NY State Senate Bill S5299A

Archive: Last Bill Status Via A1741 - Signed by Governor

Introduced
In Committee
On Floor Calendar
- Passed Senate
- Passed Assembly
Delivered to Governor
Signed by Governor

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Actions

view actions (22)

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Dec 23, 2022	approval memo.54 signed chap.736
Dec 12, 2022	delivered to governor
May 24, 2022	returned to assembly passed senate 3rd reading cal.762 substituted for s5299a
May 24, 2022	substituted by a1741a
May 05, 2022	amended on third reading 5299a
Apr 27, 2022	advanced to third reading
Apr 26, 2022	2nd report cal.
Apr 25, 2022	1st report cal.762
Jan 05, 2022	referred to insurance returned to senate died in assembly
May 12, 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.576
Mar 01, 2021	referred to insurance

Votes

view votes

May 24, 2022 - floor Vote

A1741A

floor

Aye

Nay

Absent

Excused

Abstained

Apr 25, 2022 - Insurance committee Vote

S5299

committee

Aye

Nay

Aye with Reservations

Absent

Excused

Abstained

May 12, 2021 - floor Vote

S5299

floor

Aye

Nay

Absent

Excused

Abstained

Mar 16, 2021 - Insurance committee Vote

S5299

committee

Aye

Nay

Aye with Reservations

Absent

Excused

Abstained

Bill Amendments

Original

A (Active)

Original

A (Active)

Co-Sponsors

view additional co-sponsors

S5299 - Details

See Assembly Version of this Bill:: A1741
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2019-2020 Legislative Session:: S6303, A8246

S5299 - Summary

Requires any third-party payments, financial assistance, discount, voucher or other price reduction instrument for out-of-pocket expenses made on behalf of an insured individual for the cost of prescription drugs to be applied to the insured's deductible, copayment, coinsurance, out-of-pocket maximum, or any other cost-sharing requirement when calculating such insured individual's overall contribution to any out-of-pocket maximum or any cost-sharing requirement.

S5299 - Sponsor Memo

 
BILL NUMBER: S5299

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the insurance law, in relation to calculating an insured
individual's overall contribution to any out-of-pocket maximum or any
cost-sharing requirement

 
PURPOSE OR GENERAL IDEA OF BILL:

Requires insurance companies or pharmacy benefit managers to apply price
reduction instruments for out-of-pocket expenses when calculating an
insured individual's cost-sharing requirement.

 
SUMMARY OF PROVISIONS:

Section 1 requires any individual insurance policy that provides cover-
age for prescription drugs to apply any third party payments or other
price reduction instruments for out-of-pocket expenses made on behalf of
an insured person when calculating the insured individuals overall

contribution to any out-of-pocket maximum or cost-sharing requirement.

Section 2 applies these same provisions to group or blanket policies
that provide coverage for prescription drugs.

Section 3 applies these same provisions to non-profit medical expense
indemnity policies, hospital service corporations or health service
corporations that provides coverage for prescription drugs.

 
JUSTIFICATION:

Recently, many insurance companies and pharmacy benefit managers have
started to adopt new cost-shifting mechanisms that change the way an
insured individual's out-of-pocket contributions for prescription drugs
are calculated. These "copay accumulators" do not take into account any
discounts or coupons that the insured person receives from the drug
manufacturer when calculating the insured individuals out-of-pocket
expenses.

Some insurance plans with a deductible require that the patient pay up
to a certain amount of out-of-pocket expenses before the plan pays for
all of the healthcare services. Many drug manufacturers, especially for
high-cost drugs that treat rare diseases offer copay cards or other
assistance to help pay for their prescription drugs.

By not applying the discounts paid by the manufacturer, it takes the
insured person longer to reach their deductible. This means that the
insured person has to continue to pay copays for the drug for a longer
period of time and may be paying significantly more in out-of-pocket
expenses.

This practice shifts the cost towards patients as the insurance plan are
essentially "double dipping" by requiring the patient to pay their
normal copay and still receiving a discount or coupon from the drug
manufacturer, while taking longer to satisfy their deductible.  Several
states have already prohibited copay accumulators including Arizona,
Virginia and West Virginia. Several other states have introduced legis-
lation (Connecticut, Illinois, California, and others) that is currently
moving through the legislative process that either limit or prohibit the
use of "copay accumulators" by insurers.

 
PRIOR LEGISLATIVE HISTORY:

2019-2020: S6303/A8246 Gottfried

 
FISCAL IMPLICATIONS:

None to the state.

 
EFFECTIVE DATE:
First of January next succeeding the date on which it shall become a
law.

S5299 - Bill Text download pdf

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5299
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                               March 1, 2021
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation to calculating an insured
   individual's overall contribution to any out-of-pocket maximum or  any
   cost-sharing requirement

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
 amended by adding a new paragraph 36 to read as follows:
   (36)  ANY  POLICY  THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL
 APPLY ANY THIRD-PARTY PAYMENTS, FINANCIAL ASSISTANCE, DISCOUNT,  VOUCHER
 OR  OTHER  PRICE REDUCTION INSTRUMENT FOR OUT-OF-POCKET EXPENSES MADE ON
 BEHALF OF AN INSURED INDIVIDUAL FOR THE COST OF  PRESCRIPTION  DRUGS  TO
 THE INSURED'S DEDUCTIBLE, COPAYMENT, COINSURANCE, OUT-OF-POCKET MAXIMUM,
 OR  ANY  OTHER  COST-SHARING  REQUIREMENT  WHEN CALCULATING SUCH INSURED
 INDIVIDUAL'S OVERALL CONTRIBUTION TO ANY OUT-OF-POCKET  MAXIMUM  OR  ANY
 COST-SHARING REQUIREMENT.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 21 to read as follows:
   (21) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN
 THIS STATE THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL APPLY ANY
 THIRD-PARTY  PAYMENTS,  FINANCIAL ASSISTANCE, DISCOUNT, VOUCHER OR OTHER
 PRICE REDUCTION INSTRUMENT FOR OUT-OF-POCKET EXPENSES MADE ON BEHALF  OF
 AN  INSURED  INDIVIDUAL  FOR  THE  COST  OF  PRESCRIPTION  DRUGS  TO THE
 INSURED'S DEDUCTIBLE, COPAYMENT, COINSURANCE, OUT-OF-POCKET MAXIMUM,  OR
 ANY  OTHER  COST-SHARING REQUIREMENT WHEN CALCULATING SUCH INSURED INDI-
 VIDUAL'S OVERALL CONTRIBUTION TO ANY OUT-OF-POCKET MAXIMUM OR ANY  COST-
 SHARING REQUIREMENT.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (ss) to read as follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD00472-01-1

 S. 5299                             2
 
   (SS) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION,
 HOSPITAL  SERVICE  CORPORATION,  OR  HEALTH  SERVICE  CORPORATION   THAT
 PROVIDES  COVERAGE  FOR  PRESCRIPTION  DRUGS SHALL APPLY ANY THIRD-PARTY
 PAYMENTS,  FINANCIAL  ASSISTANCE,  DISCOUNT,  VOUCHER  OR  OTHER   PRICE
 REDUCTION  INSTRUMENT  FOR  OUT-OF-POCKET  EXPENSES MADE ON BEHALF OF AN
 INSURED INDIVIDUAL FOR THE COST OF PRESCRIPTION DRUGS TO  THE  INSURED'S
 DEDUCTIBLE,  COPAYMENT, COINSURANCE, OUT-OF-POCKET MAXIMUM, OR ANY OTHER
 COST-SHARING REQUIREMENT  WHEN  CALCULATING  SUCH  INSURED  INDIVIDUAL'S
 OVERALL  CONTRIBUTION  TO  ANY OUT-OF-POCKET MAXIMUM OR ANY COST-SHARING
 REQUIREMENT.
   § 4. This act shall take effect on the first of January next  succeed-
 ing  the date on which it shall have become a law and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or after such date.

Co-Sponsors

view additional co-sponsors

S5299A (ACTIVE) - Details

See Assembly Version of this Bill:: A1741
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2019-2020 Legislative Session:: S6303, A8246

S5299A (ACTIVE) - Summary

S5299A (ACTIVE) - Sponsor Memo

 
BILL NUMBER: S5299A

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the insurance law, in relation to calculating an insured
individual's overall contribution to any out-of-pocket maximum or any
cost-sharing requirement

 
PURPOSE OR GENERAL IDEA OF BILL:

Requires insurance companies or pharmacy benefit managers to apply price
reduction instruments for out-of-pocket expenses when calculating an
insured individual's cost-sharing requirement.

 
SUMMARY OF PROVISIONS:

Section 1 requires any individual insurance policy that provides cover-
age for prescription drugs to apply any third party payments or other
price reduction instruments for out-of-pocket expenses made on behalf of
an insured person when calculating the insured individuals overall
contribution to any out-of-pocket maximum or cost-sharing requirement.

Section 2 applies these same provisions to group or blanket policies
that provide coverage for prescription drugs.

Section 3 applies these same provisions to non-profit medical expense
indemnity policies, hospital service corporations or health service
corporations that provide coverage for prescription drugs.

Should any of these requirements result in health savings account inel-
igibility under federal law, they shall instead only apply to the deduc-
tible after the required deductible threshold is met.

 
JUSTIFICATION:

Recently, many insurance companies and pharmacy benefit managers have
started to adopt new cost-shifting mechanisms that change the way an
insured individual's out-of-pocket contributions for prescription drugs
are calculated. These "copay accumulators" do not take into account any
discounts or coupons that the insured person receives from the drug
manufacturer when calculating the insured individuals out-of-pocket
expenses.

Some insurance plans with a deductible require that the patient pay up
to a certain amount of out-of-pocket expenses before the plan pays for
all of the healthcare services. Many drug manufacturers, especially for
high-cost drugs that treat rare diseases offer copay cards or other
assistance to help pay for their prescription drugs.

By not applying the discounts paid by the manufacturer, it takes insured
individuals longer to reach their deductible. This means that the
insured person has to continue to pay copays for the drug for a longer
period of time and may be paying significantly more in out-of-pocket
expenses.

This practice shifts the cost towards patients as the insurance plan are
essentially "double dipping" by requiring the patient to pay their
normal copay and still receiving a discount or coupon from the drug
manufacturer, while taking longer to satisfy their deductible.  Several
states have already prohibited copay accumulators including Arizona,
Virginia and West Virginia. Several other states have introduced legis-
lation (Connecticut, Illinois, California, and others) that is currently
moving through the legislative process that either limit or prohibit the
use of "copay accumulators" by insurers.

 
PRIOR LEGISLATIVE HISTORY:

2021: S5299/A1741 Gottfried - Passed Senate

2019-2020: S6303/A8246 Gottfried - Passed Senate

 
FISCAL IMPLICATIONS:

None to the state.

 
EFFECTIVE DATE:
First of January next succeeding the date on which it shall become a
law.

S5299A (ACTIVE) - Bill Text download pdf

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5299--A
     Cal. No. 762
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                               March 1, 2021
                                ___________
 
 Introduced  by  Sens.  RIVERA, ADDABBO, AKSHAR, BROOKS, COONEY, HOYLMAN,
   JACKSON, KENNEDY, KRUEGER, SALAZAR, SKOUFIS -- read twice and  ordered
   printed,  and  when printed to be committed to the Committee on Insur-
   ance -- recommitted to the Committee on Insurance in  accordance  with
   Senate  Rule  6,  sec.  8  --  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 insurance law, in relation to calculating an insured
   individual's overall contribution to any out-of-pocket maximum or  any
   cost-sharing requirement
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
 amended by adding a new paragraph 37 to read as follows:
   (37)  ANY  POLICY  THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL
 APPLY ANY THIRD-PARTY PAYMENTS, FINANCIAL ASSISTANCE, DISCOUNT,  VOUCHER
 OR  OTHER  PRICE REDUCTION INSTRUMENT FOR OUT-OF-POCKET EXPENSES MADE ON
 BEHALF OF AN INSURED INDIVIDUAL FOR THE COST OF  PRESCRIPTION  DRUGS  TO
 THE INSURED'S DEDUCTIBLE, COPAYMENT, COINSURANCE, OUT-OF-POCKET MAXIMUM,
 OR  ANY  OTHER  COST-SHARING  REQUIREMENT  WHEN CALCULATING SUCH INSURED
 INDIVIDUAL'S OVERALL CONTRIBUTION TO ANY OUT-OF-POCKET  MAXIMUM  OR  ANY
 COST-SHARING  REQUIREMENT.    IF  UNDER FEDERAL LAW, APPLICATION OF THIS
 REQUIREMENT WOULD RESULT IN HEALTH SAVINGS ACCOUNT  INELIGIBILITY  UNDER
 26 USC 223, THIS REQUIREMENT SHALL APPLY FOR HEALTH SAVINGS ACCOUNT-QUA-
 LIFIED  HIGH  DEDUCTIBLE  HEALTH PLANS WITH RESPECT TO THE DEDUCTIBLE OF
 SUCH A PLAN AFTER THE ENROLLEE  HAS  SATISFIED  THE  MINIMUM  DEDUCTIBLE
 UNDER  26 USC 223, EXCEPT FOR WITH RESPECT TO ITEMS OR SERVICES THAT ARE
 PREVENTIVE CARE PURSUANT TO 26  USC  223(C)(2)(C),  IN  WHICH  CASE  THE
 REQUIREMENTS  OF  THIS  PARAGRAPH  SHALL APPLY REGARDLESS OF WHETHER THE
 MINIMUM DEDUCTIBLE UNDER 26 USC 223 HAS BEEN SATISFIED.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD00472-02-2
 S. 5299--A                          2
 
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 21 to read as follows:
   (21) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN
 THIS STATE THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL APPLY ANY
 THIRD-PARTY  PAYMENTS,  FINANCIAL ASSISTANCE, DISCOUNT, VOUCHER OR OTHER
 PRICE REDUCTION INSTRUMENT FOR OUT-OF-POCKET EXPENSES MADE ON BEHALF  OF
 AN  INSURED  INDIVIDUAL  FOR  THE  COST  OF  PRESCRIPTION  DRUGS  TO THE
 INSURED'S DEDUCTIBLE, COPAYMENT, COINSURANCE, OUT-OF-POCKET MAXIMUM,  OR
 ANY  OTHER  COST-SHARING REQUIREMENT WHEN CALCULATING SUCH INSURED INDI-
 VIDUAL'S OVERALL CONTRIBUTION TO ANY OUT-OF-POCKET MAXIMUM OR ANY  COST-
 SHARING REQUIREMENT.  IF UNDER FEDERAL LAW, APPLICATION OF THIS REQUIRE-
 MENT  WOULD  RESULT IN HEALTH SAVINGS ACCOUNT INELIGIBILITY UNDER 26 USC
 223, THIS REQUIREMENT SHALL APPLY FOR HEALTH  SAVINGS  ACCOUNT-QUALIFIED
 HIGH  DEDUCTIBLE  HEALTH  PLANS WITH RESPECT TO THE DEDUCTIBLE OF SUCH A
 PLAN AFTER THE ENROLLEE HAS SATISFIED THE MINIMUM  DEDUCTIBLE  UNDER  26
 USC  223,  EXCEPT FOR WITH RESPECT TO ITEMS OR SERVICES THAT ARE PREVEN-
 TIVE CARE PURSUANT TO 26 USC 223(C)(2)(C), IN WHICH  CASE  THE  REQUIRE-
 MENTS  OF  THIS  PARAGRAPH SHALL APPLY REGARDLESS OF WHETHER THE MINIMUM
 DEDUCTIBLE UNDER 26 USC 223 HAS BEEN SATISFIED.
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (tt) to read as follows:
   (TT) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION,
 HOSPITAL   SERVICE  CORPORATION,  OR  HEALTH  SERVICE  CORPORATION  THAT
 PROVIDES COVERAGE FOR PRESCRIPTION DRUGS  SHALL  APPLY  ANY  THIRD-PARTY
 PAYMENTS,   FINANCIAL  ASSISTANCE,  DISCOUNT,  VOUCHER  OR  OTHER  PRICE
 REDUCTION INSTRUMENT FOR OUT-OF-POCKET EXPENSES MADE  ON  BEHALF  OF  AN
 INSURED  INDIVIDUAL FOR THE COST OF PRESCRIPTION DRUGS TO  THE INSURED'S
 DEDUCTIBLE,  COPAYMENT, COINSURANCE, OUT-OF-POCKET MAXIMUM, OR ANY OTHER
 COST-SHARING REQUIREMENT  WHEN  CALCULATING  SUCH  INSURED  INDIVIDUAL'S
 OVERALL  CONTRIBUTION  TO  ANY OUT-OF-POCKET MAXIMUM OR ANY COST-SHARING
 REQUIREMENT. IF UNDER FEDERAL LAW, APPLICATION OF THIS REQUIREMENT WOULD
 RESULT  IN  HEALTH  SAVINGS ACCOUNT INELIGIBILITY UNDER 26 USC 223, THIS
 REQUIREMENT SHALL APPLY FOR HEALTH SAVINGS ACCOUNT-QUALIFIED HIGH DEDUC-
 TIBLE HEALTH PLANS WITH RESPECT TO THE DEDUCTIBLE OF SUCH A  PLAN  AFTER
 THE  ENROLLEE  HAS  SATISFIED  THE  MINIMUM DEDUCTIBLE UNDER 26 USC 223,
 EXCEPT FOR WITH RESPECT TO ITEMS OR SERVICES THAT  ARE  PREVENTIVE  CARE
 PURSUANT  TO 26 USC 223(C)(2)(C), IN WHICH CASE THE REQUIREMENTS OF THIS
 PARAGRAPH SHALL APPLY REGARDLESS OF WHETHER THE MINIMUM DEDUCTIBLE UNDER
 26 USC 223 HAS BEEN SATISFIED.
   § 4. This act shall take effect on the first of January next  succeed-
 ing  the date on which it shall have become a law and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or after such date.

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The New York State Senate

senate Bill S5299A

Sponsored By

Archive: Last Bill Status Via A1741 - Signed by Governor

Your Voice

Actions

Votes

May 24, 2022 - floor Vote

Floor Vote: May 24, 2022

Apr 25, 2022 - Insurance committee Vote

Committee Vote: Apr 25, 2022

May 12, 2021 - floor Vote

Floor Vote: May 12, 2021

Mar 16, 2021 - Insurance committee Vote

Committee Vote: Mar 16, 2021

Bill Amendments

Co-Sponsors

S5299 - Details

S5299 - Summary

S5299 - Sponsor Memo

S5299 - Bill Text download pdf

Co-Sponsors

S5299A (ACTIVE) - Details

S5299A (ACTIVE) - Summary

S5299A (ACTIVE) - Sponsor Memo

S5299A (ACTIVE) - Bill Text download pdf

Comments

senate Bill S5299A

Share this bill

Sponsored By

Archive: Last Bill Status Via A1741 - Signed by Governor

Your Voice

Actions

Votes

May 24, 2022 - floor Vote

Floor Vote: May 24, 2022

Apr 25, 2022 - Insurance committee Vote

Committee Vote: Apr 25, 2022

May 12, 2021 - floor Vote

Floor Vote: May 12, 2021

Mar 16, 2021 - Insurance committee Vote

Committee Vote: Mar 16, 2021

Bill Amendments

Co-Sponsors

S5299 - Details

S5299 - Summary

S5299 - Sponsor Memo

S5299 - Bill Text download pdf

Co-Sponsors

S5299A (ACTIVE) - Details

S5299A (ACTIVE) - Summary

S5299A (ACTIVE) - Sponsor Memo

S5299A (ACTIVE) - Bill Text download pdf

Comments