senate Bill S670

2013-2014 Legislative Session

Relates to coverage for single source drugs

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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
Jan 09, 2013 referred to insurance

Co-Sponsors

S670 - Bill Details

See Assembly Version of this Bill:
A6130
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Previous Legislative Sessions:
2011-2012: S7180, A4724
2009-2010: A4131

S670 - Bill Texts

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Provides that every insurance policy which provides coverage for prescription drugs shall insure that there is continuous coverage of a single source drug that is part of a prescribed therapy until such prescribed therapy is no longer medically necessary for the enrollee of such policy; defines "single source drug".

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BILL NUMBER:S670

TITLE OF BILL:

An act
to amend the insurance law, in relation to coverage for
single source drugs

PURPOSE OR GENERAL IDEA OF THE BILL:

The purpose of this legislation is to require continued coverage of a
prescription drug if a patient was on such drug prior to a policy
change.

SUMMARY OF PROVISIONS:

Section 1 of the bill amends the adds a new paragraph 30 to subsection
(i) of §3216 of the insurance law to require continued coverage of a
prescription drug if such drug was previously covered under an
individual's insurance plan and no generic equivalent is available.

Section 2 of the bill adds a new paragraph 19 to subsection (k) of
§3221 of the insurance law requiring each group policy to continue
coverage of a prescription drug during a grievance or an appeal when
a policy removes a prescription from the formulary while patient was
taking such drug as part of a prescribed therapy.

Section 3 of the bill adds a new subsection jj to §4303 of the
insurance law requiring contracts issued by a health service
corporation or a medical expense indemnity corporation to continue
coverage of a prescription drug during a grievance or an appeal when
a policy removes a prescription from the formulary while the patient
was taking such drug as part of a prescribed therapy.

Section 4 sets forth an effective date of the first day of the
calendar month next succeeding the sixtieth day after it shall have
become a law but shall apply only to policies and contracts issued,
renewed or amended on or after the effective date of this act.

JUSTIFICATION:

This legislation was modeled after a 1998 law in California. This bill
would require an insurance plan to continue their coverage of
prescription medication for patients currently taking the medication
when no generic equivalent is available.

When a patient is on a prescribed therapy it is very important for the
patient to maintain that therapy to the end. When a drug is dropped
from a plan, the consequences can be dire and/or costly for the
patients that are in various stages of therapy with that drug. If the
patient were to maintain the prescribed therapy, the out of pocket
cost to the patient could be so exorbitant that the patient would
eventually stop taking the prescription prior to the completion of
the therapy.


In another circumstance, the patient may be forced to change to a
similar brand name drug - that is covered under the plan- in the
midst of the prescribed therapy. That new drug may not be as suitable
or may cause adverse reactions. The new drug may not react well with
other medication that the patient is taking. Also, the new drug may
not achieve the desired effect that the other drug accomplished.

The physician should have the final say in which prescription a
patient takes. Although one drug may seem to have the same effect as
another, it may not be as compatible with other medications a patient
is taking or, one drug may be more effective under certain conditions.
In any event, health care cannot be directed by the bottom dollar in
every instance. When a patient's well being is affected, policy must
be changed for the betterment of the patient.

LEGISLATIVE HISTORY:

2011-12, S.7180/A.3718 (Rivera) (Enacting Clause Stricken)
2009-10, S.5510 (Klein)/A.4191 (Rivera)
2007-08, A.6739 (Rivera)
2005-06, S.4084 (Alesi)/A.3035 (Rivera)
2003-04, S.4904-A (Alesi)/A.6012-A (Rivera)
2001-02, S.6588-B (Alesi)/A.1912-C (Rivera)
1999-00, A.9448 (Colman)

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:

This act shall take effect on the first day of the calendar month next
succeeding the sixtieth day after it shall have become a law but
shall apply only to policies and contracts issued, renewed or amended
on or after the effective date of this act.

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

                                   670

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sen.  AVELLA -- 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  coverage  for  single
  source 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 30 to read as follows:
  (30) EVERY INDIVIDUAL OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIV-
ERY  IN THIS STATE PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH THE
USE OF A DRUG FORMULARY SHALL INCLUDE A PROVISION WHICH, IN THE EVENT OF
A CHANGE TO SUCH FORMULARY, ALLOWS A COVERED  PERSON  WHO  IS  TAKING  A
SINGLE  SOURCE DRUG COVERED UNDER SUCH POLICY THAT IS NO LONGER INCLUDED
IN OR PREFERRED UNDER SUCH FORMULARY AND HAS FILED  A  GRIEVANCE  OR  AN
APPEAL  OF  THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER OR A STATE
OR FEDERAL AGENCY OR DESIGNEE OF  SUCH  AGENCY,  TO  CONTINUE  RECEIVING
COVERAGE  FOR  SUCH  DRUG  UNDER  THE SAME TERMS AND CONDITIONS AS WOULD
APPLY UNDER THE POLICY WERE SUCH DRUG STILL  INCLUDED  IN  OR  PREFERRED
UNDER THE FORMULARY, UNTIL A FINAL DECISION IS RENDERED ON THE APPEAL OR
GRIEVANCE. FOR THE PURPOSE OF THIS PARAGRAPH, "SINGLE SOURCE DRUG" MEANS
A BRANDNAME DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
  S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 19 to read as follows:
  (19) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN
THIS  STATE PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH THE USE OF
A DRUG FORMULARY SHALL INCLUDE A PROVISION WHICH,  IN  THE  EVENT  OF  A
CHANGE TO SUCH FORMULARY, ALLOWS A COVERED PERSON WHO IS TAKING A SINGLE
SOURCE  DRUG  COVERED UNDER SUCH POLICY THAT IS NO LONGER INCLUDED IN OR
PREFERRED UNDER SUCH FORMULARY AND HAS FILED A GRIEVANCE OR AN APPEAL OF
THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER OR A STATE OR  FEDERAL

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03404-01-3

S. 670                              2

AGENCY  OR  DESIGNEE  OF SUCH AGENCY, TO CONTINUE RECEIVING COVERAGE FOR
SUCH DRUG UNDER THE SAME TERMS AND CONDITIONS AS WOULD APPLY  UNDER  THE
POLICY  WERE  SUCH  DRUG STILL INCLUDED IN OR PREFERRED UNDER THE FORMU-
LARY, UNTIL A FINAL DECISION IS RENDERED ON THE APPEAL OR GRIEVANCE. FOR
THE  PURPOSE  OF  THIS PARAGRAPH, "SINGLE SOURCE DRUG" MEANS A BRANDNAME
DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
  S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (jj) to read as follows:
  (JJ)  EVERY  CONTRACT  DELIVERED  OR ISSUED FOR DELIVERY IN THIS STATE
PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH  THE  USE  OF  A  DRUG
FORMULARY  SHALL  INCLUDE A PROVISION WHICH, IN THE EVENT OF A CHANGE TO
SUCH FORMULARY, ALLOWS A COVERED PERSON WHO IS TAKING  A  SINGLE  SOURCE
DRUG  COVERED  UNDER  SUCH  CONTRACT  THAT  IS  NO LONGER INCLUDED IN OR
PREFERRED UNDER SUCH FORMULARY AND HAS FILED A GRIEVANCE OR AN APPEAL OF
THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER CORPORATION OR  ORGAN-
IZATION  CERTIFIED  PURSUANT  TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
LAW OR A STATE OR FEDERAL AGENCY OR DESIGNEE OF SUCH AGENCY, TO CONTINUE
RECEIVING COVERAGE FOR SUCH DRUG UNDER THE SAME TERMS AND CONDITIONS  AS
WOULD  APPLY  UNDER  THE  CONTRACT  WERE  SUCH DRUG STILL INCLUDED IN OR
PREFERRED UNDER THE FORMULARY, UNTIL A FINAL DECISION IS RENDERED ON THE
APPEAL OR GRIEVANCE. FOR THE PURPOSE OF THIS SUBSECTION, "SINGLE  SOURCE
DRUG" MEANS A BRANDNAME DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
  S  4.  This  act  shall take effect on the first of the calendar month
next succeeding the sixtieth day after  it  shall  have  become  a  law;
provided,  however,  that  this  act  shall  apply  only to policies and
contracts issued, renewed or amended on or after such effective date.

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