NY State Senate Bill 2017-S7191A

Archive: Last Bill Status - In Senate Committee Health 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

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Feb 08, 2018	print number 7191a
Feb 08, 2018	amend and recommit to health
Jan 03, 2018	referred to health

Bill Amendments

Original

A (Active)

2017-S7191 - Details

See Assembly Version of this Bill:: A9893
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add §280-c, Pub Health L; amd §§3217-b & 4325, Ins L

2017-S7191 - Summary

Relates to enhancing pharmaceutical transparency and consumer protection between pharmacies and pharmacy benefit managers.

2017-S7191 - Sponsor Memo

                                
 
BILL NUMBER: S7191

SPONSOR: GRIFFO
 
TITLE OF BILL:  An act to amend the public health law and the insur-
ance law, in relation to contracts between pharmacies and pharmacy bene-
fit managers

 
PURPOSE:

To prohibit contracts entered into between a pharmacist and health
carrier, pharmacy benefits manager, or any other entity from having a
provision that prohibits a pharmacist from disclosing information to an
individual purchasing prescription medication (e.g. cost, reimbursement
to the pharmacist for sale of the drug, efficacy of the medication and
any alternative, less expensive medications).

The bill would also prohibit requiring an individual in the state to pay
for pharmacy/pharmacist services greater than what they receive from
other payment sources (e.g. public and private health insurers).

 
SUMMARY OF PROVISIONS:

Section 1 prohibits a pharmacy services contract between a pharmacist or
pharmacy and a health carrier (e.g. insurer) or pharmacy benefits manag-
er from containing language prohibiting or penalizing the pharmacist or
pharmacy from disclosing certain information regarding the purchase of
prescription medication to an individual purchasing a prescription medi-
cation.

Additionally, pharmacy benefits managers and health carriers cannot
require an individual to pay for a covered prescription medication in an
amount greater than the lesser of the following: (1) applicable copay-
ment, (2) allowable claim amount, or (3) amount an individual would pay
for the prescription if they were to have paid without using an insur-
ance plan or other source of drug benefits or discounts.

Any contract containing any provision in violation of the aforementioned
in this section is void and unenforceable.

Section 2 states that contracts between a health care provider and a
health carrier cannot contain a provision prohibiting disclosure of (1)
billed or allowed amounts, reimbursement rates, or out-of-pocket costs
or (2) any data related to the all payor database (APD).

No contract entered into under this article between a health care
provider, or any agent or vendor retained by the health care provider to
provide data or analytical services to evaluate and manage health care
services provided to the insurer's plan participants, and the insurer
shall contain a provision prohibiting disclosure of billed or allowed
amounts, reimbursement rates or out-of-pocket costs, or any data to the
all payor database (APD).

Any contract containing any provision in violation of the aforementioned
in this section is void and unenforceable.

Section 3 states that no corporation organized under this article shall
by contract, written policy or written procedure prohibit or restrict
any health care provider from disclosure of billed or allowed amounts,

reimbursement rates or out-of-pocket costs, or any data to the all payor
database (APD).

Section 4 is the effective date

 
JUSTIFICATION:

It has been revealed that there are a number of pharmacies and pharma-
cists who are having to enter into contracts with health carriers or
pharmacy benefits managers that contain gag orders which prohibit or
penalize pharmacists or pharmacies that disclose certain information.
This is unreasonable and unnecessary. Not only are pharmacists important
to the medical community, they are important to the communities which
they serve as well. Oftentimes these individuals are the most direct,
personal connection that a patient receiving a prescription drug has.
That's why it is important that we free them from the constraint of
these gag orders so as to allow them to properly serve patients when it
comes to prescriptions.

 
LEGISLATIVE HISTORY:

New Bill.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2017-S7191 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7191
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 3, 2018
                                ___________
 
 Introduced  by  Sen.  GRIFFO -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the public health law and the insurance law, in relation
   to contracts between pharmacies and pharmacy benefit managers
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  The  public health law is amended by adding a new section
 280-c to read as follows:
   § 280-C. CONTRACTS BETWEEN PHARMACIES AND PHARMACY  BENEFIT  MANAGERS.
 1.  ON  AND  AFTER JANUARY FIRST, TWO THOUSAND EIGHTEEN, NO CONTRACT FOR
 PHARMACY SERVICES ENTERED INTO IN THE STATE BETWEEN A  HEALTH  INSURANCE
 CARRIER OR A PHARMACY BENEFIT MANAGER, AS DEFINED IN SECTION TWO HUNDRED
 EIGHTY-A  OF  THIS  ARTICLE,  AND A PHARMACY, PHARMACIST OR A PHARMACY'S
 CONTRACTING AGENT, SUCH AS A PHARMACY SERVICES ADMINISTRATIVE  ORGANIZA-
 TION,  SHALL  CONTAIN  A  PROVISION PROHIBITING OR PENALIZING, INCLUDING
 THROUGH INCREASED UTILIZATION REVIEW, REDUCED PAYMENTS OR  OTHER  FINAN-
 CIAL  DISINCENTIVES, A PHARMACIST'S DISCLOSURE TO AN INDIVIDUAL PURCHAS-
 ING PRESCRIPTION MEDICATION OF INFORMATION REGARDING (A) THE COST OF THE
 PRESCRIPTION MEDICATION TO THE INDIVIDUAL, OR (B)  THE  AVAILABILITY  OF
 ANY  THERAPEUTICALLY  EQUIVALENT  ALTERNATIVE MEDICATIONS OR ALTERNATIVE
 METHODS OF PURCHASING THE PRESCRIPTION MEDICATION,  INCLUDING,  BUT  NOT
 LIMITED  TO,  PAYING A CASH PRICE, THAT ARE LESS EXPENSIVE THAN THE COST
 OF THE PRESCRIPTION MEDICATION TO THE INDIVIDUAL.
   2. ON AND AFTER JANUARY FIRST, TWO THOUSAND EIGHTEEN, NO HEALTH INSUR-
 ANCE CARRIER OR PHARMACY BENEFIT MANAGER SHALL REQUIRE AN INDIVIDUAL  TO
 MAKE  A  PAYMENT AT THE POINT OF SALE FOR A COVERED PRESCRIPTION MEDICA-
 TION IN AN AMOUNT GREATER THAN THE LESSER OF (A) THE  APPLICABLE  COPAY-
 MENT  FOR  SUCH  PRESCRIPTION MEDICATION, (B) THE ALLOWABLE CLAIM AMOUNT
 FOR THE PRESCRIPTION MEDICATION, OR (C) THE AMOUNT AN  INDIVIDUAL  WOULD
 PAY  FOR  THE  PRESCRIPTION  MEDICATION  IF THE INDIVIDUAL PURCHASED THE
 PRESCRIPTION MEDICATION WITHOUT USING A HEALTH BENEFIT PLAN OR ANY OTHER
 SOURCE  OF  PRESCRIPTION  MEDICATION  BENEFITS  OR  DISCOUNTS.  FOR  THE
 PURPOSES  OF THIS SECTION, "ALLOWABLE CLAIM AMOUNT" MEANS THE AMOUNT THE

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13660-02-7

 S. 7191                             2
 
 HEALTH INSURANCE CARRIER OR PHARMACY BENEFIT MANAGER HAS AGREED  TO  PAY
 THE PHARMACY FOR THE PRESCRIPTION MEDICATION.
   3.  ANY  PROVISION  OF A CONTRACT THAT VIOLATES THE PROVISIONS OF THIS
 SECTION SHALL BE VOID AND UNENFORCEABLE. ANY GENERAL  BUSINESS  PRACTICE
 THAT  VIOLATES THE PROVISIONS OF THIS SECTION SHALL CONSTITUTE AN UNFAIR
 TRADE PRACTICE PURSUANT TO SECTION THREE HUNDRED FORTY  OF  THE  GENERAL
 BUSINESS  LAW.  THE  INVALIDITY  OR  UNENFORCEABILITY  OF  ANY  CONTRACT
 PROVISION UNDER THIS SUBSECTION SHALL NOT AFFECT ANY OTHER PROVISION  OF
 SUCH CONTRACT.
   4.  THE SUPERINTENDENT, AS DEFINED IN SECTION ONE HUNDRED SEVEN OF THE
 INSURANCE LAW, MAY ENFORCE THE PROVISIONS  OF  THIS  SECTION,  AND  UPON
 REQUEST,  AUDIT A CONTRACT FOR PHARMACY SERVICES FOR COMPLIANCE WITH THE
 PROVISIONS OF THIS SECTION.
   5. IN ANY ACTION BROUGHT UNDER SECTION  THREE  HUNDRED  FORTY  OF  THE
 GENERAL  BUSINESS  LAW, A DEFENDANT THAT SELLS, DISTRIBUTES OR OTHERWISE
 DISPOSES OF ANY DRUG OR DEVICE, AS DEFINED IN 21 USC 321 MAY NOT  ASSERT
 AS A DEFENSE THAT THE DEFENDANT DID NOT DEAL DIRECTLY WITH THE PERSON ON
 WHOSE  BEHALF  THE ACTION IS BROUGHT AND MAY, IN ORDER TO AVOID DUPLICA-
 TIVE LIABILITY, PROVE, AS A PARTIAL OR COMPLETE DEFENSE AGAINST A DAMAGE
 CLAIM, THAT ALL OR ANY PART OF AN  ALLEGED  OVERCHARGE  FOR  A  DRUG  OR
 DEVICE  ULTIMATELY  WAS  PASSED ON TO ANOTHER PERSON BY A PURCHASER OR A
 SELLER IN THE CHAIN OF MANUFACTURE, PRODUCTION OR  DISTRIBUTION  OF  THE
 DRUG OR DEVICE THAT PAID THE ALLEGED OVERCHARGE.
   §  2.  Section  3217-b of the insurance law is amended by adding a new
 subsection (l) to read as follows:
   (L) (1) NO INSURER SUBJECT TO THIS ARTICLE SHALL BY CONTRACT,  WRITTEN
 POLICY OR WRITTEN PROCEDURE PROHIBIT OR RESTRICT ANY HEALTH CARE PROVID-
 ER FROM DISCLOSURE OF (I) BILLED OR ALLOWED AMOUNTS, REIMBURSEMENT RATES
 OR  OUT-OF-POCKET  COSTS,  OR  (II)  ANY  DATA TO THE ALL PAYOR DATABASE
 (APD). SUCH INFORMATION MAY BE USED TO  ASSIST  CONSUMERS  AND  INSTITU-
 TIONAL  PURCHASERS  IN  MAKING INFORMED DECISIONS REGARDING THEIR HEALTH
 CARE AND INFORMED CHOICES AMONG HEALTH CARE PROVIDERS AND ALLOW  COMPAR-
 ISONS  BETWEEN  PRICES  PAID  BY  VARIOUS HEALTH CARRIERS TO HEALTH CARE
 PROVIDERS.
   (2) NO CONTRACT ENTERED INTO UNDER THIS ARTICLE BETWEEN A HEALTH  CARE
 PROVIDER, OR ANY AGENT OR VENDOR RETAINED BY THE HEALTH CARE PROVIDER TO
 PROVIDE  DATA  OR ANALYTICAL SERVICES TO EVALUATE AND MANAGE HEALTH CARE
 SERVICES PROVIDED TO THE INSURER'S PLAN PARTICIPANTS,  AND  THE  INSURER
 SHALL  CONTAIN  A  PROVISION  PROHIBITING  DISCLOSURE  OF  (I) BILLED OR
 ALLOWED AMOUNTS, REIMBURSEMENT RATES OR OUT-OF-POCKET COSTS, OR (II) ANY
 DATA TO THE ALL PAYOR DATABASE (APD). SUCH INFORMATION MAY  BE  USED  TO
 ASSIST  CONSUMERS  AND INSTITUTIONAL PURCHASERS IN MAKING INFORMED DECI-
 SIONS REGARDING THEIR HEALTH CARE AND INFORMED CHOICES AMONG HEALTH CARE
 PROVIDERS AND ALLOW COMPARISONS BETWEEN PRICES PAID  BY  VARIOUS  HEALTH
 CARRIERS TO HEALTH CARE PROVIDERS.
   (3)  IF  A  CONTRACT  DESCRIBED  IN  PARAGRAPH  ONE  OR  TWO  OF  THIS
 SUBSECTION, WHICHEVER IS APPLICABLE,  CONTAINS  A  PROVISION  PROHIBITED
 UNDER  THE APPLICABLE PARAGRAPHS, SUCH PROVISION SHALL BE VOID AND UNEN-
 FORCEABLE. THE INVALIDITY OR UNENFORCEABILITY OF ANY CONTRACT  PROVISION
 UNDER  THIS  SUBSECTION  SHALL  NOT  AFFECT  ANY OTHER PROVISION OF SUCH
 CONTRACT.
   § 3. Section 4325 of the insurance law is  amended  by  adding  a  new
 subsection (m) to read as follows:
   (M) (1) NO CORPORATION ORGANIZED UNDER THIS ARTICLE SHALL BY CONTRACT,
 WRITTEN POLICY OR WRITTEN PROCEDURE PROHIBIT OR RESTRICT ANY HEALTH CARE
 PROVIDER FROM DISCLOSURE OF (I) BILLED OR ALLOWED AMOUNTS, REIMBURSEMENT

 S. 7191                             3
 
 RATES OR OUT-OF-POCKET COSTS, OR (II) ANY DATA TO THE ALL PAYOR DATABASE
 (APD).  SUCH  INFORMATION  MAY  BE USED TO ASSIST CONSUMERS AND INSTITU-
 TIONAL PURCHASERS IN MAKING INFORMED DECISIONS  REGARDING  THEIR  HEALTH
 CARE  AND INFORMED CHOICES AMONG HEALTH CARE PROVIDERS AND ALLOW COMPAR-
 ISONS BETWEEN PRICES PAID BY VARIOUS  HEALTH  CARRIERS  TO  HEALTH  CARE
 PROVIDERS.
   (2) NO CONTRACT OR AGREEMENT ENTERED INTO UNDER THIS ARTICLE BETWEEN A
 HEALTH CARE PROVIDER, OR ANY AGENT OR VENDOR RETAINED BY THE HEALTH CARE
 PROVIDER  TO  PROVIDE DATA OR ANALYTICAL SERVICES TO EVALUATE AND MANAGE
 HEALTH CARE SERVICES PROVIDED TO THE INSURER'S  PLAN  PARTICIPANTS,  AND
 THE  INSURER  SHALL  CONTAIN  A  PROVISION PROHIBITING DISCLOSURE OF (A)
 BILLED OR ALLOWED AMOUNTS, REIMBURSEMENT RATES OR  OUT-OF-POCKET  COSTS,
 OR (B) ANY DATA TO THE ALL PAYOR DATABASE (APD). SUCH INFORMATION MAY BE
 USED TO ASSIST CONSUMERS AND INSTITUTIONAL PURCHASERS IN MAKING INFORMED
 DECISIONS  REGARDING THEIR HEALTH CARE AND INFORMED CHOICES AMONG HEALTH
 CARE PROVIDERS AND ALLOW COMPARISONS  BETWEEN  PRICES  PAID  BY  VARIOUS
 HEALTH CARRIERS TO HEALTH CARE PROVIDERS.
   (3)  IF  A  CONTRACT  DESCRIBED  IN  PARAGRAPH  ONE  OR  TWO  OF  THIS
 SUBSECTION, WHICHEVER IS APPLICABLE,  CONTAINS  A  PROVISION  PROHIBITED
 UNDER  THE APPLICABLE PARAGRAPHS, SUCH PROVISION SHALL BE VOID AND UNEN-
 FORCEABLE. THE INVALIDITY OR UNENFORCEABILITY OF  ANY  POLICY  PROVISION
 UNDER  THIS  SUBSECTION  SHALL  NOT  AFFECT  ANY OTHER PROVISION OF SUCH
 CONTRACT.
   § 4. This act shall take effect immediately and  shall  apply  to  all
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date.

2017-S7191A (ACTIVE) - Details

See Assembly Version of this Bill:: A9893
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add §280-c, Pub Health L; amd §§3217-b & 4325, Ins L

2017-S7191A (ACTIVE) - Summary

Relates to enhancing pharmaceutical transparency and consumer protection between pharmacies and pharmacy benefit managers.

2017-S7191A (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S7191A

SPONSOR: GRIFFO
 
TITLE OF BILL:  An act to amend the public health law and the insur-
ance law, in relation to contracts between pharmacies and pharmacy bene-
fit managers

 
PURPOSE:

To prohibit contracts entered into between a pharmacist and health
carrier, pharmacy benefits manager, or any other entity from having a
provision that prohibits a pharmacist from disclosing information to an
individual purchasing prescription medication (e.g. cost, reimbursement
to the pharmacist for sale of the drug, efficacy of the medication and
any alternative, less expensive medications).

The bill would also prohibit requiring an individual in the state to pay
for pharmacy/pharmacist services greater than what they receive from
other payment sources (e.g. public and private health insurers).

 
SUMMARY OF PROVISIONS:

Section 1 prohibits a pharmacy services contract between a pharmacist or
pharmacy and a health carrier (e.g. insurer) or pharmacy benefits manag-
er from containing language prohibiting or penalizing the pharmacist or
pharmacy from disclosing certain information regarding the purchase of
prescription medication to an individual purchasing a prescription medi-
cation.

Additionally, pharmacy benefits managers and health carriers cannot
require an individual to pay for a covered prescription medication in an
amount greater than the lesser of the following: (1) applicable copay-
ment, (2) allowable claim amount, or (3) amount an individual would pay
for the prescription if they were to have paid without using an insur-
ance plan or other source of drug benefits or discounts.

Any contract containing any provision in violation of the aforementioned
in this section is void and unenforceable.

Section 2 states that contracts between a health care provider and a
health carrier cannot contain a provision prohibiting disclosure of (1)
billed or allowed amounts, reimbursement rates, or out-of-pocket costs
or (2) any data related to the all payor database (APD).

No contract entered into under this article between a health care
provider, or any agent or vendor retained by the health care provider to
provide data or analytical services to evaluate and manage health care
services provided to the insurer's plan participants, and the insurer
shall contain a provision prohibiting disclosure of billed or allowed
amounts, reimbursement rates or out-of-pocket costs, or any data to the
all payor database (APD).

Any contract containing any provision in violation of the aforementioned
in this section is void and unenforceable.

Section 3 states that no corporation organized under this article shall
by contract, written policy or written procedure prohibit or restrict
any health care provider from disclosure of billed or allowed amounts,

reimbursement rates or out-of-pocket costs, or any data to the all payor
database (APD).

Section 4 is the effective date

 
JUSTIFICATION:

It has been revealed that there are a number of pharmacies and pharma-
cists who are having to enter into contracts with health carriers or
pharmacy benefits managers that contain gag orders which prohibit or
penalize pharmacists or pharmacies that disclose certain information.
This is unreasonable and unnecessary. Not only are pharmacists important
to the medical community, they are important to the communities which
they serve as well. Oftentimes these individuals are the most direct,
personal connection that a patient receiving a prescription drug has.
That's why it is important that we free them from the constraint of
these gag orders so as to allow them to properly serve patients when it
comes to prescriptions.

 
LEGISLATIVE HISTORY:

New bill.

 
EFFECTIVE DATE:
Immediately.

2017-S7191A (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7191--A
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 3, 2018
                                ___________
 
 Introduced  by  Sen.  GRIFFO -- read twice and ordered printed, and when
   printed to be committed  to  the  Committee  on  Health  --  committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 AN ACT to amend the public health law and the insurance law, in relation
   to contracts between pharmacies and pharmacy benefit managers
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The public health law is amended by adding  a  new  section
 280-c to read as follows:
   §  280-C.  CONTRACTS BETWEEN PHARMACIES AND PHARMACY BENEFIT MANAGERS.
 1. ON AND AFTER JANUARY FIRST, TWO THOUSAND NINETEEN,  NO  CONTRACT  FOR
 PHARMACY  SERVICES  ENTERED INTO IN THE STATE BETWEEN A HEALTH INSURANCE
 CARRIER OR A PHARMACY BENEFIT MANAGER, AS DEFINED IN SECTION TWO HUNDRED
 EIGHTY-A OF THIS ARTICLE, AND A PHARMACY,  PHARMACIST  OR  A  PHARMACY'S
 CONTRACTING  AGENT, SUCH AS A PHARMACY SERVICES ADMINISTRATIVE ORGANIZA-
 TION, SHALL CONTAIN A PROVISION  PROHIBITING  OR  PENALIZING,  INCLUDING
 THROUGH  INCREASED  UTILIZATION REVIEW, REDUCED PAYMENTS OR OTHER FINAN-
 CIAL DISINCENTIVES, A PHARMACIST'S DISCLOSURE TO AN INDIVIDUAL  PURCHAS-
 ING PRESCRIPTION MEDICATION OF INFORMATION REGARDING (A) THE COST OF THE
 PRESCRIPTION  MEDICATION  TO  THE INDIVIDUAL, OR (B) THE AVAILABILITY OF
 ANY THERAPEUTICALLY EQUIVALENT ALTERNATIVE  MEDICATIONS  OR  ALTERNATIVE
 METHODS  OF  PURCHASING  THE PRESCRIPTION MEDICATION, INCLUDING, BUT NOT
 LIMITED TO, PAYING A CASH PRICE, THAT ARE LESS EXPENSIVE THAN  THE  COST
 OF THE PRESCRIPTION MEDICATION TO THE INDIVIDUAL.
   2. ON AND AFTER JANUARY FIRST, TWO THOUSAND NINETEEN, NO HEALTH INSUR-
 ANCE  CARRIER OR PHARMACY BENEFIT MANAGER SHALL REQUIRE AN INDIVIDUAL TO
 MAKE A PAYMENT AT THE POINT OF SALE FOR A COVERED  PRESCRIPTION  MEDICA-
 TION  IN  AN AMOUNT GREATER THAN THE LESSER OF (A) THE APPLICABLE COPAY-
 MENT FOR SUCH PRESCRIPTION MEDICATION, (B) THE  ALLOWABLE  CLAIM  AMOUNT
 FOR  THE  PRESCRIPTION MEDICATION, OR (C) THE AMOUNT AN INDIVIDUAL WOULD
 PAY FOR THE PRESCRIPTION MEDICATION  IF  THE  INDIVIDUAL  PURCHASED  THE
 PRESCRIPTION MEDICATION WITHOUT USING A HEALTH BENEFIT PLAN OR ANY OTHER

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13660-03-8

 S. 7191--A                          2
 
 SOURCE  OF  PRESCRIPTION  MEDICATION  BENEFITS  OR  DISCOUNTS.  FOR  THE
 PURPOSES OF THIS SECTION, "ALLOWABLE CLAIM AMOUNT" MEANS THE AMOUNT  THE
 HEALTH  INSURANCE  CARRIER OR PHARMACY BENEFIT MANAGER HAS AGREED TO PAY
 THE PHARMACY FOR THE PRESCRIPTION MEDICATION.
   3.  ANY  PROVISION  OF A CONTRACT THAT VIOLATES THE PROVISIONS OF THIS
 SECTION SHALL BE VOID AND UNENFORCEABLE. ANY GENERAL  BUSINESS  PRACTICE
 THAT  VIOLATES THE PROVISIONS OF THIS SECTION SHALL CONSTITUTE AN UNFAIR
 TRADE PRACTICE PURSUANT TO SECTION THREE HUNDRED FORTY  OF  THE  GENERAL
 BUSINESS  LAW.  THE  INVALIDITY  OR  UNENFORCEABILITY  OF  ANY  CONTRACT
 PROVISION UNDER THIS SUBSECTION SHALL NOT AFFECT ANY OTHER PROVISION  OF
 SUCH CONTRACT.
   4.  THE SUPERINTENDENT, AS DEFINED IN SECTION ONE HUNDRED SEVEN OF THE
 INSURANCE LAW, MAY ENFORCE THE PROVISIONS  OF  THIS  SECTION,  AND  UPON
 REQUEST,  AUDIT A CONTRACT FOR PHARMACY SERVICES FOR COMPLIANCE WITH THE
 PROVISIONS OF THIS SECTION.
   5. IN ANY ACTION BROUGHT UNDER SECTION  THREE  HUNDRED  FORTY  OF  THE
 GENERAL  BUSINESS  LAW, A DEFENDANT THAT SELLS, DISTRIBUTES OR OTHERWISE
 DISPOSES OF ANY DRUG OR DEVICE, AS DEFINED IN 21 USC 321 MAY NOT  ASSERT
 AS A DEFENSE THAT THE DEFENDANT DID NOT DEAL DIRECTLY WITH THE PERSON ON
 WHOSE  BEHALF  THE ACTION IS BROUGHT AND MAY, IN ORDER TO AVOID DUPLICA-
 TIVE LIABILITY, PROVE, AS A PARTIAL OR COMPLETE DEFENSE AGAINST A DAMAGE
 CLAIM, THAT ALL OR ANY PART OF AN  ALLEGED  OVERCHARGE  FOR  A  DRUG  OR
 DEVICE  ULTIMATELY  WAS  PASSED ON TO ANOTHER PERSON BY A PURCHASER OR A
 SELLER IN THE CHAIN OF MANUFACTURE, PRODUCTION OR  DISTRIBUTION  OF  THE
 DRUG OR DEVICE THAT PAID THE ALLEGED OVERCHARGE.
   §  2.  Section  3217-b of the insurance law is amended by adding a new
 subsection (l) to read as follows:
   (L) (1) NO INSURER SUBJECT TO THIS ARTICLE SHALL BY CONTRACT,  WRITTEN
 POLICY OR WRITTEN PROCEDURE PROHIBIT OR RESTRICT ANY HEALTH CARE PROVID-
 ER FROM DISCLOSURE OF (I) BILLED OR ALLOWED AMOUNTS, REIMBURSEMENT RATES
 OR  OUT-OF-POCKET  COSTS,  OR  (II)  ANY  DATA TO THE ALL PAYOR DATABASE
 (APD). SUCH INFORMATION MAY BE USED TO  ASSIST  CONSUMERS  AND  INSTITU-
 TIONAL  PURCHASERS  IN  MAKING INFORMED DECISIONS REGARDING THEIR HEALTH
 CARE AND INFORMED CHOICES AMONG HEALTH CARE PROVIDERS AND ALLOW  COMPAR-
 ISONS  BETWEEN  PRICES  PAID  BY  VARIOUS HEALTH CARRIERS TO HEALTH CARE
 PROVIDERS.
   (2) NO CONTRACT ENTERED INTO UNDER THIS ARTICLE BETWEEN A HEALTH  CARE
 PROVIDER, OR ANY AGENT OR VENDOR RETAINED BY THE HEALTH CARE PROVIDER TO
 PROVIDE  DATA  OR ANALYTICAL SERVICES TO EVALUATE AND MANAGE HEALTH CARE
 SERVICES PROVIDED TO THE INSURER'S PLAN PARTICIPANTS,  AND  THE  INSURER
 SHALL  CONTAIN  A  PROVISION  PROHIBITING  DISCLOSURE  OF  (I) BILLED OR
 ALLOWED AMOUNTS, REIMBURSEMENT RATES OR OUT-OF-POCKET COSTS, OR (II) ANY
 DATA TO THE ALL PAYOR DATABASE (APD). SUCH INFORMATION MAY  BE  USED  TO
 ASSIST  CONSUMERS  AND INSTITUTIONAL PURCHASERS IN MAKING INFORMED DECI-
 SIONS REGARDING THEIR HEALTH CARE AND INFORMED CHOICES AMONG HEALTH CARE
 PROVIDERS AND ALLOW COMPARISONS BETWEEN PRICES PAID  BY  VARIOUS  HEALTH
 CARRIERS TO HEALTH CARE PROVIDERS.
   (3)  IF  A  CONTRACT  DESCRIBED  IN  PARAGRAPH  ONE  OR  TWO  OF  THIS
 SUBSECTION, WHICHEVER IS APPLICABLE,  CONTAINS  A  PROVISION  PROHIBITED
 UNDER  THE APPLICABLE PARAGRAPHS, SUCH PROVISION SHALL BE VOID AND UNEN-
 FORCEABLE. THE INVALIDITY OR UNENFORCEABILITY OF ANY CONTRACT  PROVISION
 UNDER  THIS  SUBSECTION  SHALL  NOT  AFFECT  ANY OTHER PROVISION OF SUCH
 CONTRACT.
   § 3. Section 4325 of the insurance law is  amended  by  adding  a  new
 subsection (m) to read as follows:

 S. 7191--A                          3

   (M) (1) NO CORPORATION ORGANIZED UNDER THIS ARTICLE SHALL BY CONTRACT,
 WRITTEN POLICY OR WRITTEN PROCEDURE PROHIBIT OR RESTRICT ANY HEALTH CARE
 PROVIDER FROM DISCLOSURE OF (I) BILLED OR ALLOWED AMOUNTS, REIMBURSEMENT
 RATES OR OUT-OF-POCKET COSTS, OR (II) ANY DATA TO THE ALL PAYOR DATABASE
 (APD).  SUCH  INFORMATION  MAY  BE USED TO ASSIST CONSUMERS AND INSTITU-
 TIONAL PURCHASERS IN MAKING INFORMED DECISIONS  REGARDING  THEIR  HEALTH
 CARE  AND INFORMED CHOICES AMONG HEALTH CARE PROVIDERS AND ALLOW COMPAR-
 ISONS BETWEEN PRICES PAID BY VARIOUS  HEALTH  CARRIERS  TO  HEALTH  CARE
 PROVIDERS.
   (2) NO CONTRACT OR AGREEMENT ENTERED INTO UNDER THIS ARTICLE BETWEEN A
 HEALTH CARE PROVIDER, OR ANY AGENT OR VENDOR RETAINED BY THE HEALTH CARE
 PROVIDER  TO  PROVIDE DATA OR ANALYTICAL SERVICES TO EVALUATE AND MANAGE
 HEALTH CARE SERVICES PROVIDED TO THE INSURER'S  PLAN  PARTICIPANTS,  AND
 THE  INSURER  SHALL  CONTAIN  A  PROVISION PROHIBITING DISCLOSURE OF (A)
 BILLED OR ALLOWED AMOUNTS, REIMBURSEMENT RATES OR  OUT-OF-POCKET  COSTS,
 OR (B) ANY DATA TO THE ALL PAYOR DATABASE (APD). SUCH INFORMATION MAY BE
 USED TO ASSIST CONSUMERS AND INSTITUTIONAL PURCHASERS IN MAKING INFORMED
 DECISIONS  REGARDING THEIR HEALTH CARE AND INFORMED CHOICES AMONG HEALTH
 CARE PROVIDERS AND ALLOW COMPARISONS  BETWEEN  PRICES  PAID  BY  VARIOUS
 HEALTH CARRIERS TO HEALTH CARE PROVIDERS.
   (3)  IF  A  CONTRACT  DESCRIBED  IN  PARAGRAPH  ONE  OR  TWO  OF  THIS
 SUBSECTION, WHICHEVER IS APPLICABLE,  CONTAINS  A  PROVISION  PROHIBITED
 UNDER  THE APPLICABLE PARAGRAPHS, SUCH PROVISION SHALL BE VOID AND UNEN-
 FORCEABLE. THE INVALIDITY OR UNENFORCEABILITY OF  ANY  POLICY  PROVISION
 UNDER  THIS  SUBSECTION  SHALL  NOT  AFFECT  ANY OTHER PROVISION OF SUCH
 CONTRACT.
   § 4. This act shall take effect immediately and  shall  apply  to  all
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Senate Bill S7191A

Sponsored By

Archive: Last Bill Status - In Senate Committee Health Committee

Bill Amendments

2017-S7191 - Details

2017-S7191 - Summary

2017-S7191 - Sponsor Memo

2017-S7191 - Bill Text download pdf

2017-S7191A (ACTIVE) - Details

2017-S7191A (ACTIVE) - Summary

2017-S7191A (ACTIVE) - Sponsor Memo

2017-S7191A (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S7191A

Share this bill

Sponsored By

Joseph A. Griffo

Archive: Last Bill Status - In Senate Committee Health Committee

Bill Amendments

2017-S7191 - Details

2017-S7191 - Summary

2017-S7191 - Sponsor Memo

2017-S7191 - Bill Text download pdf

2017-S7191A (ACTIVE) - Details

2017-S7191A (ACTIVE) - Summary

2017-S7191A (ACTIVE) - Sponsor Memo

2017-S7191A (ACTIVE) - Bill Text download pdf

Comments