S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3543
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                             February 8, 2019
                                ___________
 
 Introduced  by  Sen. SALAZAR -- read twice and ordered printed, and when
   printed to be committed to the Committee on Women's Issues
 
 AN ACT to amend the insurance law, in relation to the definition of over
   the counter contraceptive products and voluntary sterilization  proce-
   dures

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (A) of  paragraph  16  of  subsection  (l)  of
 section  3221  of the insurance law, as amended by a chapter of the laws
 of 2019 amending the insurance law and the social services law, relating
 to requiring health  insurance  policies  to  include  coverage  of  all
 FDA-approved  contraceptive  drugs,  devices,  and  products, as well as
 voluntary sterilization procedures, contraceptive  education  and  coun-
 seling,  and  related follow up services and prohibiting a health insur-
 ance  policy  from  imposing  any  cost-sharing  requirements  or  other
 restrictions  or  delays  with  respect to this coverage, as proposed in
 legislative bills numbers S. 659-A and A. 585-A, is amended  and  a  new
 subparagraph (H) is added to read as follows:
   (A)  Every  group  or  blanket  policy  THAT  PROVIDES  MEDICAL, MAJOR
 MEDICAL, OR SIMILAR COMPREHENSIVE-TYPE COVERAGE that is issued, amended,
 renewed, effective or delivered on or after January first, two  thousand
 twenty,  shall  provide  coverage  for all of the following services and
 contraceptive methods:
   (1) All FDA-approved contraceptive drugs, devices, and other products.
 This includes all  FDA-approved  over-the-counter  contraceptive  drugs,
 devices,  and  products  as  prescribed or as otherwise authorized under
 state or federal law. The following applies to this coverage:
   (a) where the FDA has approved one or more therapeutic and  pharmaceu-
 tical  equivalent,  as  defined  by the FDA, versions of a contraceptive
 drug, device, or product, a group or blanket policy is not  required  to
 include  all  such therapeutic and pharmaceutical equivalent versions in
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD09525-01-9

 S. 3543                             2
 
 its formulary, so long as at least one is included and  covered  without
 cost-sharing and in accordance with this paragraph;
   (b)  if the covered therapeutic and pharmaceutical equivalent versions
 of a drug, device, or product are not available or are deemed  medically
 inadvisable  a  group  or  blanket  policy shall provide coverage for an
 alternate therapeutic  and  pharmaceutical  equivalent  version  of  the
 contraceptive  drug,  device,  or product without cost-sharing.   If the
 attending health care provider, in his or  her  reasonable  professional
 judgment,  determines that the use of a non-covered therapeutic or phar-
 maceutical equivalent of a drug, device, or product  is  warranted,  the
 health care provider's determination shall be final.  The superintendent
 shall  promulgate  regulations  establishing  a process, including time-
 frames, for an insured, an insured's designee  or  an  insured's  health
 care  provider  to request coverage of a non-covered contraceptive drug,
 device, or product. Such regulations shall include  a  requirement  that
 insurers  use  an exception form that shall meet criteria established by
 the superintendent;
   (c) this coverage shall include emergency contraception without  cost-
 sharing  when provided pursuant to a prescription or order under section
 sixty-eight hundred thirty-one of the education  law  or  when  lawfully
 provided over the counter; and
   (d) this coverage must allow for the dispensing of up to twelve months
 worth of a contraceptive at one time;
   (2) Voluntary sterilization procedures; PROVIDED, HOWEVER, UNTIL JANU-
 ARY  FIRST  OF  THE  YEAR FOLLOWING THE DATE THAT VASECTOMIES ARE NOT AN
 ESSENTIAL HEALTH BENEFIT THAT ARE REQUIRED TO BE COVERED PURSUANT TO  42
 U.S.C.  § 18022, THE TERM "VOLUNTARY STERILIZATION PROCEDURES" FOR SMALL
 GROUP POLICIES SHALL BE DEFINED AS THOSE PROCEDURES  IDENTIFIED  IN  THE
 COMPREHENSIVE  GUIDELINES SUPPORTED BY THE HEALTH RESOURCES AND SERVICES
 ADMINISTRATION AS OF JANUARY TWENTY-FIRST, TWO THOUSAND NINETEEN;
   (3) Patient education and counseling on contraception; and
   (4) Follow-up services related to the drugs,  devices,  products,  and
 procedures  covered under this paragraph, including, but not limited to,
 management of side effects,  counseling  for  continued  adherence,  and
 device insertion and removal.
   (H)  FOR  PURPOSES  OF  THIS PARAGRAPH, OVER THE COUNTER CONTRACEPTIVE
 PRODUCTS SHALL MEAN THOSE PRODUCTS PROVIDED FOR IN COMPREHENSIVE  GUIDE-
 LINES  SUPPORTED  BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION AS
 OF JANUARY TWENTY-FIRST, TWO THOUSAND NINETEEN.
   § 2. Paragraph 1 of subsection (cc) of section 4303 of  the  insurance
 law,  as amended by a chapter of the laws of 2019 amending the insurance
 law and social services law,  relating  to  requiring  health  insurance
 policies  to  include  coverage of all FDA-approved contraceptive drugs,
 devices, and products, as well as  voluntary  sterilization  procedures,
 contraceptive  education  and counseling, and related follow up services
 and prohibiting a health insurance policy from imposing any cost-sharing
 requirements or other restrictions or delays with respect to this cover-
 age, as proposed in legislative bills numbers S. 659-A and A. 585-A,  is
 amended and a new paragraph 8 is added as follows:
   (1)  Every  contract  THAT PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
 COMPREHENSIVE TYPE COVERAGE that is issued, amended, renewed,  effective
 or  delivered  on  or  after  January  first, two thousand twenty, shall
 provide coverage for all of the  following  services  and  contraceptive
 methods:
   (A) All FDA-approved contraceptive drugs, devices, and other products.
 This  includes  all  FDA-approved  over-the-counter contraceptive drugs,

 S. 3543                             3

 devices, and products as prescribed or  as  otherwise  authorized  under
 state or federal law.  The following applies to this coverage:
   (i)  where the FDA has approved one or more therapeutic and pharmaceu-
 tical equivalent, as defined by the FDA,  versions  of  a  contraceptive
 drug, device, or product, a contract is not required to include all such
 therapeutic  and pharmaceutical equivalent versions in its formulary, so
 long as at least one is included and covered without cost-sharing and in
 accordance with this subsection;
   (ii) if the covered therapeutic and pharmaceutical equivalent versions
 of a drug, device, or product are not available or are deemed  medically
 inadvisable a contract shall provide coverage for an alternate therapeu-
 tic  and  pharmaceutical  equivalent  version of the contraceptive drug,
 device, or product without cost-sharing.  If the attending  health  care
 provider,  in  his  or  her reasonable professional judgment, determines
 that the use of a non-covered therapeutic or  pharmaceutical  equivalent
 of  a  drug, device, or product is warranted, the health care provider's
 determination shall be final.  The superintendent shall promulgate regu-
 lations establishing a process, including timeframes, for an insured, an
 insured's designee or an  insured's  health  care  provider  to  request
 coverage  of  a non-covered contraceptive drug, device, or product. Such
 regulations shall include a requirement that insurers use  an  exception
 form that shall meet criteria established by the superintendent;
   (iii)  this  coverage  shall  include  emergency contraception without
 cost-sharing when provided pursuant to a  prescription  or  order  under
 section  sixty-eight  hundred  thirty-one  of  the education law or when
 lawfully provided over the counter; and
   (iv) this coverage must allow for  the  dispensing  of  up  to  twelve
 months worth of a contraceptive at one time;
   (B) Voluntary sterilization procedures; PROVIDED, HOWEVER, UNTIL JANU-
 ARY  FIRST  OF  THE  YEAR FOLLOWING THE DATE THAT VASECTOMIES ARE NOT AN
 ESSENTIAL HEALTH BENEFIT THAT ARE REQUIRED TO BE COVERED PURSUANT TO  42
 U.S.C.  § 18022, THE TERM "VOLUNTARY STERILIZATION PROCEDURES" FOR INDI-
 VIDUAL AND SMALL GROUP POLICIES SHALL BE  DEFINED  AS  THOSE  PROCEDURES
 IDENTIFIED  IN  THE  COMPREHENSIVE  GUIDELINES  SUPPORTED  BY THE HEALTH
 RESOURCES AND SERVICES ADMINISTRATION AS OF  JANUARY  TWENTY-FIRST,  TWO
 THOUSAND NINETEEN;
   (C) Patient education and counseling on contraception; and
   (D)  Follow-up  services  related to the drugs, devices, products, and
 procedures covered under this subsection, including, but not limited to,
 management of side effects,  counseling  for  continued  adherence,  and
 device insertion and removal.
   (8)  FOR  PURPOSES  OF THIS SUBSECTION, OVER THE COUNTER CONTRACEPTIVE
 PRODUCTS SHALL MEAN THOSE PRODUCTS PROVIDED FOR IN COMPREHENSIVE  GUIDE-
 LINES  SUPPORTED  BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION AS
 OF JANUARY TWENTY-FIRST, TWO THOUSAND NINETEEN.
   § 3. Clause (v) of subparagraph (E) of paragraph 17 of subsection  (i)
 of  section 3216 of the insurance law, as added by a chapter of the laws
 of 2019 amending the insurance law and the social services law, relating
 to requiring health  insurance  policies  to  include  coverage  of  all
 FDA-approved  contraceptive  drugs,  devices,  and  products, as well as
 voluntary sterilization procedures, contraceptive  education  and  coun-
 seling,  and  related follow up services and prohibiting a health insur-
 ance  policy  from  imposing  any  cost-sharing  requirements  or  other
 restrictions  or  delays  with  respect to this coverage, as proposed in
 legislative bills numbers S. 659-A and A. 585-A, is amended to  read  as
 follows:

 S. 3543                             4
 
   (v) all FDA-approved contraceptive drugs, devices, and other products,
 including   all   over-the-counter  contraceptive  drugs,  devices,  and
 products as prescribed or as otherwise authorized under state or federal
 law; voluntary sterilization procedures; PROVIDED, HOWEVER, UNTIL  JANU-
 ARY  FIRST  OF  THE  YEAR FOLLOWING THE DATE THAT VASECTOMIES ARE NOT AN
 ESSENTIAL HEALTH BENEFIT THAT ARE REQUIRED TO BE COVERED PURSUANT TO  42
 U.S.C.  § 18022, THE TERM "VOLUNTARY STERILIZATION PROCEDURES" FOR INDI-
 VIDUAL POLICIES SHALL BE DEFINED AS THOSE PROCEDURES IDENTIFIED  IN  THE
 COMPREHENSIVE  GUIDELINES SUPPORTED BY THE HEALTH RESOURCES AND SERVICES
 ADMINISTRATION  AS  OF  JANUARY  TWENTY-FIRST,  TWO  THOUSAND  NINETEEN;
 patient   education  and  counseling  on  contraception;  and  follow-up
 services related to the drugs, devices, products, and procedures covered
 under this clause, including, but not limited  to,  management  of  side
 effects,  counseling  for  continued adherence, and device insertion and
 removal. Except as otherwise authorized under this  clause,  a  contract
 shall  not  impose  any  restrictions or delays on the coverage required
 under this clause. However, where the FDA has approved one or more ther-
 apeutic and pharmaceutical equivalent, as defined by the  FDA,  versions
 of  a contraceptive drug, device, or product, a contract is not required
 to include all such therapeutic and pharmaceutical  equivalent  versions
 in  its formulary, so long as at least one is included and covered with-
 out cost-sharing and in accordance with  this  clause.  If  the  covered
 therapeutic and pharmaceutical equivalent versions of a drug, device, or
 product are not available or are deemed medically inadvisable a contract
 shall  provide  coverage for an alternate therapeutic and pharmaceutical
 equivalent version of the contraceptive drug, device, or product without
 cost-sharing.  (a) This coverage shall include  emergency  contraception
 without  cost sharing when provided pursuant to a prescription, or order
 under section sixty-eight hundred thirty-one of  the  education  law  or
 when  lawfully  provided over-the-counter.   (b) If the attending health
 care provider, in his or her reasonable  professional  judgment,  deter-
 mines that the use of a non-covered therapeutic or pharmaceutical equiv-
 alent  of  a  drug,  device,  or  product  is warranted, the health care
 provider's determination shall  be  final.    The  superintendent  shall
 promulgate regulations establishing a process, including timeframes, for
 an  insured,  an insured's designee or an insured's health care provider
 to request coverage of a  non-covered  contraceptive  drug,  device,  or
 product.  Such regulations shall include a requirement that insurers use
 an exception form that shall meet criteria  established  by  the  super-
 intendent.    (c)  This  coverage must allow for the dispensing of up to
 twelve months worth of a contraceptive at one time.  (D) FOR PURPOSES OF
 THIS CLAUSE, OVER-THE-COUNTER CONTRACEPTIVE PRODUCTS  SHALL  MEAN  THOSE
 PRODUCTS  PROVIDED  FOR  IN  COMPREHENSIVE  GUIDELINES  SUPPORTED BY THE
 HEALTH RESOURCES AND SERVICES ADMINISTRATION AS OF JANUARY TWENTY-FIRST,
 TWO THOUSAND NINETEEN.
   § 4. This act shall take effect on the  same  date  and  in  the  same
 manner  as  a chapter of the laws of 2019 amending the insurance law and
 the social services law, relating to requiring health insurance policies
 to include coverage of all FDA-approved  contraceptive  drugs,  devices,
 and  products, as well as voluntary sterilization procedures, contracep-
 tive education and  counseling,  and  related  follow  up  services  and
 prohibiting  a  health  insurance  policy from imposing any cost-sharing
 requirements or other restrictions or delays with respect to this cover-
 age, as proposed in legislative bills numbers S.  659-A  and  A.  585-A,
 takes effect.