S T A T E O F N E W Y O R K
________________________________________________________________________
8310
2019-2020 Regular Sessions
I N A S S E M B L Y
June 13, 2019
___________
Introduced by M. of A. WALKER -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to requiring individual
and small group insurance carriers and group and blanket accident and
health carriers to certify that at least a majority of prescription
drug rebates are provided to patients at the point of sale
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 1 of subdivision (e) of section 3231 of the
insurance law is amended by adding a new subparagraph (C) to read as
follows:
(C) AN INSURER SHALL ANNUALLY CERTIFY TO THE DEPARTMENT THAT, DURING
THE PRIOR BENEFIT YEAR, THE INSURER MADE AVAILABLE TO ENROLLEES AT THE
POINT OF SALE AT LEAST A MAJORITY (I.E., GREATER THAN FIFTY PERCENT) OF
THE REBATES RECEIVED BY SUCH INSURER OR ANY THIRD PARTY ADMINISTERING
PRESCRIPTION DRUG BENEFITS ON BEHALF OF SUCH INSURER.
(I) FOR PURPOSES OF THIS PARAGRAPH, "REBATE" MEANS:
(1) NEGOTIATED PRICE CONCESSIONS INCLUDING BUT NOT LIMITED TO BASE
REBATES AND REASONABLE ESTIMATES OF ANY PRICE PROTECTION REBATES AND
PERFORMANCE-BASED REBATES THAT MAY ACCRUE DIRECTLY OR INDIRECTLY TO THE
ISSUER DURING THE COVERAGE YEAR FROM A MANUFACTURER, DISPENSING PHARMA-
CY, OR OTHER PARTY TO THE TRANSACTION, AND
(2) REASONABLE ESTIMATES OF ANY FEES AND OTHER ADMINISTRATIVE COSTS
THAT ARE PASSED THROUGH TO THE ISSUER AND SERVE TO REDUCE THE ISSUER'S
PRESCRIPTION DRUG LIABILITIES FOR THE COVERAGE YEAR.
(II) IN PROVIDING THE CERTIFICATION REQUIRED UNDER THIS SUBPARAGRAPH,
AN ISSUER SHALL NOT PUBLISH OR OTHERWISE REVEAL INFORMATION REGARDING
THE ACTUAL AMOUNT OF REBATES THE ISSUER RECEIVED ON A PRODUCT-, MANUFAC-
TURER- OR PHARMACY-SPECIFIC BASIS. SUCH INFORMATION IS PROTECTED AS A
TRADE SECRET, IS NOT A PUBLIC RECORD AS DEFINED IN THE PUBLIC OFFICERS
LAW AND SHALL NOT BE DISCLOSED DIRECTLY OR INDIRECTLY. AN INSURER SHALL
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13316-01-9
A. 8310 2
IMPOSE THE CONFIDENTIALITY PROTECTIONS OF THIS SUBPARAGRAPH ON ANY THIRD
PARTIES OR VENDORS WITH WHICH IT CONTRACTS THAT MAY RECEIVE OR HAVE
ACCESS TO REBATE INFORMATION.
§ 2. Subdivision (b) of section 3221 of the insurance law is amended
to read as follows:
(b) (1) No such policy shall be delivered or issued for delivery in
this state unless a schedule of the premium rates pertaining to such
form shall have been filed with the superintendent.
(2) AN INSURER SHALL ANNUALLY CERTIFY TO THE DEPARTMENT THAT, DURING
THE PRIOR BENEFIT YEAR, THE INSURER MADE AVAILABLE TO ENROLLEES AT THE
POINT OF SALE AT LEAST A MAJORITY (I.E., GREATER THAN FIFTY PERCENT) OF
THE REBATES RECEIVED BY SUCH INSURER OR ANY THIRD PARTY ADMINISTERING
PRESCRIPTION DRUG BENEFITS ON BEHALF OF SUCH INSURER.
(A) FOR PURPOSES OF THIS PARAGRAPH, "REBATE" MEANS:
(I) NEGOTIATED PRICE CONCESSIONS INCLUDING BUT NOT LIMITED TO BASE
REBATES AND REASONABLE ESTIMATES OF ANY PRICE PROTECTION REBATES AND
PERFORMANCE-BASED REBATES THAT MAY ACCRUE DIRECTLY OR INDIRECTLY TO THE
ISSUER DURING THE COVERAGE YEAR FROM A MANUFACTURER, DISPENSING PHARMA-
CY, OR OTHER PARTY TO THE TRANSACTION, AND
(II) REASONABLE ESTIMATES OF ANY FEES AND OTHER ADMINISTRATIVE COSTS
THAT ARE PASSED THROUGH TO THE ISSUER AND SERVE TO REDUCE THE ISSUER'S
PRESCRIPTION DRUG LIABILITIES FOR THE COVERAGE YEAR.
(B) IN PROVIDING THE CERTIFICATION REQUIRED UNDER THIS SUBDIVISION, AN
ISSUER SHALL NOT PUBLISH OR OTHERWISE REVEAL INFORMATION REGARDING THE
ACTUAL AMOUNT OF REBATES THE ISSUER RECEIVED ON A PRODUCT-, MANUFACTUR-
ER- OR PHARMACY-SPECIFIC BASIS. SUCH INFORMATION IS PROTECTED AS A TRADE
SECRET, IS NOT A PUBLIC RECORD AS DEFINED IN THE PUBLIC OFFICERS LAW AND
SHALL NOT BE DISCLOSED DIRECTLY OR INDIRECTLY. AN INSURER SHALL IMPOSE
THE CONFIDENTIALITY PROTECTIONS OF THIS SUBDIVISION ON ANY THIRD PARTIES
OR VENDORS WITH WHICH IT CONTRACTS THAT MAY RECEIVE OR HAVE ACCESS TO
REBATE INFORMATION.
§ 3. This act shall take effect immediately.