Senate Bill S8651

2017-2018 Legislative Session

Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals

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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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2017-S8651 (ACTIVE) - Details

See Assembly Version of this Bill:
A10215
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Add §§4806, 3224-d & 4303-a, amd §§4903, 4910, 4914, 3216, 3221, 4303, 4325 & 3231, Ins L; add §4406-h, amd §§4903, 4910, 4914 & 280-a, Pub Health L; amd §§367-a & 364-j, Soc Serv L; amd §§6810 & 6826-a, Ed L
Versions Introduced in Other Legislative Sessions:
2019-2020: S6244, A4521
2021-2022: A5046
2023-2024: A8067

2017-S8651 (ACTIVE) - Summary

Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals; to access to retail pharmacies, prescription synchronization, limits on patient drug costs, explanations of benefits and rebates; to prescription drug synchronization; to pharmacy benefit management

2017-S8651 (ACTIVE) - Sponsor Memo

2017-S8651 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8651
 
                             I N  S E N A T E
 
                               May 10, 2018
                                ___________
 
 Introduced by Sen. ALCANTARA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to  access  to  appropriate  drugs  at  reasonable  prices,  formulary
   exceptions, standing prior authorizations  and  external  appeals;  to
   amend  the  insurance law, in relation to access to retail pharmacies,
   prescription synchronization, limits on patient drug  costs,  explana-
   tions  of  benefits  and rebates; to amend the social services law, in
   relation to prescription drug synchronization;  to  amend  the  public
   health  law,  in relation to pharmacy benefit management; and to amend
   the education law, in  relation  to  limits  on  copayments  and  drug
   substitutions
 
   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  4806
 to read as follows:
   §  4806.  ACCESS  TO APPROPRIATE DRUGS AT REASONABLE PRICES; FORMULARY
 EXCEPTIONS; STANDING PRIOR AUTHORIZATION  REQUIREMENT.  (A)  AN  INSURER
 OFFERING  A  PRESCRIPTION  DRUG  BENEFIT WITH A FORMULARY OF APPROVED OR
 PREFERRED DRUGS SHALL ESTABLISH  A  PROCEDURE  BY  WHICH  IT  DETERMINES
 WHETHER  A  FORMULARY  DRUG PROVIDES APPROPRIATE THERAPEUTIC BENEFITS TO
 MEET THE PARTICULAR HEALTH CARE NEEDS OF  AN  INSURED.  IF  THE  INSURER
 DETERMINES THAT NO FORMULARY DRUG PROVIDES APPROPRIATE THERAPEUTIC BENE-
 FITS TO MEET THE PARTICULAR HEALTH CARE NEEDS OF AN INSURED, THE INSURER
 SHALL  COVER  THE  COST OF AN OFF-FORMULARY DRUG FOR THAT INSURED, AT NO
 ADDITIONAL COST TO THE INSURED BEYOND WHAT THE INSURED  WOULD  OTHERWISE
 PAY FOR A PREFERRED BRAND NAME DRUG ON THE FORMULARY. THE DETERMINATIONS
 WHETHER  A  DRUG PROVIDES APPROPRIATE THERAPEUTIC BENEFITS AND WHETHER A
 NON-FORMULARY DRUG IS NECESSARY TO MEET THE PARTICULAR HEALTH CARE NEEDS
 OF THE INSURED ARE UTILIZATION REVIEW DECISIONS AND  ARE  REVIEWABLE  IN
 ACCORDANCE  WITH  ARTICLE FORTY-NINE OF THIS CHAPTER, INCLUDING EXTERNAL
 APPEAL.
   (B) (1) FOR PURPOSES OF THIS SECTION,  "PRIOR  AUTHORIZATION  REQUIRE-
 MENT"  MEANS ANY PRACTICE IMPLEMENTED BY AN INSURER IN WHICH COVERAGE OF
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

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