senate Bill S5382A

2015-2016 Legislative Session

Relates to prescription drug formulary changes during a contract year

download bill text pdf

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee


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

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Actions

view actions (4)
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

S5382 - Details

See Assembly Version of this Bill:
A7707
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: S5022, A2317
2019-2020: S2849, A2969

S5382 - Summary

Relates to prescription drug formulary changes during a contract year.

S5382 - Sponsor Memo

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

S5382A (ACTIVE) - Details

See Assembly Version of this Bill:
A7707
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: S5022, A2317
2019-2020: S2849, A2969

S5382A (ACTIVE) - Summary

Relates to prescription drug formulary changes during a contract year.

S5382A (ACTIVE) - Sponsor Memo

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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