S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3043
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 28, 2019
                                ___________
 
 Introduced  by M. of A. JOYNER, AUBRY, BLAKE, BUCHWALD, CUSICK, CYMBROW-
   ITZ, DINOWITZ, GALEF,  GOTTFRIED,  GUNTHER,  HEVESI,  JAFFEE,  LAVINE,
   PAULIN,  PERRY,  RODRIGUEZ,  L. ROSENTHAL,  SIMON,  THIELE, ZEBROWSKI,
   COLTON, COOK, ORTIZ, MONTESANO, GLICK, CARROLL, D'URSO, CRESPO,  SIMO-
   TAS,  WOERNER, TAYLOR, STECK, MOSLEY -- Multi-Sponsored by -- M. of A.
   BRAUNSTEIN, CROUCH, NOLAN -- read once and referred to  the  Committee
   on Insurance
 
 AN  ACT  to  amend  the  insurance  law,  in relation to the purchase of
   prescription drugs
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  28  of  subsection  (i) of section 3216 of the
 insurance law, as amended by chapter 11 of the laws of 2012, is  amended
 to read as follows:
   (28) (A) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
   (1) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
 UNDER  SUBPARAGRAPH  (B) OF THIS PARAGRAPH SHALL PROVIDE THE SAME BENCH-
 MARK INDEX, INCLUDING THE SAME AVERAGE WHOLESALE PRICE,  MAXIMUM  ALLOW-
 ABLE  COST AND NATIONAL PRESCRIPTION DRUG CODES TO REIMBURSE ALL PHARMA-
 CIES PARTICIPATING IN THE INSURANCE  NETWORK  REGARDLESS  OF  WHETHER  A
 PHARMACY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
   (2)  "MAIL  ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY BUSINESS IS
 TO  RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH   ELECTRONIC
 SUBMISSIONS  AND  TO  DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
 THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES  AND
 PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE-
 TO-FACE.
   (B)  Any  policy  that  provides coverage for prescription drugs shall
 permit each insured  to  fill  any  covered  prescription  that  may  be
 obtained at a network participating mail order or other non-retail phar-
 macy, at the insured's option, at a network participating non-mail order
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00271-01-9

 A. 3043                             2
 
 retail  pharmacy  provided that the network participating non-mail order
 retail pharmacy agrees [in advance, through a contractual network agree-
 ment,] to the same reimbursement amount[, as well as the same applicable
 terms  and conditions,] that the insurer has established for the network
 participating mail order or other non-retail pharmacy. In such  a  case,
 the  policy  shall not impose a co-payment fee or other condition on any
 insured who elects to purchase prescription drugs from a network partic-
 ipating non-mail order retail pharmacy which  is  not  also  imposed  on
 insureds  electing  to  purchase drugs from a network participating mail
 order or other non-retail pharmacy.
   § 2. Paragraph 18 of subsection (l) of section 3221 of  the  insurance
 law, as amended by chapter 11 of the laws of 2012, is amended to read as
 follows:
   (18) (A) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
   (1) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
 UNDER  SUBPARAGRAPH  (B) OF THIS PARAGRAPH SHALL PROVIDE THE SAME BENCH-
 MARK INDEX, INCLUDING THE SAME AVERAGE WHOLESALE PRICE,  MAXIMUM  ALLOW-
 ABLE  COST AND NATIONAL PRESCRIPTION DRUG CODES TO REIMBURSE ALL PHARMA-
 CIES PARTICIPATING IN THE INSURANCE  NETWORK  REGARDLESS  OF  WHETHER  A
 PHARMACY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
   (2)  "MAIL  ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY BUSINESS IS
 TO  RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH   ELECTRONIC
 SUBMISSIONS  AND  TO  DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
 THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES  AND
 PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE-
 TO-FACE.
   (B)  Any  insurer  delivering  a  group or blanket policy or issuing a
 group or blanket policy for delivery in this state that provides  cover-
 age for prescription drugs shall permit each insured to fill any covered
 prescription  that may be obtained at a network participating mail order
 or other non-retail pharmacy, at the  insured's  option,  at  a  network
 participating  non-mail  order retail pharmacy provided that the network
 participating non-mail order retail pharmacy agrees [in advance, through
 a contractual network agreement,] to the same reimbursement amount[,  as
 well  as the same applicable terms and conditions,] that the insurer has
 established for the network participating mail order or other non-retail
 pharmacy. In such a case, the policy shall not impose a  co-payment  fee
 or  other  condition  on any insured who elects to purchase drugs from a
 network participating non-mail order retail pharmacy which is  not  also
 imposed  on  insureds  electing to purchase drugs from a network partic-
 ipating mail order or other non-retail pharmacy; provided, however, that
 the provisions of this section  shall  not  supersede  the  terms  of  a
 collective  bargaining agreement or apply to a policy that is the result
 of a collective bargaining agreement between an employer  and  a  recog-
 nized or certified employee organization.
   §  3. Subsection (kk) of section 4303 of the insurance law, as amended
 by chapter 11 of the laws of 2012 and as relettered  by  section  55  of
 part D of chapter 56 of the laws of 2013, is amended to read as follows:
   (kk) (1) DEFINITIONS. FOR THE PURPOSE OF THIS SUBSECTION:
   (A) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
 UNDER  PARAGRAPH TWO OF THIS SUBSECTION SHALL PROVIDE THE SAME BENCHMARK
 INDEX, INCLUDING THE SAME AVERAGE  WHOLESALE  PRICE,  MAXIMUM  ALLOWABLE
 COST  AND  NATIONAL  PRESCRIPTION DRUG CODES TO REIMBURSE ALL PHARMACIES
 PARTICIPATING IN THE HEALTH BENEFIT PLAN REGARDLESS OF WHETHER A PHARMA-
 CY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.

 A. 3043                             3
 
   (B) "MAIL ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY  BUSINESS  IS
 TO   RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH  ELECTRONIC
 SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH  THE  USE  OF
 THE  UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
 PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE-
 TO-FACE.
   (2)  Any contract issued by a medical expense indemnity corporation, a
 hospital service corporation  or  a  health  services  corporation  that
 provides  coverage  for  prescription  drugs  shall  permit each covered
 person to fill any covered  prescription  that  may  be  obtained  at  a
 network  participating  mail  order or other non-retail pharmacy, at the
 covered person's option,  at  a  network  participating  non-mail  order
 retail  pharmacy  provided that the network participating non-mail order
 retail pharmacy agrees [in advance, through a contractual network agree-
 ment,] to the same reimbursement amount[, as well as the same applicable
 terms and conditions,] that the  corporation  has  established  for  the
 network  participating mail order or other non-retail pharmacy.  In such
 a case, the contract shall not impose a copayment fee or other condition
 on any covered person who  elects  to  purchase  drugs  from  a  network
 participating  non-mail  order retail pharmacy which is not also imposed
 on covered persons electing to purchase drugs from a network participat-
 ing mail order or other non-retail pharmacy; provided, however, that the
 provisions of this section shall not supersede the terms of a collective
 bargaining agreement or apply to a contract that  is  the  result  of  a
 collective  bargaining agreement between an employer and a recognized or
 certified employee organization.
   § 4. This act shall take effect immediately.