S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6492--A
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                               June 13, 2019
                                ___________
 
 Introduced by Sens. RIVERA, CARLUCCI, HOYLMAN, KAPLAN, MAYER, METZGER --
   read  twice  and  ordered printed, and when printed to be committed to
   the Committee on Rules -- recommitted to the Committee  on  Health  in
   accordance  with  Senate  Rule 6, sec. 8 -- committee discharged, bill
   amended, ordered reprinted as amended and recommitted to said  commit-
   tee
 
 AN  ACT  to  amend the public health law, in relation to drug assistance
   demonstration and emergency prescriptions; and to amend the  insurance
   law, in relation to capping cost sharing for insulin
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The public health law is amended by adding two new sections
 279-a and 279-b to read as follows:
   § 279-A. DRUG ASSISTANCE DEMONSTRATION PROGRAM. THE COMMISSIONER SHALL
 DEVELOP A DEMONSTRATION PROGRAM TO ENSURE ACCESS TO  INSULIN  AND  OTHER
 LIFE  SUSTAINING, MAINTENANCE PRESCRIPTION MEDICATIONS IDENTIFIED BY THE
 COMMISSIONER FOR RESIDENTS OF THE STATE WHO ARE UNINSURED, ARE  INELIGI-
 BLE FOR MEDICAID OR OTHER PUBLICLY FUNDED HEALTH COVERAGE, OR ARE OTHER-
 WISE  DETERMINED TO BE ELIGIBLE BY THE COMMISSIONER AND DEPEND UPON SUCH
 MEDICATION FOR THEIR SURVIVAL. IN DEVELOPING SUCH  PROGRAM  THE  COMMIS-
 SIONER SHALL:
   1.  CONSIDER MODELING THE DRUG ASSISTANCE DEMONSTRATION PROGRAM ON THE
 STATE'S HIV/AIDS DRUG ASSISTANCE PROGRAM PROVIDING  ACCESS  TO  ELIGIBLE
 INDIVIDUALS  AT  CERTAIN  INCOME  THRESHOLDS  ABOVE  THE FEDERAL POVERTY
 LEVEL;
   2. ENGAGE  WITH  PHARMACEUTICAL  MANUFACTURERS  TO  EXPLORE  A  PUBLIC
 PRIVATE PARTNERSHIP DESIGNED TO BRING AFFORDABLE MEDICATIONS THROUGH THE
 DEMONSTRATION PROGRAM TO ELIGIBLE INDIVIDUALS; AND
   3.  REPORT TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE, THE
 SPEAKER OF THE ASSEMBLY, AND THE  CHAIRS  OF  THE  SENATE  AND  ASSEMBLY
 HEALTH  COMMITTEES  ON THE AVAILABLE OPTIONS TO ESTABLISH A DRUG ASSIST-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD13323-08-0

 S. 6492--A                          2
 
 ANCE DEMONSTRATION PROGRAM, VARIOUS COST  SHARING  MODELS  FOR  ELIGIBLE
 PARTICIPANTS  AND  THE RELATED COSTS TO THE STATE ASSOCIATED WITH IMPLE-
 MENTING SUCH A PROGRAM NO LATER THAN SIXTY DAYS AFTER THE EFFECTIVE DATE
 OF THIS SECTION.
   § 279-B. EMERGENCY PRESCRIPTIONS. 1. A HEALTH CARE PRACTITIONER WHO IS
 AUTHORIZED   TO   PRESCRIBE   DRUGS  MAY  ISSUE     NON-PATIENT-SPECIFIC
 PRESCRIPTIONS FOR PHARMACISTS TO DISPENSE   EMERGENCY  PRESCRIPTIONS  TO
 REFILL  EXPIRED  PRESCRIPTIONS  PURSUANT  TO  SUBDIVISION  TWO  OF  THIS
 SECTION.
   2. A PHARMACIST MAY DISPENSE INSULIN AND RELATED  SUPPLIES,  OR  OTHER
 LIFE  SUSTAINING, MAINTENANCE PRESCRIPTION MEDICATIONS IDENTIFIED BY THE
 COMMISSIONER, THROUGH NON-PATIENT-SPECIFIC PRESCRIPTIONS, TO AN INDIVID-
 UAL WHO HAS HAD A VALID PRESCRIPTION FOR ANY TYPES OF INSULIN, OR  OTHER
 MEDICATIONS  IDENTIFIED  BY  THE  COMMISSIONER,  DURING THE PRIOR TWELVE
 MONTH PERIOD WHICH HAVE SINCE EXPIRED, ON AN  EMERGENCY  BASIS  PROVIDED
 THE PHARMACIST:
   (A)  FIRST  ATTEMPTS  TO  OBTAIN  AN AUTHORIZATION FROM THE AUTHORIZED
 PRESCRIBER AND CANNOT OBTAIN THE AUTHORIZATION;
   (B) BELIEVES, THAT IN  THE  PHARMACIST'S  PROFESSIONAL  JUDGMENT,  THE
 INTERRUPTION  OF  THE  THERAPY  REASONABLY  MIGHT PRODUCE AN UNDESIRABLE
 HEALTH CONSEQUENCE DETRIMENTAL TO THE PATIENT'S WELFARE OR  CAUSE  PHYS-
 ICAL OR MENTAL DISCOMFORT;
   (C) PROVIDES REFILL OF THE PRESCRIPTION OR PRESCRIPTIONS AND THE QUAN-
 TITY  OF  THAT  REFILL  OR  REFILLS IS IN CONFORMITY WITH THE PRESCRIBED
 DIRECTIONS FOR USE, BUT LIMITED TO AN AMOUNT NOT TO EXCEED A  THIRTY-DAY
 EMERGENCY SUPPLY; AND
   (D)  NOTIFIES,  WITHIN  SEVENTY-TWO  HOURS OF DISPENSING THE REFILL OR
 REFILLS, THE PRESCRIBER THAT AN EMERGENCY PRESCRIPTION OR  PRESCRIPTIONS
 HAVE BEEN DISPENSED.
   §  2.  Subparagraph (B) of paragraph 15-a of subsection (i) of section
 3216 of the insurance law, as added by chapter 378 of the laws  of  1993
 and  such paragraph as renumbered by chapter 338 of the laws of 2003, is
 amended to read as follows:
   (B) Such coverage may be subject to annual deductibles and coinsurance
 as may be deemed appropriate by the superintendent and as are consistent
 with those  established  for  other  benefits  within  a  given  policy;
 PROVIDED  HOWEVER, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO
 PAY OUT OF POCKET FOR COVERED PRESCRIPTION INSULIN DRUGS SHALL BE CAPPED
 AT AN AMOUNT NOT TO EXCEED ONE HUNDRED DOLLARS  PER  THIRTY-DAY  SUPPLY,
 REGARDLESS OF THE AMOUNT OR TYPES OF INSULIN NEEDED TO FILL SUCH COVERED
 PERSON'S  PRESCRIPTIONS  AND  REGARDLESS  OF  THE  INSURED'S DEDUCTIBLE,
 COPAYMENT, COINSURANCE, OUT OF POCKET MAXIMUM OR ANY OTHER COST  SHARING
 REQUIREMENT.
   § 3. Subparagraph (B) of paragraph 7 of subsection (k) of section 3221
 of  the insurance law, as amended by chapter 338 of the laws of 2003, is
 amended to read as follows:
   (B) Such coverage may be subject to annual deductibles and coinsurance
 as may be deemed appropriate by the superintendent and as are consistent
 with those  established  for  other  benefits  within  a  given  policy;
 PROVIDED  HOWEVER, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO
 PAY OUT OF POCKET FOR COVERED PRESCRIPTION INSULIN DRUGS SHALL BE CAPPED
 AT AN AMOUNT NOT TO EXCEED ONE HUNDRED DOLLARS  PER  THIRTY-DAY  SUPPLY,
 REGARDLESS OF THE AMOUNT OR TYPES OF INSULIN NEEDED TO FILL SUCH COVERED
 PERSON'S  PRESCRIPTIONS  AND  REGARDLESS  OF  THE  INSURED'S DEDUCTIBLE,
 COPAYMENT, COINSURANCE, OUT OF POCKET MAXIMUM OR ANY OTHER COST  SHARING
 REQUIREMENT.

 S. 6492--A                          3
 
   §  4.  Paragraph  2 of subsection (u) of section 4303 of the insurance
 law, as amended by chapter 338 of the laws of 2003, is amended  to  read
 as follows:
   (2) Such coverage may be subject to annual deductibles and coinsurance
 as may be deemed appropriate by the superintendent and as are consistent
 with  those  established  for  other  benefits  within  a  given policy;
 PROVIDED HOWEVER, THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED  TO
 PAY OUT OF POCKET FOR COVERED PRESCRIPTION INSULIN DRUGS SHALL BE CAPPED
 AT  AN  AMOUNT  NOT TO EXCEED ONE HUNDRED DOLLARS PER THIRTY-DAY SUPPLY,
 REGARDLESS OF THE AMOUNT OR TYPES OF INSULIN NEEDED TO FILL SUCH COVERED
 PERSON'S PRESCRIPTIONS  AND  REGARDLESS  OF  THE  INSURED'S  DEDUCTIBLE,
 COPAYMENT,  COINSURANCE, OUT OF POCKET MAXIMUM OR ANY OTHER COST SHARING
 REQUIREMENT.
   § 5. Subdivision 7 of section 4406-c of  the  public  health  law,  as
 added by chapter 536 of the laws of 2010, is amended to read as follows:
   7.  (I) No health maintenance organization which provides coverage for
 prescription drugs and for which cost-sharing, deductibles  or  co-insu-
 rance obligations are determined by category of prescription drugs shall
 impose  cost-sharing,  deductibles  or  co-insurance obligations for any
 prescription drug that exceeds the dollar amount of cost-sharing, deduc-
 tibles or co-insurance obligations for non-preferred brand drugs or  its
 equivalent (or brand drugs if there is no non-preferred brand drug cate-
 gory).
   (II)  THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO PAY OUT OF
 POCKET FOR COVERED PRESCRIPTION INSULIN DRUGS  SHALL  BE  CAPPED  AT  AN
 AMOUNT  NOT TO EXCEED ONE HUNDRED DOLLARS PER THIRTY-DAY SUPPLY, REGARD-
 LESS OF THE AMOUNT OR TYPES OF  INSULIN  NEEDED  TO  FILL  SUCH  COVERED
 PERSON'S  PRESCRIPTIONS  AND  REGARDLESS  OF  THE  INSURED'S DEDUCTIBLE,
 COPAYMENT, COINSURANCE, OUT OF POCKET MAXIMUM OR ANY OTHER COST  SHARING
 REQUIREMENT.
   §  6.  This  act  shall take effect immediately; provided however that
 sections two, three, four and five of this act shall take effect January
 1, 2021.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6492--B
     Cal. No. 555
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                               June 13, 2019
                                ___________
 
 Introduced  by  Sens.  RIVERA,  CARLUCCI,  GOUNARDES, HARCKHAM, HOYLMAN,
   KAPLAN, KRUEGER,  MAYER,  METZGER,  MYRIE,  PERSAUD,  RAMOS,  SALAZAR,
   SEPULVEDA, SERRANO -- read twice and ordered printed, and when printed
   to  be  committed  to  the  Committee  on  Rules -- recommitted to the
   Committee on Health in accordance  with  Senate  Rule  6,  sec.  8  --
   committee  discharged,  bill amended, ordered reprinted as amended and
   recommitted to said committee -- reported favorably from said  commit-
   tee  and  committed  to the Committee on Finance -- reported favorably
   from said committee, ordered to first and second report, ordered to  a
   third  reading,  amended and ordered reprinted, retaining its place in
   the order of third reading
 
 AN ACT to amend the public health law, in relation  to  drug  assistance
   demonstration and emergency prescriptions
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The public health law is amended by adding two new sections
 279-a and 279-b to read as follows:
   § 279-A. DRUG ASSISTANCE DEMONSTRATION PROGRAM.  1.  THE  COMMISSIONER
 SHALL  DEVELOP A DEMONSTRATION PROGRAM (THE "PROGRAM") TO PROVIDE ACCESS
 TO INSULIN AND OTHER  LIFE  SUSTAINING  MAINTENANCE  PRESCRIPTION  DRUGS
 IDENTIFIED  BY THE COMMISSIONER FOR RESIDENTS OF THE STATE WHO ARE WITH-
 OUT HEALTH COVERAGE, ARE INELIGIBLE FOR MEDICAID OR OTHER PUBLICLY FUND-
 ED HEALTH COVERAGE, OR ARE OTHERWISE DETERMINED TO BE  ELIGIBLE  BY  THE
 COMMISSIONER  AND  DEPEND  UPON  SUCH  MEDICATION FOR THEIR SURVIVAL. IN
 DEVELOPING THE PROGRAM THE COMMISSIONER SHALL:
   (A) CONSIDER MODELING THE PROGRAM ON THE STATE'S HIV/AIDS DRUG ASSIST-
 ANCE PROGRAM PROVIDING ACCESS TO ELIGIBLE INDIVIDUALS AT CERTAIN  INCOME
 THRESHOLDS ABOVE THE FEDERAL POVERTY LEVEL; AND
   (B)  ENGAGE  WITH  PHARMACEUTICAL  MANUFACTURERS  TO  EXPLORE A PUBLIC
 PRIVATE PARTNERSHIP TO BRING AFFORDABLE DRUGS  THROUGH  THE  PROGRAM  TO
 ELIGIBLE INDIVIDUALS.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                       [ ] is old law to be omitted.
                                                            LBD13323-13-0

 S. 6492--B                          2
 
   2. THE COMMISSIONER SHALL REPORT TO THE GOVERNOR, THE TEMPORARY PRESI-
 DENT  OF  THE SENATE, THE SPEAKER OF THE ASSEMBLY, AND THE CHAIRS OF THE
 SENATE AND ASSEMBLY HEALTH COMMITTEES ON THE AVAILABLE OPTIONS TO ESTAB-
 LISH THE PROGRAM, VARIOUS COST SHARING MODELS FOR ELIGIBLE  PARTICIPANTS
 AND  THE  RELATED  COSTS  TO  THE STATE ASSOCIATED WITH IMPLEMENTING THE
 PROGRAM. THE REPORT SHALL BE A PUBLIC DOCUMENT  POSTED  ON  THE  DEPART-
 MENT'S  WEBSITE.  THE  REPORT SHALL BE ISSUED NO LATER THAN THREE MONTHS
 AFTER THE EFFECTIVE DATE OF THIS SECTION.
   § 279-B. EMERGENCY PRESCRIPTIONS. 1. A HEALTH CARE PRACTITIONER WHO IS
 AUTHORIZED  TO  PRESCRIBE  A  DRUG  MAY  ISSUE  A   NON-PATIENT-SPECIFIC
 PRESCRIPTION  FOR  THE  DRUG  TO  A  PHARMACIST TO DISPENSE AN EMERGENCY
 REFILL FOR AN EXPIRED PRESCRIPTION FOR THE DRUG, UNDER  SUBDIVISION  TWO
 OF THIS SECTION.
   2.  A  PHARMACIST  MAY DISPENSE INSULIN AND RELATED SUPPLIES, OR OTHER
 LIFE SUSTAINING MAINTENANCE PRESCRIPTION DRUG IDENTIFIED BY THE  COMMIS-
 SIONER,  THROUGH  A  NON-PATIENT-SPECIFIC PRESCRIPTION, TO AN INDIVIDUAL
 WHO HAS HAD A VALID PRESCRIPTION FOR THE DRUG DURING  THE  PRIOR  TWELVE
 MONTH PERIOD WHICH HAS SINCE EXPIRED, ON AN EMERGENCY BASIS PROVIDED THE
 PHARMACIST:
   (A)  FIRST  ATTEMPTS TO OBTAIN AN AUTHORIZATION FROM THE PRESCRIBER OF
 THE PATIENT-SPECIFIC PRESCRIPTION AND CANNOT OBTAIN  THE  AUTHORIZATION,
 AND  THE  PRESCRIBER  DOES NOT OBJECT TO DISPENSING TO THE PATIENT UNDER
 THE NON-PATIENT-SPECIFIC PRESCRIPTION;
   (B) BELIEVES THAT, IN  THE  PHARMACIST'S  PROFESSIONAL  JUDGMENT,  THE
 INTERRUPTION  OF  THE  THERAPY  REASONABLY  MIGHT PRODUCE AN UNDESIRABLE
 HEALTH CONSEQUENCE DETRIMENTAL TO THE PATIENT'S WELFARE OR  CAUSE  PHYS-
 ICAL OR MENTAL DISCOMFORT;
   (C)  PROVIDES  REFILL  OF  THE  PRESCRIPTION  AND THE QUANTITY OF THAT
 REFILL IS IN CONFORMITY WITH THE DIRECTIONS FOR USE UNDER  THE  PATIENT-
 SPECIFIC  PRESCRIPTION, BUT LIMITED TO AN AMOUNT NOT TO EXCEED A THIRTY-
 DAY EMERGENCY SUPPLY; AND
   (D) NOTIFIES, WITHIN SEVENTY-TWO HOURS OF  DISPENSING  THE  REFILL  OR
 REFILLS, THE ORIGINAL PRESCRIBER THAT AN EMERGENCY PRESCRIPTION HAS BEEN
 DISPENSED.
   § 2. This act shall take effect immediately.