| Date of Action |
Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|---|---|
| Jun 09, 2016 |
print number 5382a |
| Jun 09, 2016 |
amend and recommit to insurance |
| Jan 06, 2016 |
referred to insurance |
| May 14, 2015 |
referred to insurance |
Senate Bill S5382A
2015-2016 Legislative Session
Sponsored By
(R, C) 7th Senate District
Archive: Last Bill Status - In Senate Committee Insurance Committee
Actions
Bill Amendments
2015-S5382 - Details
2015-S5382 - Sponsor Memo
BILL NUMBER:S5382
TITLE OF BILL: An act to amend the insurance law, in relation to
prescription drug formulary changes during a contract year
PURPOSE: To clarify that health insurance consumers covered by plans
that are required to offer essential health benefits under the
affordable care act are protected from adverse effects of mid-year
formulary changes.
SUMMARY OF PROVISIONS: Section 1 creates a new subsection 4909-a of
the Insurance Law to state that a health care plan which provides
essential health benefits under the federal affordable care act may
not remove a prescription drug from a formulary during the enrollment
year. If the plan's drug formulary has two or more tiers of drug
benefits with different deductibles, copayments or coinsurance, the
plan may not move a drug to a tier with higher patient cost sharing
during the enrollment year. The plan may also not add new or
additional formulary restrictions during the enrollment year. A health
care plan may move a prescription drug to a tier with a larger
copayment, coinsurance and different deductible if an AB-rated generic
equivalent drug is added to the formulary at the same time.
Section 2 provides that this act would take effect on the 60th day
after enactment, provided that effective immediately the
superintendent of insurance may make regulations and take other
2015-S5382 - Bill Text download pdf
S T A T E O F N E W Y O R K
________________________________________________________________________
5382
2015-2016 Regular Sessions
I N S E N A T E
May 14, 2015
___________
Introduced by Sen. MARTINS -- 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 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
(R, C, G, IP, SC) Senate District
2015-S5382A (ACTIVE) - Details
2015-S5382A (ACTIVE) - Sponsor Memo
BILL NUMBER: S5382A
TITLE OF BILL : An act to amend the insurance law, in relation to
prescription drug formulary changes during a contract year
PURPOSE :
To clarify that health insurance consumers covered by plans that are
required to offer essential health benefits under the affordable care
act are protected from adverse effects of mid-year formulary changes.
SUMMARY OF PROVISIONS :
Section 1 creates a new subsection 4909-a of the Insurance Law to
state that a health care plan which provides essential health benefits
under the federal affordable care act may not remove a prescription
drug from a formulary during the enrollment year. If the plan's drug
formulary has two or more tiers of drug benefits with different
deductibles, copayments or coinsurance, the plan may not move a drug
to a tier with higher patient cost sharing during the enrollment year.
The plan may also not add new or additional formulary restrictions
during the enrollment year. A health care plan may move a prescription
drug to a tier with a larger copayment, coinsurance and different
deductible if an AB-rated generic equivalent drug is added to the
formulary at the same time.
2015-S5382A (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K
________________________________________________________________________
5382--A
2015-2016 Regular Sessions
I N S E N A T E
May 14, 2015
___________
Introduced by Sen. MARTINS -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance -- 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 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.
LBD11110-03-6
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