The New York State Senate

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5218--A
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 12, 2021
                                ___________
 
 Introduced by M. of A. WALKER -- read once and referred to the Committee
   on  Insurance -- committee discharged, bill amended, ordered reprinted
   as amended and recommitted to said committee
 
 AN ACT to amend the insurance law, in relation to  requiring  individual
   and  small group insurance carriers and group and blanket accident and
   health carriers to certify that at least a  majority  of  prescription
   drug rebates are provided to patients at the point of sale
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph 1 of subsection (e) of section 3231 of the insur-
 ance law is amended by adding a new subparagraph (C) to read as follows:
   (C) AN INSURER SHALL ANNUALLY CERTIFY TO THE DEPARTMENT  THAT,  DURING
 THE  PRIOR  BENEFIT YEAR, THE INSURER MADE AVAILABLE TO ENROLLEES AT THE
 POINT OF SALE AT LEAST A MAJORITY (I.E., GREATER THAN FIFTY PERCENT)  OF
 THE  REBATES  RECEIVED  BY SUCH INSURER OR ANY THIRD PARTY ADMINISTERING
 PRESCRIPTION DRUG BENEFITS ON BEHALF OF SUCH INSURER.
   (I) FOR PURPOSES OF THIS PARAGRAPH, "REBATE" MEANS:
   (1) NEGOTIATED PRICE CONCESSIONS INCLUDING BUT  NOT  LIMITED  TO  BASE
 REBATES  AND  REASONABLE  ESTIMATES  OF ANY PRICE PROTECTION REBATES AND
 PERFORMANCE-BASED REBATES THAT MAY ACCRUE DIRECTLY OR INDIRECTLY TO  THE
 ISSUER  DURING THE COVERAGE YEAR FROM A MANUFACTURER, DISPENSING PHARMA-
 CY, OR OTHER PARTY TO THE TRANSACTION, AND
   (2) REASONABLE ESTIMATES OF ANY FEES AND  OTHER  ADMINISTRATIVE  COSTS
 THAT  ARE  PASSED THROUGH TO THE ISSUER AND SERVE TO REDUCE THE ISSUER'S
 PRESCRIPTION DRUG LIABILITIES FOR THE COVERAGE YEAR.
   (II) IN PROVIDING THE CERTIFICATION REQUIRED UNDER THIS  SUBPARAGRAPH,
 AN  ISSUER  SHALL  NOT PUBLISH OR OTHERWISE REVEAL INFORMATION REGARDING
 THE ACTUAL AMOUNT OF REBATES THE ISSUER RECEIVED ON A PRODUCT-, MANUFAC-
 TURER- OR PHARMACY-SPECIFIC BASIS. SUCH INFORMATION IS  PROTECTED  AS  A
 TRADE  SECRET,  IS NOT A PUBLIC RECORD AS DEFINED IN THE PUBLIC OFFICERS
 LAW AND SHALL NOT BE DISCLOSED DIRECTLY OR INDIRECTLY. AN INSURER  SHALL
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD02313-03-1

 A. 5218--A                          2
 
 IMPOSE THE CONFIDENTIALITY PROTECTIONS OF THIS SUBPARAGRAPH ON ANY THIRD
 PARTIES  OR  VENDORS  WITH  WHICH  IT CONTRACTS THAT MAY RECEIVE OR HAVE
 ACCESS TO REBATE INFORMATION.
   § 2. Subsection (b) of section 3221 of the insurance law is amended to
 read as follows:
   (b)  (1)  No  such policy shall be delivered or issued for delivery in
 this state unless a schedule of the premium  rates  pertaining  to  such
 form shall have been filed with the superintendent.
   (2)  AN  INSURER SHALL ANNUALLY CERTIFY TO THE DEPARTMENT THAT, DURING
 THE PRIOR BENEFIT YEAR, THE INSURER MADE AVAILABLE TO ENROLLEES  AT  THE
 POINT  OF SALE AT LEAST A MAJORITY (I.E., GREATER THAN FIFTY PERCENT) OF
 THE REBATES RECEIVED BY SUCH INSURER OR ANY  THIRD  PARTY  ADMINISTERING
 PRESCRIPTION DRUG BENEFITS ON BEHALF OF SUCH INSURER.
   (A) FOR PURPOSES OF THIS PARAGRAPH, "REBATE" MEANS:
   (I)  NEGOTIATED  PRICE  CONCESSIONS  INCLUDING BUT NOT LIMITED TO BASE
 REBATES AND REASONABLE ESTIMATES OF ANY  PRICE  PROTECTION  REBATES  AND
 PERFORMANCE-BASED  REBATES THAT MAY ACCRUE DIRECTLY OR INDIRECTLY TO THE
 ISSUER DURING THE COVERAGE YEAR FROM A MANUFACTURER, DISPENSING  PHARMA-
 CY, OR OTHER PARTY TO THE TRANSACTION, AND
   (II)  REASONABLE  ESTIMATES OF ANY FEES AND OTHER ADMINISTRATIVE COSTS
 THAT ARE PASSED THROUGH TO THE ISSUER AND SERVE TO REDUCE  THE  ISSUER'S
 PRESCRIPTION DRUG LIABILITIES FOR THE COVERAGE YEAR.
   (B)  IN PROVIDING THE CERTIFICATION REQUIRED UNDER THIS SUBSECTION, AN
 ISSUER SHALL NOT PUBLISH OR OTHERWISE REVEAL INFORMATION  REGARDING  THE
 ACTUAL  AMOUNT OF REBATES THE ISSUER RECEIVED ON A PRODUCT-, MANUFACTUR-
 ER- OR PHARMACY-SPECIFIC BASIS. SUCH INFORMATION IS PROTECTED AS A TRADE
 SECRET, IS NOT A PUBLIC RECORD AS DEFINED IN THE PUBLIC OFFICERS LAW AND
 SHALL NOT BE DISCLOSED DIRECTLY OR INDIRECTLY. AN INSURER  SHALL  IMPOSE
 THE  CONFIDENTIALITY PROTECTIONS OF THIS SUBSECTION ON ANY THIRD PARTIES
 OR VENDORS WITH WHICH IT CONTRACTS THAT MAY RECEIVE OR  HAVE  ACCESS  TO
 REBATE INFORMATION.
   § 3. This act shall take effect immediately.