S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  4463--A
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                              March 12, 2019
                                ___________
 
 Introduced  by Sens. BRESLIN, ADDABBO -- read twice and ordered printed,
   and when printed to be committed to  the  Committee  on  Insurance  --
   reported  favorably from said committee and committed to the Committee
   on Finance -- committee discharged, bill amended, ordered reprinted as
   amended and recommitted to said committee

 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:
   (I) "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.
   (II) "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
 retail pharmacy provided that the network participating  non-mail  order
 retail pharmacy agrees [in advance, through a contractual network agree-

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00271-02-9

 S. 4463--A                          2

 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;  PROVIDED,  HOWEVER,  THAT   THE
 PROVISIONS  OF  THIS  SUBPARAGRAPH  SHALL  NOT  SUPERSEDE THE TERMS OF A
 COLLECTIVE BARGAINING AGREEMENT OR APPLY TO A POLICY THAT IS A RESULT OF
 A COLLECTIVE BARGAINING AGREEMENT BETWEEN AN EMPLOYER AND  A  RECOGNIZED
 OR CERTIFIED EMPLOYEE ORGANIZATION.
   §  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:
   (I) "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.
   (II) "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

 S. 4463--A                          3
 
 PARTICIPATING IN THE HEALTH BENEFIT PLAN REGARDLESS OF WHETHER A PHARMA-
 CY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
   (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.