Senate Bill S5022C

2017-2018 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 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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Bill Amendments

co-Sponsors

2017-S5022 - Details

See Assembly Version of this Bill:
A2317
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L; add §4909, Pub Health L
Versions Introduced in Other Legislative Sessions:
2015-2016: S5382, A7707
2019-2020: S2849, A2969

2017-S5022 - Summary

Prohibits a health care plan from making prescription drug formulary changes during a contract year.

2017-S5022 - Sponsor Memo

2017-S5022 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5022
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               March 6, 2017
                                ___________
 
 Introduced  by  Sens.  SERINO, MURPHY -- 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:
   §  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
              

co-Sponsors

2017-S5022A - Details

See Assembly Version of this Bill:
A2317
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L; add §4909, Pub Health L
Versions Introduced in Other Legislative Sessions:
2015-2016: S5382, A7707
2019-2020: S2849, A2969

2017-S5022A - Summary

Prohibits a health care plan from making prescription drug formulary changes during a contract year.

2017-S5022A - Sponsor Memo

2017-S5022A - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5022--A
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               March 6, 2017
                                ___________
 
 Introduced  by  Sens.  SERINO,  CROCI, GRIFFO, LATIMER, MURPHY, SANDERS,
   SAVINO, VALESKY -- read twice and ordered printed, and when printed to
   be committed to the Committee on Insurance  --  committee  discharged,
   bill  amended,  ordered  reprinted  as amended and recommitted to said
   committee

 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.
                                                            LBD05529-05-7
              

co-Sponsors

2017-S5022B - Details

See Assembly Version of this Bill:
A2317
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L; add §4909, Pub Health L
Versions Introduced in Other Legislative Sessions:
2015-2016: S5382, A7707
2019-2020: S2849, A2969

2017-S5022B - Summary

Prohibits a health care plan from making prescription drug formulary changes during a contract year.

2017-S5022B - Sponsor Memo

2017-S5022B - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5022--B
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               March 6, 2017
                                ___________
 
 Introduced  by  Sens.  SERINO,  AVELLA, CROCI, GOLDEN, GRIFFO, KAMINSKY,
   KRUEGER, MURPHY, SANDERS, SAVINO, VALESKY -- read  twice  and  ordered
   printed,  and  when printed to be committed to the Committee on Insur-
   ance -- committee  discharged,  bill  amended,  ordered  reprinted  as
   amended  and  recommitted  to  said  committee  --  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 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

co-Sponsors

2017-S5022C (ACTIVE) - Details

See Assembly Version of this Bill:
A2317
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L; add §4909, Pub Health L
Versions Introduced in Other Legislative Sessions:
2015-2016: S5382, A7707
2019-2020: S2849, A2969

2017-S5022C (ACTIVE) - Summary

Prohibits a health care plan from making prescription drug formulary changes during a contract year.

2017-S5022C (ACTIVE) - Sponsor Memo

2017-S5022C (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5022--C
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               March 6, 2017
                                ___________
 
 Introduced by Sens. SERINO, ALCANTARA, AVELLA, BRESLIN, CARLUCCI, CROCI,
   GOLDEN, GRIFFO, HAMILTON, HANNON, HELMING, KAMINSKY, KENNEDY, KRUEGER,
   MARCHIONE,  MURPHY,  ORTT,  RITCHIE,  SANDERS, SAVINO, VALESKY -- read
   twice and ordered printed, and when printed to  be  committed  to  the
   Committee  on Insurance -- committee discharged, bill amended, ordered
   reprinted as amended and recommitted to said committee --  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  --  committee  discharged,  bill
   amended,  ordered reprinted as amended and recommitted to said commit-
   tee
 
 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

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05529-10-8
              

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