Senate Bill S5061

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5061
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                               April 5, 2019
                                ___________
 
 Introduced  by  Sen.  PARKER -- 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  social  services  law,  in
   relation  to  allowing  individuals to obtain a twelve month supply of
   contraception at one time

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. The opening paragraph of paragraph 16 of subsection (l) of
 section 3221 of the insurance law, as added by chapter 554 of  the  laws
 of 2002, is amended to read as follows:
   Every group or blanket policy which provides coverage for prescription
 drugs  shall  include  coverage  for  the cost of contraceptive drugs or
 devices approved by the federal food and drug administration or  generic
 equivalents approved as substitutes by such food and drug administration
 under  the  prescription of a health care provider legally authorized to
 prescribe under title eight of the education law.   THIS COVERAGE  SHALL
 ALLOW  FOR  A  THREE  MONTH  SUPPLY  OF  A CONTRACEPTIVE FOR THE INITIAL
 DISPENSING OF THE CONTRACEPTIVE AND A TWELVE MONTH SUPPLY  OF  THE  SAME
 CONTRACEPTIVE  FOR  ALL SUBSEQUENT DISPENSINGS TO THE CERTIFICATE HOLDER
 REGARDLESS OF WHETHER SUCH CERTIFICATE HOLDER WAS ENROLLED IN THE POLICY
 AT THE TIME OF THE INITIAL DISPENSING. The  coverage  required  by  this
 section  shall be included in policies and certificates only through the
 addition of a rider.
   § 2. The opening paragraph of subsection (cc) of section 4303  of  the
 insurance  law,  as added by chapter 554 of the laws of 2002, is amended
 to read as follows:
   Every contract which provides coverage for  prescription  drugs  shall
 include coverage for the cost of contraceptive drugs or devices approved
 by  the  federal  food  and  drug  administration or generic equivalents
 approved as substitutes by such food and drug administration  under  the
 prescription  of  a health care provider legally authorized to prescribe
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD10489-01-9

 S. 5061                             2
 
 under title eight of the education law. THIS COVERAGE SHALL ALLOW FOR  A
 THREE  MONTH SUPPLY OF A CONTRACEPTIVE FOR THE INITIAL DISPENSING OF THE
 CONTRACEPTIVE AND A TWELVE MONTH SUPPLY OF THE  SAME  CONTRACEPTIVE  FOR
 ALL  SUBSEQUENT  DISPENSINGS  TO  THE  INSURED REGARDLESS OF WHETHER THE
 INSURED WAS ENROLLED UNDER THE CONTRACT  AT  THE  TIME  OF  THE  INITIAL
 DISPENSING.  The  coverage required by this section shall be included in
 contracts and certificates only through the addition of a rider.
   § 3. Paragraph 25 of subsection (b) of section 4322 of  the  insurance
 law,  as  added by chapter 504 of the laws of 1995 and the opening para-
 graph as amended by chapter 388 of the laws of 2013, is amended to  read
 as follows:
   (25)  Prescription  drugs,  including  contraceptive  drugs or devices
 approved by the federal food and drug administration or  generic  equiv-
 alents  approved as substitutes by such food and drug administration and
 nutritional supplements (formulas), whether administered orally or via a
 feeding tube for the therapeutic treatment of phenylketonuria, branched-
 chain ketonuria, galactosemia and homocystinuria, obtained at a  partic-
 ipating  pharmacy  under a prescription written by an in-plan or out-of-
 plan  provider.  Health  maintenance  organizations,  in   addition   to
 providing  coverage  for prescription drugs at a participating pharmacy,
 may utilize a mail order prescription drug program.  Health  maintenance
 organizations  may  provide prescription drugs pursuant to a drug formu-
 lary;  however,  health  maintenance  organizations  must  implement  an
 appeals  process so that the use of non-formulary prescription drugs may
 be requested by a physician or other provider.
   WITH RESPECT TO CONTRACEPTIVE DRUGS, ANY PLAN SHALL ALLOW FOR A  THREE
 MONTH  SUPPLY  OF  A  CONTRACEPTIVE  FOR  THE  INITIAL DISPENSING OF THE
 CONTRACEPTIVE AND A TWELVE MONTH SUPPLY OF THE  SAME  CONTRACEPTIVE  FOR
 ALL SUBSEQUENT DISPENSINGS TO THE ENROLLEE.
   Health  maintenance  organizations  shall  impose a one hundred dollar
 individual deductible and a three hundred dollar family  deductible  per
 calendar year for prescription drugs obtained at a participating pharma-
 cy.  Health  maintenance  organizations  may  not impose a deductible on
 prescriptions obtained through the mail order drug program.
   In addition to the deductible, a ten dollar copayment shall be imposed
 on up to a thirty-four day  supply  of  brand  name  prescription  drugs
 obtained  at  a participating pharmacy. A five dollar copayment shall be
 imposed on up to a thirty-four day supply of generic prescription  drugs
 or brand name drugs for which there is no generic equivalent obtained at
 a participating pharmacy.
   If  a  mail  order drug program is utilized, a twenty dollar copayment
 shall be imposed on a ninety  day  supply  of  brand  name  prescription
 drugs. A ten dollar copayment shall be imposed on a ninety day supply of
 generic  prescription  drugs  or  brand name drugs for which there is no
 generic equivalent obtained through the mail order drug program.
   In no event shall the copayment exceed  the  cost  of  the  prescribed
 drug.
   §  4.  Subparagraph  (E)  of paragraph 17 of subsection (i) of section
 3216 of the insurance law is amended by adding a new clause (v) to  read
 as follows:
   (V)  CONTRACEPTIVES, ALLOWING FOR A THREE MONTH SUPPLY FOR THE INITIAL
 DISPENSING OF THE CONTRACEPTIVE AND A TWELVE MONTH SUPPLY  OF  THE  SAME
 CONTRACEPTIVE  FOR  ALL SUBSEQUENT DISPENSINGS TO THE INSURED REGARDLESS
 OF WHETHER THE INSURED WAS ENROLLED UNDER THE POLICY AT THE TIME OF  THE
 INITIAL DISPENSING.

 S. 5061                             3
 
   §  5.  Paragraph  (d)  of subdivision 3 of section 365-a of the social
 services law, as amended by chapter 909 of  the  laws  of  1974  and  as
 relettered  by  chapter  82  of  the laws of 1995, is amended to read as
 follows:
   (d)  family  planning  services and supplies, INCLUDING CONTRACEPTION,
 for eligible persons of childbearing age, including children under twen-
 ty-one years of age who can be considered sexually  active,  who  desire
 such  services  and  supplies,  in  accordance  with the requirements of
 federal law and regulations and the regulations of  the  department.  No
 person  shall  be  compelled  or  coerced  to  accept  such  services or
 supplies.  WITH RESPECT TO CONTRACEPTION, COVERAGE  SHALL  ALLOW  FOR  A
 THREE  MONTH SUPPLY OF A CONTRACEPTIVE FOR THE INITIAL DISPENSING OF THE
 CONTRACEPTIVE AND A TWELVE MONTH SUPPLY OF THE  SAME  CONTRACEPTIVE  FOR
 ALL SUBSEQUENT DISPENSINGS.
   §  6. This act shall take effect immediately, and shall apply to poli-
 cies and contracts issued, renewed, modified, altered or amended  on  or
 after such effective date.