILL ANY MAIL ORDER COVERED PRESCRIPTION, AT
HIS OR HER OPTION, AT ANY MAIL ORDER PHARMACY OR  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. ANY POLICY WHICH PROVIDES COVERAGE FOR
PRESCRIPTION DRUGS 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  MAIL  ORDER  PHARMACY;
PROVIDED,  HOWEVER, THAT THE PROVISIONS OF THIS SECTION SHALL NOT SUPER-
SEDE 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 2. Subsection (1) of section 3221 of the insurance law is amended by
adding a new paragraph 18 to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09145-07-1

S. 3510--B                          2

  (18)  ANY  INSURER  DELIVERING  A GROUP OR BLANKET POLICY OR ISSUING A
GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE WHICH PROVIDES COVER-
AGE FOR PRESCRIPTION DRUGS SHALL PERMIT EACH  PARTICIPANT  TO  FILL  ANY
MAIL ORDER COVERED PRESCRIPTION, AT HIS OR HER OPTION, AT ANY MAIL ORDER
PHARMACY  OR 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. ANY POLICY
WHICH PROVIDES COVERAGE  FOR  PRESCRIPTION  DRUGS  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 DESIG-
NATED  MAIL  ORDER  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 RECOGNIZED  OR  CERTIFIED
EMPLOYEE ORGANIZATION.
  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (hh) to read as follows:
  (HH) ANY POLICY ISSUED BY A MEDICAL EXPENSE INDEMNITY  CORPORATION,  A
HOSPITAL  SERVICE  CORPORATION  OR  A  HEALTH SERVICES CORPORATION WHICH
PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL PERMIT  EACH  PARTICIPANT
TO  FILL  ANY  MAIL ORDER COVERED PRESCRIPTION, AT HIS OR HER OPTION, AT
ANY MAIL ORDER PHARMACY OR 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.  ANY  POLICY  WHICH  PROVIDES  COVERAGE FOR PRESCRIPTION DRUGS
SHALL NOT IMPOSE A COPAYMENT 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 MAIL ORDER 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.
  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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