NY State Senate Bill 2017-S1766

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2018	referred to insurance
Jan 10, 2017	referred to insurance

co-Sponsors

2017-S1766 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2015-2016 Legislative Session:: S7591

2017-S1766 (ACTIVE) - Summary

Provides for reimbursement requirements and coverage for the purchase of prescription drugs through mail order pharmacies.

2017-S1766 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S1766

 TITLE OF BILL :  An act to amend the insurance law, in relation to
reimbursements to mail order pharmacies

 PURPOSE OR GENERAL IDEA OF BILL :

To clarify and strengthen provisions in current law to ensure that
consumers have the option to access every covered medication from a
local network participating pharmacy and are not forced to use a mail
order pharmacy.

 SUMMARY OF PROVISIONS :


Section one of this bill amends paragraphs (13-a) and (28) of
Insurance Law section 380(i) to provide new terms with corresponding
definitions and to remove certain requirements that have become
impediments to the Legislature's intent in this area. The new defined
terms are "same reimbursement amount," "mail order pharmacy," and
"standard terms and conditions."  The amendment to these paragraphs
also provides that when a prescription has been written for and may be
filled for more than a 30-day supply, the insurance policy may not
impose an additional fee, co-pay or other cost that would exceed the
amount that would be paid to a mail order pharmacy for a supply in
excess of 30 days.

Finally, the amendment provides that if a mail order shipment for
which the mail or carrier service has documentation of delivery was
not received by the insured or was damaged or spoiled in the delivery
process, the mail order pharmacy must replace the prescription without
any additional charge to the insured, provided that the insured
complies with any requirements imposed by the plan. In the case of
spoiled or damaged prescriptions, the policy may require that the
insured return such spoiled or damaged prescriptions to the mail order
pharmacy, which will bear the cost of such returns. If the insured
fails to comply with the return requirement, the policy may require
the insured to reimburse the policy for the cost of the prescription.
Prescriptions must be replaced before return of a spoiled or damaged
prescription, unless the insured was previously required to reimburse
the policy for an undelivered, damaged or spoiled prescription and in
that case, the policy may wait until it receives a copy of the police
report or the damaged or spoiled prescription before sending the
replacement to the insured.

Regarding the removal of provisions in the current law, this amendment
removes the requirements that a non-mail order retail pharmacy agree
"in advance through a contractual network agreement" to the same
"terms and conditions" as those imposed on network mail order
pharmacies and other non-retail pharmacies. These provisions are being
removed because they have served to impose extra requirements on
network community pharmacies as a precondition for providing certain
covered medications otherwise available by mail order.


Section two of this bill amends Insurance Law section 3221(k)(6)(D) in
the same manner as the amendments provided in section one of this
bill.


Section three of this bill amends Insurance Law section 3221(1)(18) in
the same manner as the amendments provided in section one of this
bill.



Section four of this bill amends Insurance Law section 4303(s)(4) in
the same manner as the amendments provided in section one of this
bill.


Section five of this bill amends Insurance Law section 4303(kk) in the
same manner as the amendments provided in section one of this bill.


Section six of this bill provides severability language.


Section seven of this bill provides this act shall take effect
immediately.

 EXISTING LAW AND JUSTIFICATION :

In January 2012, the current provisions of Insurance Law took effect
guaranteeing that consumers would always have the choice of obtaining
covered prescription drugs from a local network participating
pharmacy.

Over the course of the years since then, it became clear that the law
was not working as intended. Consumers received letters from pharmacy
benefit managers directing them to out-of-state "specialty"
pharmacies. Consumers returning to their local participating pharmacy
could no longer obtain their prescription drugs there because the
claim was blocked. The pharmacy was notified that coverage for that
medication was no longer covered in the "retail" pharmacy network.
The patient was to be directed to the "specialty" pharmacy.

Contrary to the intent of the law, beneficiaries are forced into
mandatory mail order programs based upon the medications that they are
prescribed. These medications are being deemed to be "specialty"
medications and, thus, cannot be filled at a non-specialty retail
pharmacy. Local pharmacies in the network were not considered
"specialty" pharmacies and, thus, were excluded from the new
"restricted" network. This allowed pharmacy benefit managers to steer
prescription volume out of the network retail pharmacies into their
wholly owned pharmacy subsidiaries. Defining "mail order pharmacy" is
necessary so that its meaning cannot be manipulated by self-promoting
pharmacy benefit managers.

Community pharmacy owners took action. They contacted plan sponsors
and pharmacy benefit managers asking for contracts that would allow
them to continue to dispense covered medications available to them
from their wholesalers. The phone calls, letters, and e-mails that
followed document that large pharmacy benefit managers were using
"terms and conditions" as a legal roadblock against community
pharmacies. These included unreasonable and onerous "terms" such as
costly accreditations, on-call 24- hour nursing services, and
excessive liability insurance demands. Some threatened to exclude
community pharmacies from the retail network in order to be enrolled
as a mail order pharmacy. For these reasons, it is necessary to remove
"terms and conditions" from current law.

The term "in advance through a contractual network agreement" has
served as another roadblock to the community pharmacies envisioned in
the original law. A close reading of the law allows a local network
pharmacy to agree to accept the same reimbursement amount, but nothing
in the law requires the pharmacy benefit manager to grant the
participating community pharmacy an additional contract to meet the
mail order reimbursement price. The present statute must be amended to
resolve this contradiction and restore the original legislative
intent.

Consumers have had many issues with mail order pharmacies. When
medication requires refrigeration, spoilage is an issue for consumers.
Because many consumers are employed and cannot control the time that
the medication will be delivered, medication that requires
refrigeration could be left outside in the sun for an extended period
of time melting whatever cold packaging was included to keep the
medication refrigerated.

Additionally, many medications have been lost in the mail or stolen.
When medication that a person relies on in order to maintain his or
her health is lost or stolen, that person's health is placed at risk.
This risk is intensified by the fact that the only replacement option
is the mail order pharmacy, which means that the replacement
medication may not arrive for days. Because many prescriptions cannot
be refilled more than one week ahead of time, a person could run out
of the medication while he or she waits for a second delivery. While
it could be argued that the person could simply wait at home for the
medication to be delivered, this argument ignores some practical
realities such as employment and the inability to simply take a day
off from work to wait for a package to be delivered.

The original intent of the law has been distorted. With these
amendments, the original legislative intent will be restored.
Consumers will finally have the ability to use in-network community
pharmacies for their prescriptions, regardless of whether the
medication is considered to be a "specialty" medication.

 PRIOR LEGISLATIVE HISTORY :

2016: S.7591-C - Referred to Insurance

 FISCAL IMPLICATIONS :

Undetermined.

 EFFECTIVE DATE :
This act shall take effect immediately.

2017-S1766 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1766
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                             January 10, 2017
                                ___________
 
 Introduced  by  Sens.  GOLDEN,  ADDABBO, LANZA, O'MARA -- 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 reimbursements to mail
   order pharmacies
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraphs 13-a and 28 of subsection (i) of section 3216 of
 the insurance law, paragraph 13-a as amended by chapter 10 of  the  laws
 of  2012, paragraph 28 as amended by chapter 11 of the laws of 2012, are
 amended to read as follows:
   (13-a) (A) DEFINITIONS. FOR THE PURPOSES OF THIS PARAGRAPH:
   (1) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
 UNDER SUBPARAGRAPH (B) OF THIS PARAGRAPH SHALL  USE  THE  SAME  SINGULAR
 BENCHMARK INDEX, WHICH MAY BE AVERAGE WHOLESALE PRICE, MAXIMUM ALLOWABLE
 COST,  FEDERAL  UPPER  LIMIT, OR ANOTHER SIMILAR BENCHMARK INDEX USED BY
 THE INSURANCE INDUSTRY, AND NATIONAL PRESCRIPTION DRUG  CODES  TO  REIM-
 BURSE  ALL  PHARMACIES  PARTICIPATING  IN  THE INSURANCE NETWORK FOR ALL
 PRESCRIPTIONS REGARDLESS OF WHETHER A PHARMACY IS A MAIL ORDER  PHARMACY
 OR  A  NON-MAIL  RETAIL ORDER PHARMACY, PROVIDED, HOWEVER, THAT WHEN THE
 SELECTED BENCHMARK  INDEX  DOES  NOT  INCLUDE  ONE  OR  MORE  PARTICULAR
 PRESCRIPTION  DRUGS,  A  HIERARCHY OF BENCHMARK INDICES SHALL BE USED IN
 THEIR HIERARCHICAL ORDER AND SUCH  SECONDARY  INDEX  SHALL  BE  USED  TO
 PROVIDE  PRICING FOR ONLY THOSE DRUGS NOT INCLUDED IN THE MAIN INDEX. IF
 THE TWO SELECTED BENCHMARKS  DO  NOT  INCLUDE  ONE  OR  MORE  PARTICULAR
 PRESCRIPTION  DRUGS,  A  THIRD  BENCHMARK INDEX SHALL BE USED TO PROVIDE
 PRICING ONLY FOR THOSE DRUGS NOT INCLUDED IN THE MAIN INDEX OR SECONDARY
 INDEX. ALL PARTICIPATING NETWORK PHARMACIES, NON-MAIL ORDER RETAIL PHAR-
 MACIES AND MAIL ORDER PHARMACIES, SHALL  RECEIVE  A  DISCLOSURE  OF  THE
 REIMBURSEMENT  HIERARCHY,  THE  CURRENT BENCHMARK PRICES FOR THE INDICES
 INCLUDED IN THE HIERARCHY, AND MONTHLY UPDATES TO THE  BENCHMARK  PRICES
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD05109-01-7

 S. 1766                             2
 
 FOR  EACH  OF  THE  HIERARCHICAL INDICES. ANY CHANGE TO THE HIERARCHICAL
 BENCHMARK STRUCTURE SHALL NOT BE MADE UNLESS NOTICE OF SUCH  CHANGE  HAS
 BEEN  PROVIDED  TO  ALL PARTICIPATING NETWORK PHARMACIES AT LEAST THIRTY
 DAYS IN ADVANCE OF SUCH CHANGE.
   (2) "MAIL ORDER PHARMACY" SHALL MEAN A PHARMACY WHOSE PRIMARY BUSINESS
 IS  TO  RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX OR THROUGH ELECTRONIC
 SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH  THE  USE  OF
 THE  UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
 PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE-
 TO-FACE.
   (3) "STANDARD TERMS AND CONDITIONS" SHALL MEAN THE  CONTRACTUAL  TERMS
 AND  CONDITIONS  APPLICABLE TO ALL NETWORK NON-MAIL ORDER RETAIL PHARMA-
 CIES, PROVIDED, HOWEVER THAT  FOR  MAIL  ORDER  PRESCRIPTIONS  THAT  ARE
 SUBJECT  TO  THE  FEDERAL  DRUG ADMINISTRATION RISK EVALUATION AND MITI-
 GATION STRATEGIES PROGRAM, THE INSURANCE POLICY MAY IMPOSE AN ADDITIONAL
 TERM AND CONDITION REQUIRING DOCUMENTATION STATING THAT THE PHARMACY  IS
 AUTHORIZED  TO  DISPENSE  SUCH MAIL ORDER PRESCRIPTION BEFORE A NON-MAIL
 ORDER RETAIL PHARMACY MAY BE REIMBURSED FOR DISPENSING SUCH  MAIL  ORDER
 PRESCRIPTION DRUG.
   (B)  Every  policy  that  provides coverage for prescription fertility
 drugs and requires or permits prescription drugs to be purchased through
 a network participating mail order or other  non-retail  pharmacy  shall
 provide the same coverage for prescription fertility drugs AND SHALL NOT
 LIMIT  THE SUPPLY THAT MAY BE DISPENSED TO A THIRTY-DAY SUPPLY when such
 drugs are purchased from a network participating non-mail  order  retail
 pharmacy  provided  that the network participating non-mail order retail
 pharmacy agrees [in advance through a contractual network agreement,] to
 the same reimbursement amount[, as well as the same applicable terms and
 conditions,] AND STANDARD TERMS AND  CONDITIONS  that  the  insurer  has
 established  for  [a] network participating [mail order or other non-re-
 tail pharmacy] NON-MAIL ORDER RETAIL PHARMACIES.    In  such  case,  the
 policy shall not impose any fee, co-payment, co-insurance, deductible or
 other  condition,  INCLUDING REQUIRING MONTHLY REFILLS OF A PRESCRIPTION
 THAT WAS WRITTEN FOR AND MAY  BE  FILLED  FOR  MORE  THAN  A  THIRTY-DAY
 SUPPLY,  on  any  insured  who elects to purchase prescription fertility
 drugs through a network participating  non-mail  order  retail  pharmacy
 that  it  does  not  impose  on  any  insured who purchases prescription
 fertility drugs through a network  participating  mail  order  or  other
 non-retail pharmacy.
   (C) ANY POLICY THAT PROVIDES COVERAGE FOR PRESCRIPTION FERTILITY DRUGS
 SHALL  REQUIRE  MAIL  ORDER PHARMACIES TO REPLACE DISPENSED PRESCRIPTION
 FERTILITY DRUGS THAT HAVE SPOILED OR DAMAGED, PROVIDED THAT, THE  POLICY
 MAY  REQUIRE  THAT THE SPOILED OR DAMAGED PRESCRIPTION FERTILITY DRUG BE
 RETURNED TO THE MAIL ORDER PHARMACY WITH THE COST TO BE  BORNE  BY  SUCH
 PHARMACY, AND PROVIDED FURTHER THAT SUCH SPOILED OR DAMAGED PRESCRIPTION
 FERTILITY  DRUG  SHALL  BE REPLACED IN AN AMOUNT THAT IS NOT LESS THAN A
 ONE MONTH SUPPLY BEFORE RECEIPT  OF  THE  RETURNED  SPOILED  OR  DAMAGED
 PRESCRIPTION  FERTILITY  DRUG.  IF  THE  SPOILED OR DAMAGED PRESCRIPTION
 FERTILITY DRUG IS NOT RETURNED, THE POLICY MAY REQUIRE  THE  INSURED  TO
 REIMBURSE  THE  POLICY  FOR  THE COST OF THE PRESCRIPTION FERTILITY DRUG
 AND, NOTWITHSTANDING THE FOREGOING, WHEN AN INSURED WHO  WAS  PREVIOUSLY
 REQUIRED  TO REIMBURSE THE INSURANCE POLICY FOR A DISPENSED PRESCRIPTION
 FERTILITY DRUG THAT WAS SPOILED OR DAMAGED, THE  POLICY  MAY  REFUSE  TO
 REPLACE  SUCH  PRESCRIPTION  FERTILITY  DRUG FOR SUCH INSURED UNTIL SUCH
 INSURED HAS RETURNED THE SPOILED OR DAMAGED PRESCRIPTION FERTILITY DRUG.
 REPLACEMENT OF A PRESCRIPTION FERTILITY DRUG PURSUANT TO  THIS  SUBPARA-

 S. 1766                             3

 GRAPH  SHALL NOT BE LIMITED TO A SPECIFIC NUMBER OF OCCURRENCES DURING A
 CONTRACT YEAR.
   (28) (A) DEFINITIONS. FOR THE PURPOSES OF THIS PARAGRAPH:
   (1) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
 UNDER  SUBPARAGRAPH  (B)  OF  THIS PARAGRAPH SHALL USE THE SAME SINGULAR
 BENCHMARK INDEX, WHICH MAY BE AVERAGE WHOLESALE PRICE, MAXIMUM ALLOWABLE
 COST, FEDERAL UPPER LIMIT, OR ANOTHER SIMILAR BENCHMARK  INDEX  USED  BY
 THE  INSURANCE  INDUSTRY,  AND NATIONAL PRESCRIPTION DRUG CODES TO REIM-
 BURSE ALL PHARMACIES PARTICIPATING IN  THE  INSURANCE  NETWORK  FOR  ALL
 PRESCRIPTIONS  REGARDLESS OF WHETHER A PHARMACY IS A MAIL ORDER PHARMACY
 OR A NON-MAIL ORDER RETAIL PHARMACY, PROVIDED, HOWEVER,  THAT  WHEN  THE
 SELECTED  BENCHMARK  INDEX  DOES  NOT  INCLUDE  ONE  OR  MORE PARTICULAR
 PRESCRIPTION DRUGS, A HIERARCHY OF BENCHMARK INDICES SHALL  BE  USED  IN
 THEIR  HIERARCHICAL  ORDER  AND  SUCH  SECONDARY  INDEX SHALL BE USED TO
 PROVIDE PRICING FOR ONLY THOSE DRUGS NOT INCLUDED IN THE MAIN INDEX.  IF
 THE  TWO  SELECTED  BENCHMARKS  DO  NOT  INCLUDE  ONE OR MORE PARTICULAR
 PRESCRIPTION DRUGS, A THIRD BENCHMARK INDEX SHALL  BE  USED  TO  PROVIDE
 PRICING ONLY FOR THOSE DRUGS NOT INCLUDED IN THE MAIN INDEX OR SECONDARY
 INDEX. ALL PARTICIPATING NETWORK PHARMACIES, NON-MAIL ORDER RETAIL PHAR-
 MACIES  AND  MAIL  ORDER  PHARMACIES,  SHALL RECEIVE A DISCLOSURE OF THE
 REIMBURSEMENT HIERARCHY, THE CURRENT BENCHMARK PRICES  FOR  THE  INDICES
 INCLUDED  IN  THE HIERARCHY, AND MONTHLY UPDATES TO THE BENCHMARK PRICES
 FOR EACH OF THE HIERARCHICAL INDICES. ANY  CHANGE  TO  THE  HIERARCHICAL
 BENCHMARK  STRUCTURE  SHALL NOT BE MADE UNLESS NOTICE OF SUCH CHANGE HAS
 BEEN PROVIDED TO ALL PARTICIPATING NETWORK  PHARMACIES,  NON-MAIL  ORDER
 RETAIL  PHARMACIES  AND  MAIL  ORDER PHARMACIES, AT LEAST THIRTY DAYS IN
 ADVANCE OF SUCH CHANGE.
   (2) "MAIL ORDER PHARMACY" SHALL MEAN A PHARMACY WHOSE PRIMARY BUSINESS
 IS TO RECEIVE PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH  ELECTRONIC
 SUBMISSIONS  AND  TO  DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
 THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES  AND
 PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE-
 TO-FACE.
   (3)  "STANDARD  TERMS AND CONDITIONS" SHALL MEAN THE CONTRACTUAL TERMS
 AND CONDITIONS APPLICABLE TO ALL NETWORK NON-MAIL ORDER  RETAIL  PHARMA-
 CIES,  PROVIDED,  HOWEVER  THAT  FOR  MAIL  ORDER PRESCRIPTIONS THAT ARE
 SUBJECT TO THE FEDERAL DRUG ADMINISTRATION  RISK  EVALUATION  AND  MITI-
 GATION STRATEGIES PROGRAM, THE INSURANCE POLICY MAY IMPOSE AN ADDITIONAL
 TERM  AND CONDITION REQUIRING DOCUMENTATION STATING THAT THE PHARMACY IS
 AUTHORIZED TO DISPENSE SUCH MAIL ORDER PRESCRIPTION  BEFORE  A  NON-MAIL
 ORDER  RETAIL  PHARMACY MAY BE REIMBURSED FOR DISPENSING SUCH MAIL ORDER
 PRESCRIPTION DRUG.
   (B) Any policy that provides coverage  for  prescription  drugs  shall
 permit  each  insured  to  fill  any  covered  prescription  that may be
 obtained at a network participating mail order or other non-retail phar-
 macy, at the insured's option, at a network participating non-mail order
 retail pharmacy provided that the network participating  non-mail  order
 retail pharmacy agrees [in advance, through a contractual network agree-
 ment,] to the same reimbursement amount[, as well as the same applicable
 terms and conditions,] AND STANDARD TERMS AND CONDITIONS that the insur-
 er  has  established  for the network participating [mail order or other
 non-retail pharmacy] NON-MAIL ORDER RETAIL PHARMACIES. In such  a  case,
 the policy shall not impose a co-payment fee or other condition, INCLUD-
 ING REQUIRING MONTHLY REFILLS OF A PRESCRIPTION THAT WAS WRITTEN FOR AND
 MAY  BE  FILLED  FOR  MORE  THAN A THIRTY-DAY SUPPLY, on any insured who
 elects to purchase prescription drugs from a network participating  non-

 S. 1766                             4
 
 mail  order retail pharmacy which is not also imposed on insureds elect-
 ing to purchase drugs from a network participating mail order  or  other
 non-retail pharmacy.
   (C)  ANY  POLICY  THAT  PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL
 REQUIRE MAIL ORDER PHARMACIES TO REPLACE  DISPENSED  PRESCRIPTION  DRUGS
 THAT HAVE BEEN SPOILED OR DAMAGED, PROVIDED THAT, THE POLICY MAY REQUIRE
 THAT  THE  SPOILED  OR DAMAGED PRESCRIPTION DRUG BE RETURNED TO THE MAIL
 ORDER PHARMACY WITH THE COST TO BE BORNE BY SUCH PHARMACY, AND  PROVIDED
 FURTHER THAT SUCH SPOILED OR DAMAGED PRESCRIPTION DRUG SHALL BE REPLACED
 IN  AN AMOUNT THAT IS NOT LESS THAN A ONE MONTH SUPPLY BEFORE RECEIPT OF
 THE SPOILED OR DAMAGED PRESCRIPTION DRUG.   IF SUCH SPOILED  OR  DAMAGED
 PRESCRIPTION DRUG IS NOT RETURNED, THE POLICY MAY REQUIRE THE INSURED TO
 REIMBURSE THE POLICY FOR THE COST OF THE PRESCRIPTION DRUG AND, NOTWITH-
 STANDING  THE  FOREGOING, WHEN AN INSURED WHO WAS PREVIOUSLY REQUIRED TO
 REIMBURSE THE POLICY FOR A DISPENSED  SPOILED  OR  DAMAGED  PRESCRIPTION
 DRUG,  THE  POLICY MAY REFUSE TO REPLACE SUCH PRESCRIPTION DRUG FOR SUCH
 INSURED  UNTIL  SUCH  INSURED  HAS  RETURNED  THE  SPOILED  OR   DAMAGED
 PRESCRIPTION  DRUG.  REPLACEMENT OF A PRESCRIPTION DRUG PURSUANT TO THIS
 SUBPARAGRAPH SHALL NOT BE LIMITED TO A SPECIFIC  NUMBER  OF  OCCURRENCES
 DURING A CONTRACT YEAR.
   § 2. Subparagraph (D) of paragraph 6 of subsection (k) of section 3221
 of  the  insurance law, as amended by chapter 10 of the laws of 2012, is
 amended to read as follows:
   (D) (I) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
   (1) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
 UNDER ITEM (II) OF THIS SUBPARAGRAPH SHALL USE THE SAME SINGULAR  BENCH-
 MARK  INDEX,  WHICH  MAY  BE  AVERAGE WHOLESALE PRICE, MAXIMUM ALLOWABLE
 COST, FEDERAL UPPER LIMIT, OR ANOTHER SIMILAR BENCHMARK  INDEX  USED  BY
 THE  INSURANCE  INDUSTRY,  AND NATIONAL PRESCRIPTION DRUG CODES TO REIM-
 BURSE ALL PHARMACIES PARTICIPATING IN  THE  INSURANCE  NETWORK  FOR  ALL
 PRESCRIPTIONS  REGARDLESS OF WHETHER A PHARMACY IS A MAIL ORDER PHARMACY
 OR A NON-MAIL RETAIL ORDER PHARMACY, PROVIDED, HOWEVER,  THAT  WHEN  THE
 SELECTED  BENCHMARK  INDEX  DOES  NOT  INCLUDE  ONE  OR  MORE PARTICULAR
 PRESCRIPTION DRUGS, A HIERARCHY OF BENCHMARK INDICES SHALL  BE  USED  IN
 THEIR  HIERARCHICAL  ORDER  AND  SUCH  SECONDARY  INDEX SHALL BE USED TO
 PROVIDE PRICING FOR ONLY THOSE DRUGS NOT INCLUDED IN THE MAIN INDEX.  IF
 THE  TWO  SELECTED  BENCHMARKS  DO  NOT  INCLUDE  ONE OR MORE PARTICULAR
 PRESCRIPTION DRUGS, A THIRD BENCHMARK INDEX SHALL  BE  USED  TO  PROVIDE
 PRICING ONLY FOR THOSE DRUGS NOT INCLUDED IN THE MAIN INDEX OR SECONDARY
 INDEX. ALL PARTICIPATING NETWORK PHARMACIES, NON-MAIL ORDER RETAIL PHAR-
 MACIES  AND  MAIL  ORDER  PHARMACIES,  SHALL RECEIVE A DISCLOSURE OF THE
 REIMBURSEMENT HIERARCHY, THE CURRENT BENCHMARK PRICES  FOR  THE  INDICES
 INCLUDED  IN  THE HIERARCHY, AND MONTHLY UPDATES TO THE BENCHMARK PRICES
 FOR EACH OF THE HIERARCHICAL INDICES. ANY  CHANGE  TO  THE  HIERARCHICAL
 BENCHMARK  STRUCTURE  SHALL NOT BE MADE UNLESS NOTICE OF SUCH CHANGE HAS
 BEEN PROVIDED TO ALL PARTICIPATING NETWORK PHARMACIES, AT  LEAST  THIRTY
 DAYS IN ADVANCE OF SUCH CHANGE.
   (2) "MAIL ORDER PHARMACY" SHALL MEAN A PHARMACY WHOSE PRIMARY BUSINESS
 IS  TO  RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX OR THROUGH ELECTRONIC
 SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH  THE  USE  OF
 THE  UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
 PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE-
 TO-FACE.
   (3) "STANDARD TERMS AND CONDITIONS" SHALL MEAN THE  CONTRACTUAL  TERMS
 AND  CONDITIONS  APPLICABLE TO ALL NETWORK NON-MAIL ORDER RETAIL PHARMA-
 CIES, PROVIDED, HOWEVER THAT  FOR  MAIL  ORDER  PRESCRIPTIONS  THAT  ARE

 S. 1766                             5
 
 SUBJECT  TO  THE  FEDERAL  DRUG ADMINISTRATION RISK EVALUATION AND MITI-
 GATION STRATEGIES PROGRAM, THE INSURANCE POLICY MAY IMPOSE AN ADDITIONAL
 TERM AND CONDITION REQUIRING DOCUMENTATION STATING THAT THE PHARMACY  IS
 AUTHORIZED  TO  DISPENSE  SUCH MAIL ORDER PRESCRIPTION BEFORE A NON-MAIL
 ORDER RETAIL PHARMACY MAY BE REIMBURSED FOR DISPENSING SUCH  MAIL  ORDER
 PRESCRIPTION DRUG.
   (II)  Every  policy  that provides coverage for prescription fertility
 drugs and requires or permits prescription drugs to be purchased through
 a network participating mail order or other  non-retail  pharmacy  shall
 provide the same coverage for prescription fertility drugs AND SHALL NOT
 LIMIT  THE SUPPLY THAT MAY BE DISPENSED TO A THIRTY-DAY SUPPLY when such
 drugs are purchased from a network participating non-mail  order  retail
 pharmacy  provided  that the network participating non-mail order retail
 pharmacy agrees [in advance through a contractual network agreement,] to
 the same reimbursement amount[, as well as the same applicable terms and
 conditions,] AND STANDARD TERMS AND  CONDITIONS  that  the  insurer  has
 established  for  [a] network participating [mail order or other non-re-
 tail pharmacy] NON-MAIL ORDER RETAIL PHARMACIES. In such case, the poli-
 cy shall not impose any fee,  co-payment,  co-insurance,  deductible  or
 other  condition,  INCLUDING REQUIRING MONTHLY REFILLS OF A PRESCRIPTION
 THAT WAS WRITTEN FOR AND MAY  BE  FILLED  FOR  MORE  THAN  A  THIRTY-DAY
 SUPPLY,  on  any  covered  person  who  elects  to purchase prescription
 fertility drugs through a network participating  non-mail  order  retail
 pharmacy  that  it  does  not impose on any covered person who purchases
 prescription fertility drugs through a network participating mail  order
 or  other non-retail pharmacy; provided, however, that the provisions of
 this section shall not supersede the terms of  a  collective  bargaining
 agreement  or  apply  to  a  policy  that  is the result of a collective
 bargaining agreement between an employer and a recognized  or  certified
 employee organization.
   (III)  ANY  POLICY  THAT  PROVIDES COVERAGE FOR PRESCRIPTION FERTILITY
 DRUGS SHALL, IN ADDITION TO THE STANDARD TERMS AND  CONDITIONS,  REQUIRE
 MAIL  ORDER PHARMACIES TO REPLACE DISPENSED PRESCRIPTION FERTILITY DRUGS
 THAT HAVE BEEN SPOILED OR DAMAGED, PROVIDED THAT, THE POLICY MAY REQUIRE
 THAT THE SPOILED OR DAMAGED PRESCRIPTION FERTILITY DRUG BE  RETURNED  TO
 THE  MAIL ORDER PHARMACY WITH THE COST TO BE BORNE BY SUCH PHARMACY, AND
 PROVIDED FURTHER THAT SUCH SPOILED  OR  DAMAGED  PRESCRIPTION  FERTILITY
 DRUG  SHALL  BE  REPLACED IN AN AMOUNT THAT IS NOT LESS THAN A ONE MONTH
 SUPPLY BEFORE RECEIPT OF THE SPOILED OR DAMAGED  PRESCRIPTION  FERTILITY
 DRUG.  IF  SUCH  SPOILED  OR  DAMAGED PRESCRIPTION FERTILITY DRUG IS NOT
 RETURNED, THE POLICY MAY REQUIRE THE INSURED TO REIMBURSE THE POLICY FOR
 THE COST OF THE PRESCRIPTION FERTILITY  DRUG  AND,  NOTWITHSTANDING  THE
 FOREGOING,  WHEN AN INSURED WHO WAS PREVIOUSLY REQUIRED TO REIMBURSE THE
 POLICY FOR A DISPENSED PRESCRIPTION FERTILITY DRUG THAT WAS  SPOILED  OR
 DAMAGED,  THE  POLICY  MAY REFUSE TO REPLACE SUCH PRESCRIPTION FERTILITY
 DRUG FOR SUCH INSURED UNTIL SUCH INSURED HAS  RETURNED  THE  SPOILED  OR
 DAMAGED  PRESCRIPTION  FERTILITY  DRUG.    REPLACEMENT OF A PRESCRIPTION
 FERTILITY DRUG PURSUANT TO THIS CLAUSE SHALL NOT BE LIMITED TO A SPECIF-
 IC NUMBER OF OCCURRENCES DURING A CONTRACT YEAR.
   § 3. Paragraph 18 of subsection (l) of section 3221 of  the  insurance
 law, as amended by chapter 11 of the laws of 2012, is amended to read as
 follows:
   (18) (A) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
   (1) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
 UNDER  SUBPARAGRAPH  (B)  OF  THIS PARAGRAPH SHALL USE THE SAME SINGULAR
 BENCHMARK INDEX, WHICH MAY BE AVERAGE WHOLESALE PRICE, MAXIMUM ALLOWABLE

 S. 1766                             6

 COST, FEDERAL UPPER LIMIT, OR ANOTHER SIMILAR BENCHMARK  INDEX  USED  BY
 THE  INSURANCE  INDUSTRY,  AND NATIONAL PRESCRIPTION DRUG CODES TO REIM-
 BURSE ALL PHARMACIES PARTICIPATING IN  THE  INSURANCE  NETWORK  FOR  ALL
 PRESCRIPTIONS  REGARDLESS OF WHETHER A PHARMACY IS A MAIL ORDER PHARMACY
 OR A NON-MAIL ORDER RETAIL PHARMACY, PROVIDED, HOWEVER,  THAT  WHEN  THE
 SELECTED  BENCHMARK  INDEX  DOES  NOT  INCLUDE  ONE  OR  MORE PARTICULAR
 PRESCRIPTION DRUGS, A HIERARCHY OF BENCHMARK INDICES SHALL  BE  USED  IN
 THEIR  HIERARCHICAL  ORDER  AND  SUCH  SECONDARY  INDEX SHALL BE USED TO
 PROVIDE PRICING FOR ONLY THOSE DRUGS NOT INCLUDED IN THE MAIN INDEX.  IF
 THE  TWO  SELECTED  BENCHMARKS  DO  NOT  INCLUDE  ONE OR MORE PARTICULAR
 PRESCRIPTION DRUGS, A THIRD BENCHMARK INDEX SHALL  BE  USED  TO  PROVIDE
 PRICING ONLY FOR THOSE DRUGS NOT INCLUDED IN THE MAIN INDEX OR SECONDARY
 INDEX. ALL PARTICIPATING NETWORK PHARMACIES, NON-MAIL ORDER RETAIL PHAR-
 MACIES  AND  MAIL  ORDER  PHARMACIES,  SHALL RECEIVE A DISCLOSURE OF THE
 REIMBURSEMENT HIERARCHY, THE CURRENT BENCHMARK PRICES  FOR  THE  INDICES
 INCLUDED  IN  THE HIERARCHY, AND MONTHLY UPDATES TO THE BENCHMARK PRICES
 FOR EACH OF THE HIERARCHICAL INDICES. ANY  CHANGE  TO  THE  HIERARCHICAL
 BENCHMARK  STRUCTURE  SHALL NOT BE MADE UNLESS NOTICE OF SUCH CHANGE HAS
 BEEN PROVIDED TO ALL PARTICIPATING NETWORK PHARMACIES, AT  LEAST  THIRTY
 DAYS IN ADVANCE OF SUCH CHANGE.
   (2) "MAIL ORDER PHARMACY" SHALL MEAN A PHARMACY WHOSE PRIMARY BUSINESS
 IS  TO  RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX OR THROUGH ELECTRONIC
 SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH  THE  USE  OF
 THE  UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
 PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE-
 TO-FACE.
   (3) "STANDARD TERMS AND CONDITIONS" SHALL MEAN THE  CONTRACTUAL  TERMS
 AND  CONDITIONS  APPLICABLE TO ALL NETWORK NON-MAIL ORDER RETAIL PHARMA-
 CIES, PROVIDED, HOWEVER THAT  FOR  MAIL  ORDER  PRESCRIPTIONS  THAT  ARE
 SUBJECT  TO  THE  FEDERAL  DRUG ADMINISTRATION RISK EVALUATION AND MITI-
 GATION STRATEGIES PROGRAM, THE INSURANCE POLICY MAY IMPOSE AN ADDITIONAL
 TERM AND CONDITION REQUIRING DOCUMENTATION STATING THAT THE PHARMACY  IS
 AUTHORIZED  TO  DISPENSE  SUCH MAIL ORDER PRESCRIPTION BEFORE A NON-MAIL
 ORDER RETAIL PHARMACY MAY BE REIMBURSED FOR DISPENSING SUCH  MAIL  ORDER
 PRESCRIPTION DRUG.
   (B)  Any  insurer  delivering  a  group or blanket policy or issuing a
 group or blanket policy for delivery in this state that provides  cover-
 age for prescription drugs shall permit each insured to fill any covered
 prescription  that may be obtained at a network participating mail order
 or other non-retail pharmacy, at the  insured's  option,  at  a  network
 participating  non-mail  order retail pharmacy provided that the network
 participating non-mail order retail pharmacy [agrees in advance, through
 a contractual network agreement,] to the same reimbursement amount[,  as
 well  as  the  same applicable terms and conditions,] AND STANDARD TERMS
 AND CONDITIONS that the insurer has established for the network  partic-
 ipating  [mail  order  or  other non-retail pharmacy] FOR NON-MAIL ORDER
 RETAIL PHARMACIES.   In such a case,  the  policy  shall  not  impose  a
 co-payment  fee  or other condition, INCLUDING REQUIRING MONTHLY REFILLS
 OF A PRESCRIPTION THAT WAS WRITTEN FOR AND MAY BE FILLED FOR MORE THAN A
 THIRTY-DAY SUPPLY, on any insured who elects to purchase  drugs  from  a
 network  participating  non-mail order retail pharmacy which is not also
 imposed on insureds electing to purchase drugs from  a  network  partic-
 ipating mail order or other non-retail pharmacy; provided, however, that
 the  provisions  of  this  section  shall  not  supersede the terms of a
 collective bargaining agreement or apply to a policy that is the  result

 S. 1766                             7
 
 of  a  collective  bargaining agreement between an employer and a recog-
 nized or certified employee organization.
   (C)  ANY  POLICY  THAT  PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL
 REQUIRE MAIL ORDER PHARMACIES TO REPLACE  DISPENSED  PRESCRIPTION  DRUGS
 THAT  HAVE BEEN SPOILED OR DAMAGED, PROVIDED THAT THE POLICY MAY REQUIRE
 THAT THE SPOILED OR DAMAGED PRESCRIPTION DRUG BE RETURNED  TO  THE  MAIL
 ORDER  PHARMACY WITH THE COST TO BE BORNE BY SUCH PHARMACY, AND PROVIDED
 FURTHER THAT SUCH SPOILED OR DAMAGED PRESCRIPTION DRUG SHALL BE REPLACED
 IN AN AMOUNT THAT IS NOT LESS THAN A ONE MONTH SUPPLY BEFORE RECEIPT  OF
 THE  SPOILED  OR  DAMAGED  PRESCRIPTION  DRUG. IF THE DAMAGED OR SPOILED
 PRESCRIPTION DRUG IS NOT RETURNED, THE POLICY MAY REQUIRE THE INSURED TO
 REIMBURSE THE POLICY FOR THE COST OF THE PRESCRIPTION DRUG AND, NOTWITH-
 STANDING THE FOREGOING, WHEN AN INSURED WHO WAS PREVIOUSLY  REQUIRED  TO
 REIMBURSE  THE POLICY FOR A DISPENSED PRESCRIPTION DRUG THAT WAS SPOILED
 OR DAMAGED, THE POLICY MAY REFUSE TO REPLACE SUCH PRESCRIPTION DRUG  FOR
 SUCH  INSURED  UNTIL  SUCH  INSURED  RETURNED  THE  SPOILED  OR  DAMAGED
 PRESCRIPTION DRUG. REPLACEMENT OF A PRESCRIPTION DRUG PURSUANT  TO  THIS
 SUBPARAGRAPH  SHALL  NOT  BE LIMITED TO A SPECIFIC NUMBER OF OCCURRENCES
 DURING A CONTRACT YEAR.
   § 4.  Paragraph 4 of subsection (s) of section 4303 of  the  insurance
 law, as amended by chapter 10 of the laws of 2012, is amended to read as
 follows:
   (4) (A) DEFINITION. FOR THE PURPOSE OF THIS PARAGRAPH:
   (I) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
 UNDER  SUBPARAGRAPH  (B)  OF THIS SUBSECTION SHALL USE THE SAME SINGULAR
 BENCHMARK INDEX, WHICH MAY BE AVERAGE WHOLESALE PRICE, MAXIMUM ALLOWABLE
 COST, FEDERAL UPPER LIMIT, OR ANOTHER SIMILAR BENCHMARK  INDEX  USED  BY
 THE  INSURANCE  INDUSTRY,  AND NATIONAL PRESCRIPTION DRUG CODES TO REIM-
 BURSE ALL PHARMACIES PARTICIPATING IN  THE  INSURANCE  NETWORK  FOR  ALL
 PRESCRIPTIONS  REGARDLESS OF WHETHER A PHARMACY IS A MAIL ORDER PHARMACY
 OR A NON-MAIL RETAIL ORDER PHARMACY, PROVIDED, HOWEVER,  THAT  WHEN  THE
 SELECTED  BENCHMARK  INDEX  DOES  NOT  INCLUDE  ONE  OR  MORE PARTICULAR
 PRESCRIPTION DRUGS, A HIERARCHY OF BENCHMARK INDICES SHALL  BE  USED  IN
 THEIR  HIERARCHICAL  ORDER  AND  SUCH  SECONDARY  INDEX SHALL BE USED TO
 PROVIDE PRICING FOR ONLY THOSE DRUGS NOT INCLUDED IN THE MAIN INDEX.  IF
 THE  TWO  SELECTED  BENCHMARKS  DO  NOT  INCLUDE  ONE OR MORE PARTICULAR
 PRESCRIPTION DRUGS, A THIRD BENCHMARK INDEX SHALL  BE  USED  TO  PROVIDE
 PRICING ONLY FOR THOSE DRUGS NOT INCLUDED IN THE MAIN INDEX OR SECONDARY
 INDEX. ALL PARTICIPATING NETWORK PHARMACIES, NON-MAIL ORDER RETAIL PHAR-
 MACIES  AND  MAIL  ORDER  PHARMACIES,  SHALL RECEIVE A DISCLOSURE OF THE
 REIMBURSEMENT HIERARCHY, THE CURRENT BENCHMARK PRICES  FOR  THE  INDICES
 INCLUDED  IN  THE HIERARCHY, AND MONTHLY UPDATES TO THE BENCHMARK PRICES
 FOR EACH OF THE HIERARCHICAL INDICES. ANY  CHANGE  TO  THE  HIERARCHICAL
 BENCHMARK  STRUCTURE  SHALL NOT BE MADE UNLESS NOTICE OF SUCH CHANGE HAS
 BEEN PROVIDED TO ALL PARTICIPATING NETWORK PHARMACIES, AT  LEAST  THIRTY
 DAYS IN ADVANCE OF SUCH CHANGE.
   (II)  "MAIL  ORDER PHARMACY" SHALL MEAN A PHARMACY WHOSE PRIMARY BUSI-
 NESS IS TO RECEIVE PRESCRIPTIONS BY MAIL, TELEFAX OR THROUGH  ELECTRONIC
 SUBMISSIONS  AND  TO  DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
 THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES  AND
 PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE-
 TO-FACE.
   (III) "STANDARD TERMS AND CONDITIONS" SHALL MEAN THE CONTRACTUAL TERMS
 AND  CONDITIONS  APPLICABLE TO ALL NETWORK NON-MAIL ORDER RETAIL PHARMA-
 CIES, PROVIDED, HOWEVER THAT  FOR  MAIL  ORDER  PRESCRIPTIONS  THAT  ARE
 SUBJECT  TO  THE  FEDERAL  DRUG ADMINISTRATION RISK EVALUATION AND MITI-

 S. 1766                             8
 
 GATION STRATEGIES PROGRAM, THE INSURANCE POLICY MAY IMPOSE AN ADDITIONAL
 TERM AND CONDITION REQUIRING DOCUMENTATION STATING THAT THE PHARMACY  IS
 AUTHORIZED  TO  DISPENSE  SUCH MAIL ORDER PRESCRIPTION BEFORE A NON-MAIL
 ORDER  RETAIL  PHARMACY MAY BE REIMBURSED FOR DISPENSING SUCH MAIL ORDER
 PRESCRIPTION DRUG.
   (B) Every contract issued by a medical expense indemnity  corporation,
 a  hospital  service  corporation  or a health services corporation that
 provides coverage for  prescription  fertility  drugs  and  requires  or
 permits prescription drugs to be purchased through a network participat-
 ing  mail  order  or  other  non-retail  pharmacy shall provide the same
 coverage for prescription fertility drugs AND SHALL NOT LIMIT THE SUPPLY
 THAT MAY BE DISPENSED  TO  A  THIRTY-DAY  SUPPLY  when  such  drugs  are
 purchased  from  a  network participating non-mail order retail pharmacy
 provided that the network participating non-mail order  retail  pharmacy
 agrees  [in  advance,  through  a contractual network agreement,] to the
 same reimbursement amount[, as well as the  same  applicable  terms  and
 conditions,]  AND STANDARD TERMS AND CONDITIONS that the corporation has
 established for the network participating [mail order or  other  non-re-
 tail  pharmacy]  NON-MAIL  ORDER  RETAIL PHARMACIES.   In such case, the
 contract shall not impose any fee, co-payment, co-insurance,  deductible
 or   other   condition,   INCLUDING   REQUIRING  MONTHLY  REFILLS  OF  A
 PRESCRIPTION THAT WAS WRITTEN FOR AND MAY BE  FILLED  FOR  MORE  THAN  A
 THIRTY-DAY  SUPPLY, on any covered person who does not elect to purchase
 prescription fertility drugs through a network participating mail  order
 or  other non-retail pharmacy; provided, however, that the provisions of
 this section shall not supersede the terms of  a  collective  bargaining
 agreement  or  apply  to  a  contract that is the result of a collective
 bargaining agreement between an employer and a recognized  or  certified
 employee organization.
   (3) ANY POLICY THAT PROVIDES COVERAGE FOR PRESCRIPTION FERTILITY DRUGS
 SHALL  REQUIRE  MAIL  ORDER PHARMACIES TO REPLACE DISPENSED PRESCRIPTION
 FERTILITY DRUGS THAT HAVE BEEN SPOILED OR  DAMAGED,  PROVIDED  THAT  THE
 POLICY  MAY  REQUIRE  THAT THE SPOILED OR DAMAGED PRESCRIPTION FERTILITY
 DRUG BE RETURNED TO THE MAIL ORDER PHARMACY WITH THE COST TO BE BORNE BY
 SUCH PHARMACY,  AND  PROVIDED  FURTHER  THAT  SUCH  SPOILED  OR  DAMAGED
 PRESCRIPTION  FERTILITY  DRUG SHALL BE REPLACED IN AN AMOUNT THAT IS NOT
 LESS THAN A THIRTY DAY SUPPLY BEFORE RECEIPT OF THE SPOILED  OR  DAMAGED
 PRESCRIPTION  FERTILITY  DRUG.  IF  SUCH SPOILED OR DAMAGED PRESCRIPTION
 FERTILITY DRUG IS NOT RETURNED, THE POLICY MAY REQUIRE  THE  INSURED  TO
 REIMBURSE  THE  POLICY  FOR  THE COST OF THE PRESCRIPTION FERTILITY DRUG
 AND, NOTWITHSTANDING THE FOREGOING, WHEN AN INSURED WHO  WAS  PREVIOUSLY
 REQUIRED  TO REIMBURSE THE POLICY FOR A DISPENSED PRESCRIPTION FERTILITY
 DRUG THAT WAS DAMAGED OR SPOILED, THE POLICY MAY REFUSE TO REPLACE  SUCH
 PRESCRIPTION  FERTILITY  DRUG  FOR  SUCH  INSURED UNTIL SUCH INSURED HAS
 RETURNED THE SPOILED OR DAMAGED PRESCRIPTION FERTILITY DRUG. REPLACEMENT
 OF A PRESCRIPTION FERTILITY DRUG PURSUANT TO THIS PARAGRAPH SHALL NOT BE
 LIMITED TO A SPECIFIC NUMBER OF OCCURRENCES DURING A CONTRACT YEAR.
   § 5. Subsection (kk) of section 4303 of the insurance law, as  amended
 by  chapter  11  of  the laws of 2012 and as relettered by section 55 of
 part D of chapter 56 of the laws of 2013, is amended to read as follows:
   (kk) (1) DEFINITIONS. FOR THE PURPOSE OF THIS SUBSECTION:
   (A) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
 UNDER PARAGRAPH TWO OF THIS SUBSECTION  SHALL  USE  THE  SAME  BENCHMARK
 INDEX,  WHICH  MAY  BE  AVERAGE WHOLESALE PRICE, MAXIMUM ALLOWABLE COST,
 FEDERAL UPPER LIMIT, OR ANOTHER SIMILAR  BENCHMARK  INDEX  USED  BY  THE
 INSURANCE  INDUSTRY,  AND  NATIONAL PRESCRIPTION DRUG CODES TO REIMBURSE

 S. 1766                             9
 
 ALL  PHARMACIES  PARTICIPATING  IN  THE  INSURANCE   NETWORK   FOR   ALL
 PRESCRIPTIONS  REGARDLESS OF WHETHER A PHARMACY IS A MAIL ORDER PHARMACY
 OR A NON-MAIL RETAIL ORDER PHARMACY, PROVIDED, HOWEVER,  THAT  WHEN  THE
 SELECTED  BENCHMARK  INDEX  DOES  NOT  INCLUDE  ONE  OR  MORE PARTICULAR
 PRESCRIPTION DRUGS, A HIERARCHY OF BENCHMARK INDICES SHALL  BE  USED  IN
 THEIR  HIERARCHICAL  ORDER  AND  SUCH  SECONDARY  INDEX SHALL BE USED TO
 PROVIDE PRICING FOR ONLY THOSE DRUGS NOT INCLUDED IN THE MAIN INDEX.  IF
 THE  TWO  SELECTED  BENCHMARKS  DO  NOT  INCLUDE  ONE OR MORE PARTICULAR
 PRESCRIPTION DRUGS, A THIRD BENCHMARK INDEX SHALL  BE  USED  TO  PROVIDE
 PRICING ONLY FOR THOSE DRUGS NOT INCLUDED IN THE MAIN INDEX OR SECONDARY
 INDEX. ALL PARTICIPATING NETWORK PHARMACIES, NON-MAIL ORDER RETAIL PHAR-
 MACIES  AND  MAIL  ORDER  PHARMACIES,  SHALL RECEIVE A DISCLOSURE OF THE
 REIMBURSEMENT HIERARCHY, THE CURRENT BENCHMARK PRICES  FOR  THE  INDICES
 INCLUDED  IN  THE HIERARCHY, AND MONTHLY UPDATES TO THE BENCHMARK PRICES
 FOR EACH OF THE HIERARCHICAL INDICES. ANY  CHANGE  TO  THE  HIERARCHICAL
 BENCHMARK  STRUCTURE  SHALL NOT BE MADE UNLESS NOTICE OF SUCH CHANGE HAS
 BEEN PROVIDED TO ALL PARTICIPATING NETWORK PHARMACIES, AT  LEAST  THIRTY
 DAYS IN ADVANCE OF SUCH CHANGE.
   (B) "MAIL ORDER PHARMACY" SHALL MEAN A PHARMACY WHOSE PRIMARY BUSINESS
 IS  TO  RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX OR THROUGH ELECTRONIC
 SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH  THE  USE  OF
 THE  UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
 PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE-
 TO-FACE.
   (C) "STANDARD TERMS AND CONDITIONS" SHALL MEAN THE  CONTRACTUAL  TERMS
 AND  CONDITIONS  APPLICABLE TO ALL NETWORK NON-MAIL ORDER RETAIL PHARMA-
 CIES, PROVIDED, HOWEVER THAT  FOR  MAIL  ORDER  PRESCRIPTIONS  THAT  ARE
 SUBJECT  TO  THE  FEDERAL  DRUG ADMINISTRATION RISK EVALUATION AND MITI-
 GATION STRATEGIES PROGRAM, THE INSURANCE POLICY MAY IMPOSE AN ADDITIONAL
 TERM AND CONDITION REQUIRING DOCUMENTATION STATING THAT THE PHARMACY  IS
 AUTHORIZED  TO  DISPENSE  SUCH MAIL ORDER PRESCRIPTION BEFORE A NON-MAIL
 ORDER RETAIL PHARMACY MAY BE REIMBURSED FOR DISPENSING SUCH  MAIL  ORDER
 PRESCRIPTION DRUG.
   (2)  Any contract issued by a medical expense indemnity corporation, a
 hospital service corporation  or  a  health  services  corporation  that
 provides  coverage  for  prescription  drugs  shall  permit each covered
 person to fill any covered  prescription  that  may  be  obtained  at  a
 network  participating  mail  order or other non-retail pharmacy, at the
 covered person's option,  at  a  network  participating  non-mail  order
 retail  pharmacy  provided that the network participating non-mail order
 retail pharmacy agrees [in advance, through a contractual network agree-
 ment,] to the same reimbursement amount[, as well as the same applicable
 terms and conditions,] AND STANDARD TERMS AND CONDITIONS that the corpo-
 ration has established for the  network  participating  [mail  order  or
 other  non-retail  pharmacy] NON-MAIL ORDER RETAIL PHARMACIES. In such a
 case, the contract shall not impose a copayment fee or other  condition,
 INCLUDING  REQUIRING  MONTHLY REFILLS OF A PRESCRIPTION THAT WAS WRITTEN
 FOR AND MAY BE FILLED FOR MORE THAN A THIRTY-DAY SUPPLY, on any  covered
 person  who  elects  to purchase drugs from a network participating non-
 mail order retail pharmacy which is not also imposed on covered  persons
 electing  to  purchase  drugs from a network participating mail order or
 other non-retail pharmacy; provided, however,  that  the  provisions  of
 this  section  shall  not supersede the terms of a collective bargaining
 agreement or apply to a contract that is  the  result  of  a  collective
 bargaining  agreement  between an employer and a recognized or certified
 employee organization.

 S. 1766                            10
 
   (3) ANY POLICY THAT PROVIDES COVERAGE  FOR  PRESCRIPTION  DRUGS  SHALL
 REQUIRE  MAIL  ORDER  PHARMACIES TO REPLACE DISPENSED PRESCRIPTION DRUGS
 THAT HAVE BEEN SPOILED OR DAMAGED, PROVIDED THAT THE POLICY MAY  REQUIRE
 THAT  THE  SPOILED  OR DAMAGED PRESCRIPTION DRUG BE RETURNED TO THE MAIL
 ORDER  PHARMACY WITH THE COST TO BE BORNE BY SUCH PHARMACY, AND PROVIDED
 FURTHER THAT SUCH SPOILED OR DAMAGED PRESCRIPTION DRUG SHALL BE REPLACED
 IN AN AMOUNT THAT IS NOT LESS THAN A THIRTY DAY SUPPLY BEFORE RECEIPT OF
 THE SPOILED OR DAMAGED PRESCRIPTION DRUG. IF  SUCH  SPOILED  OR  DAMAGED
 PRESCRIPTION  DRUG  IS NOT RETURNED, THE POLICY  MAY REQUIRE THE INSURED
 TO REIMBURSE THE POLICY FOR THE  COST  OF  THE  PRESCRIPTION  DRUG  AND,
 NOTWITHSTANDING  THE  FOREGOING,  WHEN  AN  INSURED  WHO  WAS PREVIOUSLY
 REQUIRED TO REIMBURSE THE POLICY FOR A DISPENSED PRESCRIPTION DRUG  THAT
 WAS   SPOILED  OR  DAMAGED,  THE  POLICY  MAY  REFUSE  TO  REPLACE  SUCH
 PRESCRIPTION DRUG FOR SUCH INSURED UNTIL SUCH INSURED HAS  RETURNED  THE
 SPOILED OR DAMAGED PRESCRIPTION DRUG. REPLACEMENT OF A PRESCRIPTION DRUG
 PURSUANT  TO THIS PARAGRAPH SHALL NOT BE LIMITED TO A SPECIFIC NUMBER OF
 OCCURRENCES DURING A CONTRACT YEAR.
   § 6. Severability. If any clause, sentence, paragraph, section or part
 of this act shall be adjudged by any court of competent jurisdiction  to
 be  invalid,  the  judgement shall not affect, impair, or invalidate the
 remainder thereof, but shall be confined in its operation to the clause,
 sentence, paragraph, section or part thereof directly  involved  in  the
 controversy in which the judgement shall have been rendered.
   § 7. This act shall take effect immediately.

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Senate Bill S1766

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

co-Sponsors

2017-S1766 (ACTIVE) - Details

2017-S1766 (ACTIVE) - Summary

2017-S1766 (ACTIVE) - Sponsor Memo

2017-S1766 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S1766

Share this bill

Sponsored By

Martin J. Golden

Archive: Last Bill Status - In Senate Committee Insurance Committee

co-Sponsors

Joseph P. Addabbo Jr.

Phil Boyle

Andrew J. Lanza

Thomas F. O'Mara

2017-S1766 (ACTIVE) - Details

2017-S1766 (ACTIVE) - Summary

2017-S1766 (ACTIVE) - Sponsor Memo

2017-S1766 (ACTIVE) - Bill Text download pdf

Comments