assembly Bill A5046

2021-2022 Legislative Session

Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals

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Archive: Last Bill Status - In Assembly Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

view actions (2)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 05, 2022 referred to insurance
Feb 10, 2021 referred to insurance

Co-Sponsors

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Multi-Sponsors

A5046 (ACTIVE) - Details

Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd Ins L, generally; add §4406-h, amd §§4903, 4910 & 4914, Pub Health L; amd §§367-a & 364-j, Soc Serv L; amd §§6810 & 6826-a, Ed L
Versions Introduced in Other Legislative Sessions:
2017-2018: A10215
2019-2020: A4521

A5046 (ACTIVE) - Summary

Relates to access to appropriate drugs at reasonable prices, formulary exceptions, standing prior authorizations and external appeals; to access to retail pharmacies, prescription synchronization, limits on patient drug costs, explanations of benefits and rebates; to prescription drug synchronization; to pharmacy benefit management (view more) and to limits on copayments and drug substitutions.

A5046 (ACTIVE) - Bill Text download pdf

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5046
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 10, 2021
                                ___________
 
 Introduced  by  M.  of  A. SOLAGES, TAYLOR, SEAWRIGHT, MONTESANO, RAMOS,
   SIMON, L. ROSENTHAL, GOTTFRIED, GLICK,  BARRON,  DICKENS,  GUNTHER  --
   Multi-Sponsored  by -- M. of A.  COOK -- read once and referred to the
   Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to  access  to  appropriate  drugs  at  reasonable  prices,  formulary
   exceptions,  standing  prior  authorizations  and external appeals; to
   amend the insurance law, in relation to access to  retail  pharmacies,
   prescription  synchronization,  limits on patient drug costs, explana-
   tions of benefits and rebates; to amend the social  services  law,  in
   relation to prescription drug synchronization; and to amend the educa-
   tion law, in relation to limits on copayments and drug substitutions
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The insurance law is amended by adding a new  section  4806
 to read as follows:
   §  4806.  ACCESS  TO APPROPRIATE DRUGS AT REASONABLE PRICES; FORMULARY
 EXCEPTIONS; STANDING PRIOR AUTHORIZATION  REQUIREMENT.  (A)  AN  INSURER
 OFFERING  A  PRESCRIPTION  DRUG  BENEFIT WITH A FORMULARY OF APPROVED OR
 PREFERRED DRUGS SHALL ESTABLISH  A  PROCEDURE  BY  WHICH  IT  DETERMINES
 WHETHER  A  FORMULARY  DRUG PROVIDES APPROPRIATE THERAPEUTIC BENEFITS TO
 MEET THE PARTICULAR HEALTH CARE NEEDS OF  AN  INSURED.  IF  THE  INSURER
 DETERMINES THAT NO FORMULARY DRUG PROVIDES APPROPRIATE THERAPEUTIC BENE-
 FITS TO MEET THE PARTICULAR HEALTH CARE NEEDS OF AN INSURED, THE INSURER
 SHALL  COVER  THE  COST OF AN OFF-FORMULARY DRUG FOR THAT INSURED, AT NO
 ADDITIONAL COST TO THE INSURED BEYOND WHAT THE INSURED  WOULD  OTHERWISE
 PAY FOR A PREFERRED BRAND NAME DRUG ON THE FORMULARY. THE DETERMINATIONS
 WHETHER  A  DRUG PROVIDES APPROPRIATE THERAPEUTIC BENEFITS AND WHETHER A
 NON-FORMULARY DRUG IS NECESSARY TO MEET THE PARTICULAR HEALTH CARE NEEDS
 OF THE INSURED ARE UTILIZATION REVIEW DECISIONS AND  ARE  REVIEWABLE  IN
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD06436-02-1