senate Bill S5022

2017-2018 Legislative Session

Relates to prescription drug formulary changes during a contract year

download bill text pdf

Sponsored By

Current Bill Status - In Senate 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

Co-Sponsors

view additional co-sponsors

S5022 - Details

See Assembly Version of this Bill:
A2317
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L
Versions Introduced in 2015-2016 Legislative Session:
S5382A, A7707A

S5022 - Summary

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

S5022 - Sponsor Memo

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:
  S  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

view additional co-sponsors

S5022A - Details

See Assembly Version of this Bill:
A2317
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L
Versions Introduced in 2015-2016 Legislative Session:
S5382A, A7707A

S5022A - Summary

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

S5022A - Sponsor Memo

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:
  S 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

view additional co-sponsors

S5022B - Details

See Assembly Version of this Bill:
A2317
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L
Versions Introduced in 2015-2016 Legislative Session:
S5382A, A7707A

S5022B - Summary

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

S5022B - Sponsor Memo

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:
  S 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

Co-Sponsors

view additional co-sponsors

S5022C (ACTIVE) - Details

See Assembly Version of this Bill:
A2317
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L
Versions Introduced in 2015-2016 Legislative Session:
S5382A, A7707A

S5022C (ACTIVE) - Summary

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

S5022C (ACTIVE) - Sponsor Memo

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:
  S 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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