Assembly Bill A7707A

                            
                    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.
              

                                                           LBD11110-02-6

A. 7707--A                          2

  (II)  A  HEALTH CARE PLAN MAY REMOVE A PRESCRIPTION DRUG FROM A FORMU-
LARY IF THE FEDERAL FOOD AND DRUG ADMINISTRATION  DETERMINES  THAT  SUCH
DRUG SHOULD BE REMOVED FROM THE MARKET.
  S  2.  This  act  shall take effect on the sixtieth day after it shall
have become a law; provided, however, that  effective  immediately,  the
addition,  amendment  and/or  repeal of any rule or regulation necessary
for the implementation of this act on its effective date are  authorized
to  be made and completed by the superintendent of financial services on
or before such date.