senate Bill S5851

2013-2014 Legislative Session

Relates to the purchase of fertility drugs through mail order pharmacies

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Archive: Last Bill Status - In Committee


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

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 08, 2014 referred to insurance
Jun 18, 2013 referred to rules

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S5851 - Bill Details

See Assembly Version of this Bill:
A8099
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221 & 4303, Ins L

S5851 - Bill Texts

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Relates to the purchase of fertility drugs through mail order pharmacies.

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BILL NUMBER:S5851

TITLE OF BILL: An act to amend the insurance law, in relation to the
purchase of fertility drugs through mail order pharmacies

PURPOSE: To clarify the terms and conditions expected of non-mail order
retail pharmacies in relation to reimbursement for fertility drugs.

SUMMARY OF PROVISIONS:

Section one amends section 3216 of the Insurance Law providing that the
terms and conditions of an agreement between an insurer and a non-mail
order retail pharmacy shall not be inconsistent with the terms and
conditions of agreements with network participating mail order pharma-
cies in 2009. The provisions include exceptions for new products enter-
ing the market place; updated manufacturer guidelines; or as required by
state and federal law.

Section two amends section 3221 of the Insurance Law providing that the
terms and conditions of an agreement between an insurer and a non-mail
order retail pharmacy shall not be inconsistent with the terms and
conditions of agreements with network participating mail order pharma-
cies in 2009. The provisions include exceptions for new products enter-
ing the market place; updated manufacturer guidelines; or as required by
state and federal law.

Section three amends 4303 of the Insurance Law providing that the terms
and conditions of an agreement between an insurer and a non-mail order
retail pharmacy shall not be inconsistent with the terms and conditions
of agreements with network participating mail order pharmacies in 2009.
The provisions include exceptions for new products entering the market
place; updated manufacturer guidelines; or as required by state and
federal law.

Section four, effective date.

EXISTING LAW:

Sections 3216, 3221 and 4303 of the insurance law currently requires
insurance plans to reimburse local pharmacies for the provision of
fertility drugs in the same manner they do mail order pharmacies,
provided the local pharmacy agrees in advance to the same reimbursement
amount and the same terms and conditions the insurer has established for
a network participating mail order pharmacy.

JUSTIFICATION: This bill amends provisions enacted in 2011, that
require insurance plans to reimburse local pharmacies for the provision
of fertility drugs in the same manner they do mail order pharmacies, to
clarify that the terms and conditions that must be met by the non-mail
order retail pharmacy are the terms and conditions that were in place
prior to the enactment of Chapter 598.

LEGISLATIVE HISTORY: New Bill

FISCAL IMPLICATIONS: New Bill

LOCAL FISCAL IMPLICATIONS: None

EFFECTIVE DATE: Immediately

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

                                  5851

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              June 18, 2013
                               ___________

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
  fertility drugs through mail order pharmacies

  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 amended by chapter 10 of the laws of 2012, 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 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 a network  participat-
ing  mail  order  or other non-retail pharmacy.  PROVIDED, HOWEVER, THAT
THE TERMS AND CONDITIONS OF SUCH AGREEMENT  SHALL  NOT  BE  INCONSISTENT
WITH  THE  TERMS  AND  CONDITIONS OF AGREEMENTS MADE BY THE INSURER WITH
NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY  PROVIDERS
FOR  THE  FIVE YEAR PERIOD PRIOR TO THE EFFECTIVE DATE OF THE CHAPTER OF
THE LAWS OF TWO THOUSAND THIRTEEN WHICH  AMENDED  THIS  PARAGRAPH.  THIS
PARAGRAPH SHALL NOT BE CONSTRUED AS PROHIBITING THE UPDATING OF POLICIES
AND  PROCEDURES  (A)  AS THEY RELATE TO NEW PRODUCTS ENTERING THE MARKET
THAT ARE DISTRIBUTED BY THE MAIL ORDER, OTHER NON-RETAIL,  AND  NON-MAIL
ORDER  RETAIL  PHARMACIES,  (B)  AS  NECESSARY  TO  COMPLY  WITH UPDATED
MANUFACTURER GUIDELINES,  OR  UPDATED  MEDICAL  GUIDELINES,  OR  (C)  AS
REQUIRED  BY  STATE  OR  FEDERAL LAW. In such case, the policy shall not
impose any fee, co-payment, co-insurance, deductible or other  condition

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11574-02-3

S. 5851                             2

on  any  insured  who  elects  to  purchase prescription fertility drugs
through a 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 amended by chapter 10 of the laws of  2012,  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
drugs are purchased from a network participating non-mail  order  retail
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 a network participat-
ing mail order or other non-retail pharmacy.   PROVIDED,  HOWEVER,  THAT
THE  TERMS  AND  CONDITIONS  OF SUCH AGREEMENT SHALL NOT BE INCONSISTENT
WITH THE TERMS AND CONDITIONS OF AGREEMENTS MADE  BY  THE  INSURER  WITH
NETWORK  PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY PROVIDERS
FOR THE FIVE YEAR PERIOD PRIOR TO THE EFFECTIVE DATE OF THE  CHAPTER  OF
THE  LAWS OF TWO THOUSAND THIRTEEN WHICH AMENDED THIS SUBPARAGRAPH. THIS
PARAGRAPH SHALL NOT BE CONSTRUED AS PROHIBITING THE UPDATING OF POLICIES
AND PROCEDURES (I) AS THEY RELATE TO NEW PRODUCTS  ENTERING  THE  MARKET
THAT  ARE  DISTRIBUTED BY THE MAIL ORDER, OTHER NON-RETAIL, AND NON-MAIL
ORDER RETAIL PHARMACIES,  (II)  AS  NECESSARY  TO  COMPLY  WITH  UPDATED
MANUFACTURER  GUIDELINES,  OR  UPDATED  MEDICAL  GUIDELINES, OR (III) AS
REQUIRED BY STATE OR FEDERAL LAW. In such case,  the  policy  shall  not
impose  any fee, co-payment, co-insurance, deductible or other condition
on any covered person who  elects  to  purchase  prescription  fertility
drugs  through  a  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  agree-
ment  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 amended by chapter 10 of the laws of 2012, is amended to read as
follows:
  (4) Every contract issued by a medical expense indemnity  corporation,
a  hospital  service  corporation  or a health services corporation that
provides coverage for  prescription  fertility  drugs  and  requires  or
permits prescription drugs to be purchased through a network participat-
ing  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 provided
that the network participating non-mail order retail pharmacy agrees  in
advance, through a contractual network agreement, to the same reimburse-
ment 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.   PROVIDED, HOWEVER, THAT THE TERMS AND
CONDITIONS OF SUCH AGREEMENT SHALL NOT BE INCONSISTENT  WITH  THE  TERMS
AND  CONDITIONS  OF  AGREEMENTS MADE BY THE INSURER WITH NETWORK PARTIC-

S. 5851                             3

IPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY PROVIDERS FOR  THE  FIVE
YEAR  PERIOD  PRIOR  TO THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF
TWO THOUSAND THIRTEEN WHICH AMENDED THIS PARAGRAPH. THIS PARAGRAPH SHALL
NOT  BE CONSTRUED AS PROHIBITING THE UPDATING OF POLICIES AND PROCEDURES
(A) AS THEY RELATE TO NEW PRODUCTS ENTERING THE MARKET THAT ARE DISTRIB-
UTED BY THE MAIL ORDER, OTHER  NON-RETAIL,  AND  NON-MAIL  ORDER  RETAIL
PHARMACIES,  (B) AS NECESSARY TO COMPLY WITH UPDATED MANUFACTURER GUIDE-
LINES, OR UPDATED MEDICAL GUIDELINES, OR (C) AS  REQUIRED  BY  STATE  OR
FEDERAL  LAW.  In  such  case,  the  contract  shall not impose any fee,
co-payment, co-insurance, deductible or other condition 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  super-
sede  the  terms  of  a  collective  bargaining  agreement or apply to a
contract that is the result of a collective bargaining agreement between
an employer and a recognized or certified employee organization.
  S 4. This act shall take effect immediately.

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