senate Bill S3419C

Signed By Governor
2015-2016 Legislative Session

Relates to expedited utilization review of prescription drugs

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Sponsored By

Archive: Last Bill Status - Signed by Governor


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

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Actions

view actions (20)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Dec 31, 2016 signed chap.512
approval memo.30
Dec 20, 2016 delivered to governor
Jun 16, 2016 returned to senate
passed assembly
Jun 14, 2016 ordered to third reading rules cal.266
substituted for a2834d
referred to insurance
delivered to assembly
passed senate
ordered to third reading cal.1675
committee discharged and committed to rules
Jun 07, 2016 print number 3419c
amend (t) and recommit to insurance
Mar 16, 2016 print number 3419b
Mar 16, 2016 amend and recommit to insurance
Jan 06, 2016 referred to insurance
May 06, 2015 print number 3419a
amend (t) and recommit to insurance
Feb 09, 2015 referred to insurance

Co-Sponsors

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S3419 - Details

See Assembly Version of this Bill:
A2834D
Law Section:
Insurance Law
Laws Affected:
Amd §§3217-a, 4324, 4900, 4902 & 4903, Ins L; amd §§4408, 4900, 4902 & 4903, Pub Health L

S3419 - Summary

Relates to expedited utilization review of prescription drugs.

S3419 - Sponsor Memo

S3419 - Bill Text download pdf

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

                                  3419

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                            February 9, 2015
                               ___________

Introduced  by  Sens.  YOUNG, BRESLIN, GOLDEN, LANZA, MARCHIONE, PARKER,
  VALESKY -- 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 regulation of step
  therapy and first fail policies

  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 article 33  to
read as follows:
                               ARTICLE 33
                     REGULATION OF STEP THERAPY AND
                           FIRST FAIL POLICIES
SECTION 3301. DEFINITIONS.
        3302. PRESCRIPTION DRUG RESTRICTION OVERRIDES.
  S 3301. DEFINITIONS. AS USED IN THIS ARTICLE:
  (A)  "INSURER"  SHALL MEAN ANY PERSON OR ENTITY WHO OFFERS A POLICY OF
ACCIDENT AND/OR HEALTH INSURANCE PURSUANT TO SECTION THREE THOUSAND  TWO
HUNDRED SIXTEEN, THREE THOUSAND TWO HUNDRED TWENTY-ONE, OR FOUR THOUSAND
THREE  HUNDRED THREE OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE PUBLIC
HEALTH LAW.
  (B) "PHARMACY BENEFIT MANAGEMENT" OR  "PBM"  SHALL  MEAN  THE  SERVICE
PROVIDED  TO  AN  INSURER, DIRECTLY OR THROUGH ANOTHER ENTITY; INCLUDING
THE PROCUREMENT  OF  PRESCRIPTION  DRUGS  TO  BE  DISPENSED  TO  COVERED
PERSONS,  OR THE ADMINISTRATION OR MANAGEMENT OF PRESCRIPTION DRUG BENE-
FITS INCLUDING, BUT NOT LIMITED TO, ANY OF THE FOLLOWING:
  (1) A MAIL ORDER PHARMACY;
  (2) CLAIMS PROCESSING, RETAIL NETWORK MANAGEMENT AND PAYMENT OF CLAIMS
TO PHARMACIES FOR DISPENSING PRESCRIPTION DRUGS;
  (3) CLINICAL OR OTHER FORMULARY, OR PREFERRED DRUG LIST DEVELOPMENT OR
MANAGEMENT;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03838-01-5

Co-Sponsors

view additional co-sponsors

S3419A - Details

See Assembly Version of this Bill:
A2834D
Law Section:
Insurance Law
Laws Affected:
Amd §§3217-a, 4324, 4900, 4902 & 4903, Ins L; amd §§4408, 4900, 4902 & 4903, Pub Health L

S3419A - Summary

Relates to expedited utilization review of prescription drugs.

S3419A - Sponsor Memo

S3419A - Bill Text download pdf

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

                                 3419--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                            February 9, 2015
                               ___________

Introduced  by  Sens.  YOUNG,  AVELLA,  BRESLIN,  GOLDEN, LANZA, LARKIN,
  MARCHIONE, PARKER,  PERKINS,  SQUADRON,  VALESKY  --  read  twice  and
  ordered  printed, and when printed to be committed to the Committee on
  Insurance -- committee discharged, bill amended, ordered reprinted  as
  amended and recommitted to said committee

AN ACT to amend the insurance law, in relation to the regulation of step
  therapy policies

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

  Section 1. Legislative findings.  The  legislature  hereby  finds  and
declares that:
  (a) Health insurance plans are increasingly making use of step therapy
protocols  under  which  patients  are  required  to  try  one  or  more
prescription drugs before coverage is provided for a  drug  selected  by
the patient's health care provider.
  (b)  The  legislature  further finds that such step therapy protocols,
where they are based on well-developed scientific standards and adminis-
tered in a flexible manner that takes into account the individual  needs
of  patients,  can  play  an  important  role in controlling health care
costs.
  (c) The legislature further finds that, in  some  cases,  requiring  a
patient  to  follow  a  step  therapy protocol may have adverse and even
dangerous consequences for the patient who may  not  realize  a  benefit
from  taking a prescription drug or may suffer harm from taking an inap-
propriate drug.
  (d) The legislature further finds that, without  uniform  policies  in
the  state for step therapy protocols, patients may not receive the best
and most appropriate treatment.
  (e) The legislature further finds that  it  is  imperative  that  step
therapy protocols in the state preserve the health care provider's right
to make treatment decisions in the best interest of the patient.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03838-03-5

Co-Sponsors

view additional co-sponsors

S3419B - Details

See Assembly Version of this Bill:
A2834D
Law Section:
Insurance Law
Laws Affected:
Amd §§3217-a, 4324, 4900, 4902 & 4903, Ins L; amd §§4408, 4900, 4902 & 4903, Pub Health L

S3419B - Summary

Relates to expedited utilization review of prescription drugs.

S3419B - Sponsor Memo

S3419B - Bill Text download pdf

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

                                 3419--B

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                            February 9, 2015
                               ___________

Introduced  by  Sens.  YOUNG,  AVELLA, BRESLIN, CARLUCCI, GOLDEN, LANZA,
  LARKIN, LAVALLE, MARCHIONE, PARKER, PERKINS, RIVERA, SAVINO, SQUADRON,
  VALESKY -- read twice and ordered printed,  and  when  printed  to  be
  committed  to the Committee on Insurance -- committee discharged, bill
  amended, ordered reprinted as amended and recommitted to said  commit-
  tee  --  recommitted  to the Committee on Insurance in accordance with
  Senate Rule 6, sec. 8 -- committee discharged, bill  amended,  ordered
  reprinted as amended and recommitted to said committee

AN ACT to amend the insurance law, in relation to the regulation of step
  therapy policies

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

  Section 1. Legislative findings.  The  legislature  hereby  finds  and
declares that:
  (a) Health insurance plans are increasingly making use of step therapy
protocols  under  which  patients  are  required  to  try  one  or  more
prescription drugs before coverage is provided for a  drug  selected  by
the patient's health care provider.
  (b)  The  legislature  further finds that such step therapy protocols,
where they are based on well-developed scientific standards and adminis-
tered in a flexible manner that takes into account the individual  needs
of  patients,  can  play  an  important  role in controlling health care
costs.
  (c) The legislature further finds that, in  some  cases,  requiring  a
patient  to  follow  a  step  therapy protocol may have adverse and even
dangerous consequences for the patient who may  not  realize  a  benefit
from  taking a prescription drug or may suffer harm from taking an inap-
propriate drug.
  (d) The legislature further finds that, without  uniform  policies  in
the  state for step therapy protocols, patients may not receive the best
and most appropriate treatment.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03838-04-6

Co-Sponsors

view additional co-sponsors

S3419C (ACTIVE) - Details

See Assembly Version of this Bill:
A2834D
Law Section:
Insurance Law
Laws Affected:
Amd §§3217-a, 4324, 4900, 4902 & 4903, Ins L; amd §§4408, 4900, 4902 & 4903, Pub Health L

S3419C (ACTIVE) - Summary

Relates to expedited utilization review of prescription drugs.

S3419C (ACTIVE) - Sponsor Memo

S3419C (ACTIVE) - Bill Text download pdf

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

                                 3419--C

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                            February 9, 2015
                               ___________

Introduced  by  Sens.  YOUNG, AKSHAR, AVELLA, BRESLIN, CARLUCCI, GOLDEN,
  KAMINSKY, LANZA, LARKIN, LATIMER, LAVALLE, MARCHIONE, PARKER, PERKINS,
  RIVERA, SAVINO, SQUADRON, VALESKY -- read twice and  ordered  printed,
  and  when  printed  to  be  committed to the Committee on Insurance --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted  to  said  committee  --  recommitted  to the Committee on
  Insurance in accordance with  Senate  Rule  6,  sec.  8  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to  said  committee  --  committee  discharged,  bill amended, ordered
  reprinted as amended and recommitted to said committee

AN ACT to amend the insurance law and the public health law, in relation
  to expedited utilization review of prescription drugs

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

  Section  1.  Paragraph  10  of subsection (b) of section 3217-a of the
insurance law, as added by chapter 705 of the laws of 1996,  is  amended
to read as follows:
  (10)  upon  written  request, provide specific written clinical review
criteria relating to a particular condition or disease  INCLUDING  CLIN-
ICAL REVIEW CRITERIA RELATING TO A STEP THERAPY PROTOCOL OVERRIDE DETER-
MINATION  PURSUANT  TO SUBSECTION (C-1), SUBSECTION (C-2) AND SUBSECTION
(C-3) OF SECTION FORTY-NINE HUNDRED THREE OF THIS  CHAPTER,  and,  where
appropriate, other clinical information which the insurer might consider
in  its utilization review and the insurer may include with the informa-
tion a description of how it will be  used  in  the  utilization  review
process;  provided,  however,  that  to  the  extent such information is
proprietary to the insurer, the insured  or  prospective  insured  shall
only  use  the information for the purposes of assisting the enrollee or
prospective enrollee in evaluating the covered services provided by  the
organization. SUCH CLINICAL REVIEW CRITERIA, AND OTHER CLINICAL INFORMA-
TION  SHALL  ALSO  BE  MADE  AVAILABLE  TO A HEALTH CARE PROFESSIONAL AS

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03838-09-6

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