Assembly Bill A2317C

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2317
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 17, 2017
                                ___________
 
 Introduced  by M. of A. PEOPLES-STOKES, HARRIS -- read once and referred
   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:
   §  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.
   (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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05529-01-7
              

 A. 2317                             2
 
   § 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.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  2317--A
                                                         Cal. No. 390
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 17, 2017
                                ___________
 
 Introduced  by  M. of A. PEOPLES-STOKES, HARRIS, SKOUFIS, BARRETT, NIOU,
   ORTIZ -- Multi-Sponsored by -- M. of A. ENGLEBRIGHT -- read  once  and
   referred  to  the  Committee  on Insurance -- 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 and the public health 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:
   §  4909.  PRESCRIPTION DRUG FORMULARY CHANGES. (A) EXCEPT AS OTHERWISE
 PROVIDED IN SUBSECTION (C) OF THIS SECTION, A  HEALTH  CARE  PLAN  SHALL
 NOT:
   (I)  REMOVE  A  PRESCRIPTION  DRUG  FROM  A FORMULARY IF THE FORMULARY
 INCLUDES TWO OR MORE TIERS OF BENEFITS PROVIDING FOR  DIFFERENT  DEDUCT-
 IBLES, 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.
   (B) PROHIBITIONS PROVIDED IN SUBSECTION  (A)  OF  THIS  SECTION  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.
   (C)  (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-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD05529-04-7

 A. 2317--A                          2
 
 SURANCE  IF AN AB-RATED GENERIC DRUG FOR SUCH PRESCRIPTION DRUG IS ADDED
 TO THE FORMULARY AT THE SAME TIME.
   (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,  INCLUDING NEW UTILIZATION
 MANAGEMENT RESTRICTIONS ISSUED PURSUANT TO FEDERAL FOOD AND DRUG  ADMIN-
 ISTRATION SAFETY CONCERNS.
   §  2. The public health law is amended by adding a new section 4909 to
 read as follows:
   § 4909. PRESCRIPTION DRUG FORMULARY CHANGES. 1.  EXCEPT  AS  OTHERWISE
 PROVIDED  IN SUBDIVISION THREE OF THIS SECTION, A HEALTH CARE PLAN SHALL
 NOT:
   (A) REMOVE A PRESCRIPTION DRUG  FROM  A  FORMULARY  IF  THE  FORMULARY
 INCLUDES  TWO  OR MORE TIERS OF BENEFITS PROVIDING FOR DIFFERENT DEDUCT-
 IBLES, 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
   (B)  ADD  UTILIZATION  MANAGEMENT  RESTRICTIONS  TO  A FORMULARY DRUG,
 UNLESS SUCH CHANGES OCCUR AT THE  TIME  OF  ENROLLMENT  OR  ISSUANCE  OF
 COVERAGE.
   2. PROHIBITION PROVIDED IN SUBDIVISION ONE OF THIS SECTION 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 PERI-
 OD APPLIES.
   3. (A) 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 DEDUCTIBLE, COPAYMENT OR COIN-
 SURANCE  IF AN AB-RATED GENERIC DRUG FOR SUCH PRESCRIPTION DRUG IS ADDED
 TO THE FORMULARY AT THE SAME TIME.
   (B) A HEALTH CARE PLAN MAY REMOVE A PRESCRIPTION DRUG FROM A FORMULARY
 IF THE FEDERAL FOOD AND DRUG ADMINISTRATION DETERMINES  THAT  SUCH  DRUG
 SHOULD  BE REMOVED FROM THE MARKET, INCLUDING NEW UTILIZATION MANAGEMENT
 RESTRICTIONS ISSUED PURSUANT TO FEDERAL  FOOD  AND  DRUG  ADMINISTRATION
 SAFETY CONCERNS.
   §  3.  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.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  2317--B
                                                         Cal. No. 171
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 17, 2017
                                ___________
 
 Introduced  by  M. of A. PEOPLES-STOKES, HARRIS, SKOUFIS, BARRETT, NIOU,
   ORTIZ, SEPULVEDA, GALEF, ABINANTI, LAVINE -- Multi-Sponsored by --  M.
   of  A.  ENGLEBRIGHT, HEVESI -- read once and referred to the Committee
   on Insurance -- reported from committee, advanced to a third  reading,
   amended  and  ordered  reprinted,  retaining its place on the order of
   third reading -- ordered to  a  third  reading,  amended  and  ordered
   reprinted, retaining its place on the order of third reading
 
 AN ACT to amend the insurance law and the public health 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:
   §  4909.  PRESCRIPTION DRUG FORMULARY CHANGES. (A) EXCEPT AS OTHERWISE
 PROVIDED IN SUBSECTION (C) OF THIS SECTION, A  HEALTH  CARE  PLAN  SHALL
 NOT:
   (I) REMOVE A PRESCRIPTION DRUG FROM A FORMULARY;
   (II)  MOVE  A  PRESCRIPTION  DRUG  TO A TIER WITH A LARGER DEDUCTIBLE,
 COPAYMENT, OR COINSURANCE 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; OR
   (III)  ADD  UTILIZATION MANAGEMENT RESTRICTIONS TO A PRESCRIPTION DRUG
 ON A FORMULARY, UNLESS SUCH CHANGES OCCUR AT THE TIME OF  ENROLLMENT  OR
 ISSUANCE OF COVERAGE.
   (B)  PROHIBITIONS  PROVIDED  IN  SUBSECTION  (A) OF THIS SECTION 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.
   (C) (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 DEDUCTIBLE, COPAYMENT OR COIN-
 SURANCE  IF AN AB-RATED GENERIC EQUIVALENT 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.
                                                            LBD05529-08-8

 A. 2317--B                          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
 PRESCRIPTION DRUG SHOULD BE  REMOVED  FROM  THE  MARKET,  INCLUDING  NEW
 UTILIZATION  MANAGEMENT RESTRICTIONS ISSUED PURSUANT TO FEDERAL FOOD AND
 DRUG ADMINISTRATION SAFETY CONCERNS.
   (D)  A  HEALTH  CARE PLAN SHALL PROVIDE NOTICE TO POLICYHOLDERS OF THE
 INTENT TO REMOVE A PRESCRIPTION DRUG FROM A FORMULARY OR  ALTER  DEDUCT-
 IBLE,  COPAYMENT  OR COINSURANCE REQUIREMENTS IN THE UPCOMING PLAN YEAR,
 THIRTY DAYS PRIOR TO THE OPEN ENROLLMENT PERIOD FOR THE CONSECUTIVE PLAN
 YEAR. SUCH NOTICE OF IMPENDING FORMULARY AND  DEDUCTIBLE,  COPAYMENT  OR
 COINSURANCE  CHANGES SHALL ALSO BE POSTED ON THE PLAN'S ONLINE FORMULARY
 AND IN ANY PRESCRIPTION DRUG FINDER SYSTEM THAT THE PLAN PROVIDES TO THE
 PUBLIC.
   § 2. The public health law is amended by adding a new section 4909  to
 read as follows:
   §  4909.  PRESCRIPTION  DRUG FORMULARY CHANGES. 1. EXCEPT AS OTHERWISE
 PROVIDED IN SUBDIVISION THREE OF THIS SECTION, A HEALTH CARE PLAN  SHALL
 NOT:
   (A) REMOVE A PRESCRIPTION DRUG FROM A FORMULARY;
   (B)  MOVE  A  PRESCRIPTION  DRUG  TO  A TIER WITH A LARGER DEDUCTIBLE,
 COPAYMENT, OR COINSURANCE 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; OR
   (C)  ADD UTILIZATION MANAGEMENT RESTRICTIONS TO A PRESCRIPTION DRUG ON
 A FORMULARY, UNLESS SUCH CHANGES OCCUR AT  THE  TIME  OF  ENROLLMENT  OR
 ISSUANCE OF COVERAGE.
   2.  PROHIBITIONS  PROVIDED  IN  SUBDIVISION  ONE OF THIS SECTION 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.
   3. (A) 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 DEDUCTIBLE, COPAYMENT OR COIN-
 SURANCE  IF AN AB-RATED GENERIC EQUIVALENT FOR SUCH PRESCRIPTION DRUG IS
 ADDED TO THE FORMULARY AT THE SAME TIME.
   (B) A HEALTH CARE PLAN MAY REMOVE A PRESCRIPTION DRUG FROM A FORMULARY
 IF THE  FEDERAL  FOOD  AND  DRUG  ADMINISTRATION  DETERMINES  THAT  SUCH
 PRESCRIPTION  DRUG  SHOULD  BE  REMOVED  FROM  THE MARKET, INCLUDING NEW
 UTILIZATION MANAGEMENT RESTRICTIONS ISSUED PURSUANT TO FEDERAL FOOD  AND
 DRUG ADMINISTRATION SAFETY CONCERNS.
   4.  A  HEALTH  CARE  PLAN SHALL PROVIDE NOTICE TO POLICYHOLDERS OF THE
 INTENT TO REMOVE A PRESCRIPTION DRUG FROM A FORMULARY OR  ALTER  DEDUCT-
 IBLE,  COPAYMENT  OR COINSURANCE REQUIREMENTS IN THE UPCOMING PLAN YEAR,
 THIRTY DAYS PRIOR TO THE OPEN ENROLLMENT PERIOD FOR THE CONSECUTIVE PLAN
 YEAR. SUCH NOTICE OF IMPENDING FORMULARY AND  DEDUCTIBLE,  COPAYMENT  OR
 COINSURANCE  CHANGES SHALL ALSO BE POSTED ON THE PLAN'S ONLINE FORMULARY
 AND IN ANY PRESCRIPTION DRUG FINDER SYSTEM THAT THE PLAN PROVIDES TO THE
 PUBLIC.
   § 3. 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.