senate Bill S4111

2021-2022 Legislative Session

Relates to prescription drug formulary changes during a contract year

download bill text pdf

Sponsored By

Current Bill Status - Passed Senate & Assembly


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

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Actions

view actions (11)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
May 26, 2021 returned to senate
passed assembly
May 19, 2021 ordered to third reading cal.361
substituted for a4668
Apr 27, 2021 referred to insurance
delivered to assembly
passed senate
Mar 18, 2021 advanced to third reading
Mar 17, 2021 2nd report cal.
Mar 16, 2021 1st report cal.574
Feb 02, 2021 referred to insurance

Co-Sponsors

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S4111 (ACTIVE) - Details

See Assembly Version of this Bill:
A4668
Law Section:
Insurance Law
Laws Affected:
Add §4909, Ins L; add §4909, Pub Health L

S4111 (ACTIVE) - Summary

Prohibits health care plans that provide essential benefits under the Affordable Care Act from removing a prescription drug from a formulary or adding new or additional formulary restrictions from a formulary during an enrollment year; requires notice to policy holders of intent to remove a drug from a formulary.

S4111 (ACTIVE) - Sponsor Memo

S4111 (ACTIVE) - Bill Text download pdf

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4111
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                             February 2, 2021
                                ___________
 
 Introduced  by Sens. BRESLIN, ADDABBO, BENJAMIN, BIAGGI, BROOKS, COMRIE,
   GAUGHRAN,  GIANARIS,  GRIFFO,  HELMING,  HOYLMAN,  JORDAN,   KAMINSKY,
   KAPLAN,  KENNEDY,  KRUEGER, LANZA, MAY, MAYER, MYRIE, PARKER, RITCHIE,
   RIVERA, SALAZAR, SANDERS, SAVINO, SEPULVEDA, SERINO, SERRANO, SKOUFIS,
   THOMAS -- read twice and ordered  printed,  and  when  printed  to  be
   committed to the Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to prescription drug formulary changes during a contract year
 
   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  4909
 to read as follows:
   §  4909.  PRESCRIPTION DRUG FORMULARY CHANGES. (A) EXCEPT AS OTHERWISE
 PROVIDED IN SUBSECTION (C) OF THIS SECTION, A  HEALTH  CARE  PLAN  SHALL
 NOT:
   (I) REMOVE A PRESCRIPTION DRUG FROM A FORMULARY;
   (II)  MOVE  A  PRESCRIPTION  DRUG  TO A TIER WITH A LARGER DEDUCTIBLE,
 COPAYMENT, OR COINSURANCE IF THE FORMULARY INCLUDES TWO OR MORE TIERS OF
 BENEFITS PROVIDING FOR DIFFERENT DEDUCTIBLES, COPAYMENTS OR  COINSURANCE
 APPLICABLE TO THE PRESCRIPTION DRUGS IN EACH TIER; OR
   (III)  ADD  UTILIZATION MANAGEMENT RESTRICTIONS TO A PRESCRIPTION DRUG
 ON A FORMULARY, UNLESS SUCH CHANGES OCCUR AT THE TIME OF  ENROLLMENT  OR
 ISSUANCE OF COVERAGE.
   (B)  PROHIBITIONS  PROVIDED  IN  SUBSECTION  (A) OF THIS SECTION SHALL
 APPLY BEGINNING ON THE DATE ON WHICH OPEN ENROLLMENT BEGINS FOR  A  PLAN
 YEAR  AND THROUGH THE END OF THE PLAN YEAR TO WHICH SUCH OPEN ENROLLMENT
 PERIOD APPLIES.
   (C) (I) A HEALTH CARE PLAN WITH A FORMULARY THAT INCLUDES TWO OR  MORE
 TIERS  OF  BENEFITS  PROVIDING  FOR DIFFERENT DEDUCTIBLES, COPAYMENTS OR
 COINSURANCE APPLICABLE TO PRESCRIPTION DRUGS IN EACH  TIER  MAY  MOVE  A
 PRESCRIPTION DRUG TO A TIER WITH A LARGER DEDUCTIBLE, COPAYMENT OR COIN-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

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