NY State Senate Bill S5022C

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 (8)

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Apr 17, 2018	print number 5022c
Apr 17, 2018	amend and recommit to insurance
Jan 18, 2018	print number 5022b
Jan 18, 2018	amend and recommit to insurance
Jan 03, 2018	referred to insurance
Jun 14, 2017	print number 5022a
Jun 14, 2017	amend (t) and recommit to insurance
Mar 06, 2017	referred to insurance

Bill Amendments

Original

C (Active)

Original

C (Active)

Co-Sponsors

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

S5022 - Summary

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

S5022 - Sponsor Memo

 BILL NUMBER:  S5022

 TITLE OF BILL :  An act to amend the insurance law, in relation to
prescription drug formulary changes during a contract year

 PURPOSE :

To clarify that health insurance consumers covered by plans that are
required to offer essential health benefits under the affordable care
act are protected from adverse effects of mid-year formulary changes.

 SUMMARY OF PROVISIONS :

Section 1 creates a new section 4909 of the Insurance Law to state
that a health care plan which provides essential health benefits under
the federal affordable care act may not remove a prescription drug
from a formulary during the enrollment year. If the plan's drug
formulary has two or more tiers of drug benefits with different
deductibles, copayments or coinsurance, the plan may not move a drug
to a tier with higher patient cost sharing during the enrollment year.
The plan may also not add new or additional formulary restrictions
during the enrollment year. A health care plan may move a prescription
drug to a tier with a larger copayment, coinsurance and different
deductible if an AB-rated generic equivalent drug is added to the
formulary at the same time.

Section 2 provides that this act would take effect on the 60th day
after enactment, provided that effective immediately the
superintendent of insurance may make regulations and take other
actions necessary to implement the act.

 JUSTIFICATION :

The purpose of the bill is to ensure that enrollees who select a
health exchange plan based on their individual prescription drug needs
have assurance that the health plan will maintain continuity in
coverage for those prescription drugs during the course of the
enrollment year. Enrollees choose health exchange plans based on the
formulary status of a necessary therapy. Not only can these unexpected
formulary changes be extremely financially burdensome, a change in
prescription drug availability could result in serious medical
problems for the enrollee.

 LEGISLATIVE HISTORY :

2017: S.5382-A, Referred to Insurance

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
On the 60th day after enactment, provided that effective immediately
the superintendent of insurance may make regulations and take other
actions necessary to implement the act.

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

S. 5022                             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.

Co-Sponsors

view additional co-sponsors

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

S5022A - Summary

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

S5022A - Sponsor Memo

 BILL NUMBER:  S5022A

 TITLE OF BILL :  An act to amend the insurance law and the public
health law, in relation to prescription drug formulary changes during
a contract year

 PURPOSE :

To clarify that health insurance consumers are protected from adverse
effects of mid-year formulary changes.

 SUMMARY OF PROVISIONS :

Section 1 creates a new section 4909 of the Insurance Law to add
restrictions to drug formulary changes. If the plan's drug formulary
has two or more tiers of drug benefits with different deductibles,
copayments or coinsurance, the plan may not move a drug to a tier with
higher patient cost sharing during the enrollment year.  Additionally,
the plan may not add new utilization management restrictions to a
formulary drug, unless such changes occur at the time of enrollment or
issuance of coverage. A health care plan may move a prescription drug
to a tier with a larger copayment, coinsurance and different
deductible if an AB-rated generic equivalent drug is added to the
formulary at the same time or if the federal Food and Drug
Administration determines that such drug should be removed from the
market, including new utilization management restrictions arising from

safety concerns.

Section 2 adds a new section 4909 of the Public Health Law to add
similar provisions as Section 1 of this act.

Section 3 provides that this act would take effect on the 60th day
after enactment, provided that effective immediately the
superintendent of insurance may make regulations and take other
actions necessary to implement the act.

 JUSTIFICATION :

The purpose of the bill is to ensure that health insurance enrollees
have assurance that their health plan will maintain continuity in
coverage for their prescription drugs during the course of the
enrollment year. Enrollees choose health exchange plans based on the
formulary status of a necessary therapy. Not only can these unexpected
formulary changes be extremely financially burdensome, a change in
prescription drug availability could result in serious medical
problems for the enrollee.

 LEGISLATIVE HISTORY :

2017: S .5382-A, Referred to Insurance

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
On the 60th day after enactment, provided that effective immediately
the superintendent of insurance may make regulations and take other
actions necessary to implement the act.

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

S. 5022--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.

Co-Sponsors

view additional co-sponsors

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

S5022B - Summary

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

S5022B - Sponsor Memo

 
BILL NUMBER: S5022B

SPONSOR: SERINO
 
TITLE OF BILL:

An act to amend the insurance law and the public health law, in relation
to prescription drug formulary changes during a contract year

 
PURPOSE:

To clarify that health insurance consumers are protected from adverse
effects of mid-year formulary changes.

 
SUMMARY OF PROVISIONS:

Section 1 creates a new section 4909 of the Insurance Law to add
restrictions to drug formulary changes. If the plan's drug formulary has
two or more tiers of drug benefits with different deductibles, copay-
ments or coinsurance, the plan may not move a drug to a tier with higher
patient cost sharing during the enrollment year.  Additionally, the plan
may not add new utilization management restrictions to a formulary drug,

unless such changes occur at the time of enrollment or issuance of
coverage, and must provide notice to policyholders of certain changes to
a formulary in an upcoming plan year. A health care plan may move a
prescription drug to a tier with a larger copayment, coinsurance and
different deductible if an AB-rated generic equivalent drug is added to
the formulary at the same time or if the federal Food and Drug Adminis-
tration determines that such drug should be removed from the market,
including new utilization management restrictions arising from safety
concerns.

Section 2 adds a new section 4909 of the Public Health Law to add simi-
lar provisions as Section 1 of this act.

Section 3 provides that this act would take effect on the 60th day after
enactment, provided that effective immediately the superintendent of
insurance may make regulations and take other actions necessary to
implement the act.

 
JUSTIFICATION:

The purpose of the bill is to ensure that health insurance enrollees
have assurance that their health plan will maintain continuity in cover-
age for their prescription drugs during the course of the enrollment
year. Enrollees choose health exchange plans based on the formulary
status of a necessary therapy. Not only can these unexpected formulary
changes be extremely financially burdensome, a change in prescription
drug availability could result in serious medical problems for the
enrollee.

 
LEGISLATIVE HISTORY:

2017: S.5382-A, Referred to Insurance

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
On the 60th day after enactment, provided that effective immediately the
superintendent of insurance may make regulations and take other actions
necessary to implement the act.

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.

                                                           LBD05529-09-8

S. 5022--B                          2

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.
  (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

S. 5022--B                          3

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.

Co-Sponsors

view additional co-sponsors

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

S5022C (ACTIVE) - Summary

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

S5022C (ACTIVE) - Sponsor Memo

 
BILL NUMBER: S5022C

SPONSOR: SERINO
 
TITLE OF BILL:  An act to amend the insurance law and the public
health law, in relation to prescription drug formulary changes during a
contract year

 
PURPOSE:

To clarify that health insurance consumers are protected from adverse
effects of mid-year formulary changes.

 
SUMMARY OF PROVISIONS:

Section 1 creates a new section 4909 of the Insurance Law to add
restrictions to drug formulary changes. If the plan's drug formulary has
two or more tiers of drug benefits with different deductibles, copay-
ments or coinsurance, the plan may not move a drug to a tier with higher
patient cost sharing during the enrollment year.  Additionally, the plan
may not add new utilization management restrictions to a formulary drug,
unless such changes occur at the time of enrollment or issuance of

coverage, and must provide notice to policyholders of certain changes to
a formulary in an upcoming plan year. A health care plan may move a
prescription drug to a tier with a larger copayment, coinsurance and
different deductible if an AB-rated generic equivalent drug or inter-
changeable biological equivalent is added to the formulary at the same
time. A prescription drug may be removed 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 aris-
ing from safety concerns.

Section 2 adds a new section 4909 of the Public Health Law to add simi-
lar provisions as Section 1 of this act.

Section 3 provides that this act would take effect on the 60th day after
enactment, provided that effective immediately the superintendent of
insurance may make regulations and take other actions necessary to
implement the act.

 
JUSTIFICATION:

The purpose of the bill is to ensure that health insurance enrollees
have assurance that their health plan will maintain continuity in cover-
age for their prescription drugs during the course of the enrollment
year. Enrollees choose health exchange plans based on the formulary
status of a necessary therapy. Not only can these unexpected formulary
changes be extremely financially burdensome, a change in prescription
drug availability could result in serious medical problems for the
enrollee.

 
LEGISLATIVE HISTORY:

2016: S.5382-A, Referred to Insurance

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
On the 60th day after enactment, provided that effective immediately the
superintendent of insurance may make regulations and take other actions
necessary to implement the act.

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

S. 5022--C                          2

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 OR INTERCHANGEABLE  BIOLOGICAL
PRODUCT 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
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 OR INTERCHANGEABLE BIOLOGICAL
PRODUCT 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

S. 5022--C                          3

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.

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