Assembly Bill A7707A

2015-2016 Legislative Session

Relates to prescription drug formulary changes during a contract year

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Sponsored By

Archive: Last Bill Status - In Senate Committee Rules Committee


  • 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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Bill Amendments

co-Sponsors

2015-A7707 - Details

See Senate Version of this Bill:
S5382
Current Committee:
Senate Rules
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: A2317, S5022
2019-2020: A2969, S2849

2015-A7707 - Summary

Relates to prescription drug formulary changes during a contract year.

2015-A7707 - Bill Text download pdf

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

                                  7707

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                              May 26, 2015
                               ___________

Introduced  by  M. of A. PEOPLES-STOKES -- read once and referred to the
  Committee on Insurance

AN ACT to amend the insurance law,  in  relation  to  prescription  drug
  formulary changes during a contract year

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. The insurance law is amended by adding a new  section  4909
to read as follows:
  S  4909.  PRESCRIPTION  DRUG FORMULARY CHANGES. (A) A HEALTH CARE PLAN
REQUIRED TO PROVIDE ESSENTIAL  HEALTH  BENEFITS  SHALL  NOT,  EXCEPT  AS
OTHERWISE   PROVIDED  IN  SUBSECTION  (B)  OF  THIS  SECTION,  REMOVE  A
PRESCRIPTION DRUG FROM A FORMULARY:
  (I) IF THE FORMULARY INCLUDES TWO OR MORE TIERS OF BENEFITS  PROVIDING
FOR  DIFFERENT  DEDUCTIBLES, COPAYMENTS OR COINSURANCE APPLICABLE TO THE
PRESCRIPTION DRUGS IN EACH TIER, MOVE A DRUG TO A  TIER  WITH  A  LARGER
DEDUCTIBLE, COPAYMENT OR COINSURANCE, OR;
  (II)  ADD  UTILIZATION  MANAGEMENT  RESTRICTIONS  TO A FORMULARY DRUG,
UNLESS SUCH CHANGES OCCUR AT THE  TIME  OF  ENROLLMENT  OR  ISSUANCE  OF
COVERAGE.    SUCH PROHIBITION SHALL APPLY BEGINNING ON THE DATE ON WHICH
OPEN ENROLLMENT BEGINS FOR A PLAN YEAR AND THROUGH THE END OF  THE  PLAN
YEAR TO WHICH SUCH OPEN ENROLLMENT PERIOD APPLIES.
  (B)  A  HEALTH  CARE  PLAN  WITH A FORMULARY THAT INCLUDES TWO OR MORE
TIERS OF BENEFITS PROVIDING FOR  DIFFERENT  DEDUCTIBLES,  COPAYMENTS  OR
COINSURANCE  APPLICABLE  TO  PRESCRIPTION  DRUGS IN EACH TIER MAY MOVE A
PRESCRIPTION DRUG TO A TIER WITH A LARGER DEDUCIBLE, COPAYMENT OR  COIN-
SURANCE  IF AN AB-RATED GENERIC DRUG FOR SUCH PRESCRIPTION DRUG IS ADDED
TO THE FORMULARY AT THE SAME TIME.
  S 2. This act shall take effect on the sixtieth  day  after  it  shall
become  a  law; provided, however, that effective immediately, the addi-
tion, amendment and/or repeal of any rule or  regulation  necessary  for
the implementation of this act on its effective date is authorized to be
made  and  completed  by  the superintendent of financial services on or
before such date.

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

co-Sponsors

2015-A7707A (ACTIVE) - Details

See Senate Version of this Bill:
S5382
Current Committee:
Senate Rules
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: A2317, S5022
2019-2020: A2969, S2849

2015-A7707A (ACTIVE) - Summary

Relates to prescription drug formulary changes during a contract year.

2015-A7707A (ACTIVE) - Bill Text download pdf

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

                                 7707--A
                                                        Cal. No. 606

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                              May 26, 2015
                               ___________

Introduced  by M. of A. PEOPLES-STOKES, HARRIS -- read once and referred
  to the Committee on Insurance -- ordered to a third reading -- commit-
  ted to the Committee on Insurance in accordance with Assembly Rule  3,
  sec.  2  --  reported  from  committee,  advanced  to a third reading,
  amended and ordered reprinted, retaining its place  on  the  order  of
  third reading

AN  ACT  to  amend  the  insurance law, in relation to prescription drug
  formulary changes during a contract year

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  The insurance law is amended by adding a new section 4909
to read as follows:
  S 4909. PRESCRIPTION DRUG FORMULARY CHANGES. (A) A  HEALTH  CARE  PLAN
REQUIRED  TO  PROVIDE  ESSENTIAL  HEALTH  BENEFITS  SHALL NOT, EXCEPT AS
OTHERWISE  PROVIDED  IN  SUBSECTION  (B)  OF  THIS  SECTION,  REMOVE   A
PRESCRIPTION DRUG FROM A FORMULARY:
  (I)  IF THE FORMULARY INCLUDES TWO OR MORE TIERS OF BENEFITS PROVIDING
FOR DIFFERENT DEDUCTIBLES, COPAYMENTS OR COINSURANCE APPLICABLE  TO  THE
PRESCRIPTION  DRUGS  IN  EACH  TIER, MOVE A DRUG TO A TIER WITH A LARGER
DEDUCTIBLE, COPAYMENT OR COINSURANCE, OR
  (II) ADD UTILIZATION MANAGEMENT  RESTRICTIONS  TO  A  FORMULARY  DRUG,
UNLESS  SUCH  CHANGES  OCCUR  AT  THE  TIME OF ENROLLMENT OR ISSUANCE OF
COVERAGE.  SUCH PROHIBITION SHALL APPLY BEGINNING ON THE DATE  ON  WHICH
OPEN  ENROLLMENT  BEGINS FOR A PLAN YEAR AND THROUGH THE END OF THE PLAN
YEAR TO WHICH SUCH OPEN ENROLLMENT PERIOD APPLIES.
  (B) (I) A HEALTH CARE PLAN WITH A FORMULARY THAT INCLUDES TWO OR  MORE
TIERS  OF  BENEFITS  PROVIDING  FOR DIFFERENT DEDUCTIBLES, COPAYMENTS OR
COINSURANCE APPLICABLE TO PRESCRIPTION DRUGS IN EACH  TIER  MAY  MOVE  A
PRESCRIPTION  DRUG TO A TIER WITH A LARGER DEDUCIBLE, COPAYMENT OR COIN-
SURANCE IF AN AB-RATED GENERIC DRUG FOR SUCH PRESCRIPTION DRUG IS  ADDED
TO THE FORMULARY AT THE SAME TIME.

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

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