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

                                  6126

                            I N  S E N A T E

                               (PREFILED)

                             January 4, 2012
                               ___________

Introduced  by  Sen.  SKELOS -- 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 13-a of subsection (i) of  section  3216  of  the
insurance  law,  as added by Chapter 598 of the laws of 2011, is amended
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  NETWORK  PARTICIPATING  mail order OR OTHER NON-RETAIL pharmacy shall
provide the same coverage for prescription  fertility  drugs  when  such
drugs  are  purchased from a NETWORK PARTICIPATING NON-MAIL ORDER RETAIL
pharmacy [that is not a 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 ESTAB-
LISHED  FOR A NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHAR-
MACY.  [Such] IN SUCH CASE, THE policy shall not impose any [additional]
fee, co-payment, co-insurance, deductible  or  other  condition  on  any
insured  who  [does not elect] ELECTS to purchase prescription fertility
drugs through a [mail order] NETWORK PARTICIPATING NON-MAIL ORDER RETAIL
pharmacy  THAT  IT  DOES  NOT  IMPOSE  ON  ANY  INSURED  WHO   PURCHASES
PRESCRIPTION  FERTILITY DRUGS THROUGH A NETWORK PARTICIPATING MAIL ORDER
OR OTHER NON-RETAIL PHARMACY.
  S 2. Subparagraph (D) of paragraph 6 of subsection (k) of section 3221
of the insurance law, as added by Chapter 598 of the laws  of  2011,  is
amended 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 NETWORK PARTICIPATING mail order OR OTHER  NON-RETAIL  pharmacy  shall
provide  the  same  coverage  for prescription fertility drugs when such

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                      [ ] is old law to be omitted.
                                                           LBD10740-06-2

S. 6126                             2

drugs are purchased from a NETWORK PARTICIPATING NON-MAIL  ORDER  RETAIL
pharmacy  [that  is not a 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 ESTAB-
LISHED  FOR A NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHAR-
MACY.  [Such] IN SUCH CASE, THE policy shall not impose any [additional]
fee, co-payment, co-insurance, deductible  or  other  condition  on  any
covered  person  who  [does  not  elect] ELECTS to purchase prescription
fertility drugs through a [mail order]  NETWORK  PARTICIPATING  NON-MAIL
ORDER  RETAIL pharmacy THAT IT DOES NOT IMPOSE ON ANY COVERED PERSON WHO
PURCHASES PRESCRIPTION FERTILITY DRUGS THROUGH A  NETWORK  PARTICIPATING
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 RECOGNIZED OR
CERTIFIED EMPLOYEE ORGANIZATION.
  S 3. Paragraph 4 of subsection (s) of section 4303  of  the  insurance
law,  as added by Chapter 598 of the laws of 2011, is amended to read as
follows:
  (4) Every [policy] CONTRACT issued  by  a  medical  expense  indemnity
corporation,  a hospital service corporation or a health services corpo-
ration that provides  coverage  for  prescription  fertility  drugs  and
requires or permits prescription drugs to be purchased through a NETWORK
PARTICIPATING  mail order OR OTHER NON-RETAIL pharmacy shall provide the
same coverage for prescription  fertility  drugs  when  such  drugs  are
purchased  from  a  NETWORK PARTICIPATING NON-MAIL ORDER RETAIL pharmacy
[that is not a mail order pharmacy] PROVIDED THAT  THE  NETWORK  PARTIC-
IPATING  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.  [Such policy] IN SUCH CASE, THE CONTRACT shall not impose any
[additional]  fee,  co-payment, co-insurance, deductible or other condi-
tion on any covered person who does not elect to  purchase  prescription
fertility  drugs  through  a  NETWORK  PARTICIPATING mail order OR OTHER
NON-RETAIL pharmacy; PROVIDED, HOWEVER,  THAT  THE  PROVISIONS  OF  THIS
SECTION  SHALL NOT SUPERSEDE THE TERMS OF A COLLECTIVE BARGAINING AGREE-
MENT OR APPLY TO A CONTRACT THAT IS THE RESULT OF A COLLECTIVE  BARGAIN-
ING AGREEMENT BETWEEN AN EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE
ORGANIZATION.
  S  4.  This  act  shall  take  effect on the same date and in the same
manner as section 5 of chapter 598 of the laws of 2011, takes effect.