assembly Bill A10215

2017-2018 Legislative Session

Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals

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Archive: Last Bill Status - In Assembly Committee


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

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Mar 26, 2018 referred to insurance

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A10215 (ACTIVE) - Details

See Senate Version of this Bill:
S8651
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Add §§4806, 3224-d & 4303-a, amd §§4903, 4910, 4914, 3216, 3221, 4303, 4325 & 3231, Ins L; add §4406-h, amd §§4903, 4910, 4914 & 280-a, Pub Health L; amd §§367-a & 364-j, Soc Serv L; amd §§6810 & 6826-a, Ed L
Versions Introduced in 2019-2020 Legislative Session:
A4521, S6244

A10215 (ACTIVE) - Summary

Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals; to access to retail pharmacies, prescription synchronization, limits on patient drug costs, explanations of benefits and rebates; to prescription drug synchronization; to pharmacy benefit management (view more) and to limits on copayments and drug substitutions.

A10215 (ACTIVE) - Bill Text download pdf


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

                                  10215

                          I N  A S S E M B L Y

                             March 26, 2018
                               ___________

Introduced  by M. of A. SOLAGES -- read once and referred to the Commit-
  tee on Insurance

AN ACT to amend the insurance law and the public health law, in relation
  to  access  to  appropriate  drugs  at  reasonable  prices,  formulary
  exceptions,  standing  prior  authorizations  and external appeals; to
  amend the insurance law, in relation to access to  retail  pharmacies,
  prescription  synchronization,  limits on patient drug costs, explana-
  tions of benefits and rebates; to amend the social  services  law,  in
  relation  to  prescription  drug  synchronization; to amend the public
  health law, in relation to pharmacy benefit management; and  to  amend
  the  education  law,  in  relation  to  limits  on copayments and drug
  substitutions

  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 4806
to read as follows:
  § 4806. ACCESS TO APPROPRIATE DRUGS AT  REASONABLE  PRICES;  FORMULARY
EXCEPTIONS;  STANDING  PRIOR  AUTHORIZATION  REQUIREMENT. (A) AN INSURER
OFFERING A PRESCRIPTION DRUG BENEFIT WITH A  FORMULARY  OF  APPROVED  OR
PREFERRED  DRUGS  SHALL  ESTABLISH  A  PROCEDURE  BY WHICH IT DETERMINES
WHETHER A FORMULARY DRUG PROVIDES APPROPRIATE  THERAPEUTIC  BENEFITS  TO
MEET  THE  PARTICULAR  HEALTH  CARE  NEEDS OF AN INSURED. IF THE INSURER
DETERMINES THAT NO FORMULARY DRUG PROVIDES APPROPRIATE THERAPEUTIC BENE-
FITS TO MEET THE PARTICULAR HEALTH CARE NEEDS OF AN INSURED, THE INSURER
SHALL COVER THE COST OF AN OFF-FORMULARY DRUG FOR THAT  INSURED,  AT  NO
ADDITIONAL  COST  TO THE INSURED BEYOND WHAT THE INSURED WOULD OTHERWISE
PAY FOR A PREFERRED BRAND NAME DRUG ON THE FORMULARY. THE DETERMINATIONS
WHETHER A DRUG PROVIDES APPROPRIATE THERAPEUTIC BENEFITS AND  WHETHER  A
NON-FORMULARY DRUG IS NECESSARY TO MEET THE PARTICULAR HEALTH CARE NEEDS
OF  THE  INSURED  ARE UTILIZATION REVIEW DECISIONS AND ARE REVIEWABLE IN
ACCORDANCE WITH ARTICLE FORTY-NINE OF THIS CHAPTER,  INCLUDING  EXTERNAL
APPEAL.
  (B)  (1)  FOR  PURPOSES OF THIS SECTION, "PRIOR AUTHORIZATION REQUIRE-
MENT" MEANS ANY PRACTICE IMPLEMENTED BY AN INSURER IN WHICH COVERAGE  OF

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

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