S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1962--A
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 23, 2023
                                ___________
 
 Introduced  by  M.  of A. WALKER, DILAN, TAPIA, ALVAREZ, REYES, HYNDMAN,
   SEPTIMO, DE LOS SANTOS, ZACCARO --  read  once  and  referred  to  the
   Committee on Insurance -- recommitted to the Committee on Insurance in
   accordance  with Assembly Rule 3, sec. 2 -- committee discharged, bill
   amended, ordered reprinted as amended and recommitted to said  commit-
   tee
 
 AN ACT to amend the insurance law and the public health law, in relation
   to requiring certain health insurance issuers 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.  The insurance law is amended by adding a new section 3246
 to read as follows:
   § 3246. ENSURING FAIRNESS IN CERTAIN COST SHARING. (A) AS USED IN THIS
 SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
   (1) "DEFINED COST SHARING" MEANS A DEDUCTIBLE PAYMENT  OR  COINSURANCE
 AMOUNT  IMPOSED ON AN ENROLLEE FOR A COVERED PRESCRIPTION DRUG UNDER THE
 ENROLLEE'S HEALTH PLAN.
   (2) "INSURER" MEANS ANY HEALTH INSURANCE ISSUER  THAT  IS  SUBJECT  TO
 STATE  LAW REGULATING INSURANCE AND OFFERS HEALTH INSURANCE COVERAGE, AS
 DEFINED IN 42 U.S.C. § 300GG-91, OR  ANY  STATE  OR  LOCAL  GOVERNMENTAL
 EMPLOYER PLAN.
   (3) "PRICE PROTECTION REBATE" MEANS A NEGOTIATED PRICE CONCESSION THAT
 ACCRUES  DIRECTLY OR INDIRECTLY TO THE INSURER, OR OTHER PARTY ON BEHALF
 OF THE INSURER, IN THE EVENT OF AN INCREASE IN THE WHOLESALE ACQUISITION
 COST OF A DRUG ABOVE A SPECIFIED THRESHOLD.
   (4) "REBATE" MEANS:
   (A) NEGOTIATED PRICE CONCESSIONS INCLUDING BUT  NOT  LIMITED  TO  BASE
 PRICE  CONCESSIONS,  WHETHER  DESCRIBED  AS  A  REBATE OR OTHERWISE, AND
 REASONABLE ESTIMATES OF ANY PRICE PROTECTION  REBATES  AND  PERFORMANCE-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05427-05-3
              

 A. 1962--A                          2
 
 BASED  PRICE  CONCESSIONS  THAT MAY ACCRUE DIRECTLY OR INDIRECTLY TO THE
 INSURER DURING THE COVERAGE YEAR FROM A MANUFACTURER, DISPENSING PHARMA-
 CY, OR OTHER PARTY IN CONNECTION WITH THE DISPENSING  OR  ADMINISTRATION
 OF A PRESCRIPTION DRUG, AND
   (B) REASONABLE ESTIMATES OF ANY NEGOTIATED PRICE CONCESSIONS, FEES AND
 OTHER  ADMINISTRATIVE  COSTS  THAT ARE PASSED THROUGH, OR ARE REASONABLY
 ANTICIPATED TO BE PASSED THROUGH, TO THE INSURER AND SERVE TO REDUCE THE
 INSURER'S LIABILITIES FOR A PRESCRIPTION DRUG.
   (B) AN ENROLLEE'S DEFINED COST  SHARING  FOR  EACH  PRESCRIPTION  DRUG
 SHALL  BE  CALCULATED  AT  THE  POINT  OF  SALE BASED ON A PRICE THAT IS
 REDUCED BY AN AMOUNT EQUAL  TO  AT  LEAST  EIGHTY-FIVE  PERCENT  OF  ALL
 REBATES  RECEIVED,  OR TO BE RECEIVED, IN CONNECTION WITH THE DISPENSING
 OR ADMINISTRATION OF THE PRESCRIPTION DRUG. NOTHING  SHALL  PRECLUDE  AN
 INSURER  FROM DECREASING AN ENROLLEE'S DEFINED COST SHARING BY AN AMOUNT
 GREATER THAN THAT REQUIRED UNDER THIS SUBSECTION.
   (C) AN INSURER SHALL SUBMIT TO THE  SUPERINTENDENT  BY  THE  FIRST  OF
 JANUARY  OF EACH YEAR A CERTIFICATION IN A FORM TO BE ESTABLISHED BY THE
 SUPERINTENDENT ATTESTING THAT IT HAS COMPLIED WITH THE  REQUIREMENTS  OF
 SUBSECTION (B) OF THIS SECTION FOR THE PRIOR CALENDAR YEAR.
   (D)  IN  COMPLYING  WITH THE PROVISIONS OF THIS SECTION, AN INSURER OR
 ITS AGENTS SHALL NOT PUBLISH OR OTHERWISE  PUBLICLY  REVEAL  INFORMATION
 REGARDING  THE ACTUAL AMOUNT OF REBATES AN INSURER RECEIVES ON A PRODUCT
 OR THERAPEUTIC CLASS OF  PRODUCTS,  MANUFACTURER,  OR  PHARMACY-SPECIFIC
 BASIS.  SUCH  INFORMATION  SHALL BE EXEMPT FROM DISCLOSURE UNDER SECTION
 EIGHTY-SEVEN OF THE PUBLIC OFFICERS  LAW  AND  SHALL  NOT  BE  DISCLOSED
 DIRECTLY  OR  INDIRECTLY,  OR IN A MANNER THAT WOULD ALLOW FOR THE IDEN-
 TIFICATION OF AN INDIVIDUAL PRODUCT, THERAPEUTIC CLASS OF  PRODUCTS,  OR
 MANUFACTURER, OR IN A MANNER THAT WOULD HAVE THE POTENTIAL TO COMPROMISE
 THE  FINANCIAL,  COMPETITIVE, OR PROPRIETARY NATURE OF SUCH INFORMATION.
 AN INSURER SHALL IMPOSE THE CONFIDENTIALITY PROTECTIONS OF THIS SUBDIVI-
 SION ON ANY VENDOR OR DOWNSTREAM THIRD-PARTY THAT PERFORMS  HEALTH  CARE
 OR  ADMINISTRATIVE SERVICES ON BEHALF OF THE INSURER THAT MAY RECEIVE OR
 HAVE ACCESS TO REBATE INFORMATION.
   § 2. The insurance law is amended by adding a new section 4331 to read
 as follows:
   § 4331. ENSURING FAIRNESS IN CERTAIN COST SHARING. (A) AS USED IN THIS
 SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
   (1) "DEFINED COST SHARING" MEANS A DEDUCTIBLE PAYMENT  OR  COINSURANCE
 AMOUNT  IMPOSED ON AN ENROLLEE FOR A COVERED PRESCRIPTION DRUG UNDER THE
 ENROLLEE'S HEALTH PLAN.
   (2) "CORPORATION" MEANS ANY HEALTH INSURANCE ISSUER THAT IS SUBJECT TO
 STATE LAW REGULATING INSURANCE AND OFFERS HEALTH INSURANCE COVERAGE,  AS
 DEFINED  IN  42  U.S.C.  §  300GG-91, OR ANY STATE OR LOCAL GOVERNMENTAL
 EMPLOYER PLAN.
   (3) "PRICE PROTECTION REBATE" MEANS A NEGOTIATED PRICE CONCESSION THAT
 ACCRUES DIRECTLY OR INDIRECTLY TO THE CORPORATION,  OR  OTHER  PARTY  ON
 BEHALF  OF THE CORPORATION, IN THE EVENT OF AN INCREASE IN THE WHOLESALE
 ACQUISITION COST OF A DRUG ABOVE A SPECIFIED THRESHOLD.
   (4) "REBATE" MEANS:
   (A) NEGOTIATED PRICE CONCESSIONS INCLUDING BUT  NOT  LIMITED  TO  BASE
 PRICE  CONCESSIONS,  WHETHER  DESCRIBED  AS  A  REBATE OR OTHERWISE, AND
 REASONABLE ESTIMATES OF ANY PRICE PROTECTION  REBATES  AND  PERFORMANCE-
 BASED  PRICE  CONCESSIONS  THAT MAY ACCRUE DIRECTLY OR INDIRECTLY TO THE
 CORPORATION DURING THE COVERAGE YEAR  FROM  A  MANUFACTURER,  DISPENSING
 PHARMACY,  OR  OTHER PARTY IN CONNECTION WITH THE DISPENSING OR ADMINIS-
 TRATION OF A PRESCRIPTION DRUG, AND
 A. 1962--A                          3
 
   (B) REASONABLE ESTIMATES OF ANY NEGOTIATED PRICE CONCESSIONS, FEES AND
 OTHER ADMINISTRATIVE COSTS THAT ARE PASSED THROUGH,  OR  ARE  REASONABLY
 ANTICIPATED TO BE PASSED THROUGH, TO THE CORPORATION AND SERVE TO REDUCE
 THE CORPORATION'S LIABILITIES FOR A PRESCRIPTION DRUG.
   (B)  AN  ENROLLEE'S  DEFINED  COST  SHARING FOR EACH PRESCRIPTION DRUG
 SHALL BE CALCULATED AT THE POINT OF  SALE  BASED  ON  A  PRICE  THAT  IS
 REDUCED  BY  AN  AMOUNT  EQUAL  TO  AT  LEAST EIGHTY-FIVE PERCENT OF ALL
 REBATES RECEIVED, OR TO BE RECEIVED, IN CONNECTION WITH  THE  DISPENSING
 OR  ADMINISTRATION  OF  THE  PRESCRIPTION DRUG. NOTHING SHALL PRECLUDE A
 CORPORATION FROM DECREASING AN ENROLLEE'S DEFINED  COST  SHARING  BY  AN
 AMOUNT GREATER THAN THAT REQUIRED UNDER THIS SUBSECTION.
   (C)  A  CORPORATION SHALL SUBMIT TO THE SUPERINTENDENT BY THE FIRST OF
 JANUARY OF EACH YEAR A CERTIFICATION IN A FORM TO BE ESTABLISHED BY  THE
 SUPERINTENDENT  ATTESTING  THAT IT HAS COMPLIED WITH THE REQUIREMENTS OF
 SUBSECTION (B) OF THIS SECTION FOR THE PRIOR CALENDAR YEAR.
   (D) IN COMPLYING WITH THE PROVISIONS OF THIS SECTION, A CORPORATION OR
 ITS AGENTS SHALL NOT PUBLISH OR OTHERWISE  PUBLICLY  REVEAL  INFORMATION
 REGARDING THE ACTUAL AMOUNT OF REBATES A CORPORATION RECEIVES ON A PROD-
 UCT OR THERAPEUTIC CLASS OF PRODUCTS, MANUFACTURER, OR PHARMACY-SPECIFIC
 BASIS.  SUCH  INFORMATION  SHALL BE EXEMPT FROM DISCLOSURE UNDER SECTION
 EIGHTY-SEVEN OF THE PUBLIC OFFICERS  LAW  AND  SHALL  NOT  BE  DISCLOSED
 DIRECTLY  OR  INDIRECTLY,  OR IN A MANNER THAT WOULD ALLOW FOR THE IDEN-
 TIFICATION OF AN INDIVIDUAL PRODUCT, THERAPEUTIC CLASS OF  PRODUCTS,  OR
 MANUFACTURER, OR IN A MANNER THAT WOULD HAVE THE POTENTIAL TO COMPROMISE
 THE FINANCIAL, COMPETITIVE, OR PROPRIETARY NATURE OF SUCH INFORMATION. A
 CORPORATION  SHALL IMPOSE THE CONFIDENTIALITY PROTECTIONS OF THIS SUBDI-
 VISION ON ANY VENDOR OR DOWNSTREAM THIRD-PARTY THAT PERFORMS HEALTH CARE
 OR ADMINISTRATIVE SERVICES ON BEHALF OF THE CORPORATION THAT MAY RECEIVE
 OR HAVE ACCESS TO REBATE INFORMATION.
   § 3. The public health law is amended by adding a new section 4417  to
 read as follows:
   §  4417. ENSURING FAIRNESS IN CERTAIN COST SHARING. 1. AS USED IN THIS
 SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
   (A) "DEFINED COST SHARING" MEANS A DEDUCTIBLE PAYMENT  OR  COINSURANCE
 AMOUNT  IMPOSED ON AN ENROLLEE FOR A COVERED PRESCRIPTION DRUG UNDER THE
 ENROLLEE'S HEALTH PLAN.
   (B) "ORGANIZATION" MEANS ANY HEALTH INSURANCE ISSUER THAT  IS  SUBJECT
 TO  STATE LAW REGULATING INSURANCE AND OFFERS HEALTH INSURANCE COVERAGE,
 AS DEFINED IN 42 U.S.C. § 300GG-91, OR ANY STATE OR  LOCAL  GOVERNMENTAL
 EMPLOYER PLAN.
   (C) "PRICE PROTECTION REBATE" MEANS A NEGOTIATED PRICE CONCESSION THAT
 ACCRUES  DIRECTLY  OR  INDIRECTLY TO THE ORGANIZATION, OR OTHER PARTY ON
 BEHALF OF THE ORGANIZATION, IN THE EVENT OF AN INCREASE IN THE WHOLESALE
 ACQUISITION COST OF A DRUG ABOVE A SPECIFIED THRESHOLD.
   (D) "REBATE" MEANS:
   (I) NEGOTIATED PRICE CONCESSIONS INCLUDING BUT  NOT  LIMITED  TO  BASE
 PRICE  CONCESSIONS,  WHETHER  DESCRIBED  AS  A  REBATE OR OTHERWISE, AND
 REASONABLE ESTIMATES OF ANY PRICE PROTECTION  REBATES  AND  PERFORMANCE-
 BASED  PRICE  CONCESSIONS  THAT MAY ACCRUE DIRECTLY OR INDIRECTLY TO THE
 ORGANIZATION DURING THE COVERAGE YEAR FROM  A  MANUFACTURER,  DISPENSING
 PHARMACY,  OR  OTHER PARTY IN CONNECTION WITH THE DISPENSING OR ADMINIS-
 TRATION OF A PRESCRIPTION DRUG, AND
   (II) REASONABLE ESTIMATES OF ANY NEGOTIATED  PRICE  CONCESSIONS,  FEES
 AND  OTHER  ADMINISTRATIVE COSTS THAT ARE PASSED THROUGH, OR ARE REASON-
 ABLY ANTICIPATED TO BE PASSED THROUGH, TO THE ORGANIZATION AND SERVE  TO
 REDUCE THE ORGANIZATION'S LIABILITIES FOR A PRESCRIPTION DRUG.
 A. 1962--A                          4
 
   2. AN ENROLLEE'S DEFINED COST SHARING FOR EACH PRESCRIPTION DRUG SHALL
 BE  CALCULATED  AT THE POINT OF SALE BASED ON A PRICE THAT IS REDUCED BY
 AN AMOUNT EQUAL TO AT LEAST EIGHTY-FIVE PERCENT OF ALL REBATES RECEIVED,
 OR TO BE RECEIVED, IN CONNECTION WITH THE DISPENSING  OR  ADMINISTRATION
 OF  THE  PRESCRIPTION  DRUG. NOTHING SHALL PRECLUDE AN ORGANIZATION FROM
 DECREASING AN ENROLLEE'S DEFINED COST SHARING BY AN AMOUNT GREATER  THAN
 THAT REQUIRED UNDER THIS SUBDIVISION.
   3.  AN ORGANIZATION SHALL SUBMIT TO THE SUPERINTENDENT BY THE FIRST OF
 JANUARY OF EACH YEAR A CERTIFICATION IN A FORM TO BE ESTABLISHED BY  THE
 SUPERINTENDENT  ATTESTING  THAT IT HAS COMPLIED WITH THE REQUIREMENTS OF
 SUBDIVISION TWO OF THIS SECTION FOR THE PRIOR CALENDAR YEAR.
   4. IN COMPLYING WITH THE PROVISIONS OF THIS SECTION,  AN  ORGANIZATION
 OR ITS AGENTS SHALL NOT PUBLISH OR OTHERWISE PUBLICLY REVEAL INFORMATION
 REGARDING  THE  ACTUAL  AMOUNT  OF REBATES AN ORGANIZATION RECEIVES ON A
 PRODUCT OR THERAPEUTIC CLASS OF PRODUCTS, MANUFACTURER, OR PHARMACY-SPE-
 CIFIC BASIS. SUCH INFORMATION SHALL  BE  EXEMPT  FROM  DISCLOSURE  UNDER
 SECTION  EIGHTY-SEVEN  OF  THE  PUBLIC  OFFICERS  LAW  AND  SHALL NOT BE
 DISCLOSED DIRECTLY OR INDIRECTLY, OR IN A MANNER THAT  WOULD  ALLOW  FOR
 THE  IDENTIFICATION  OF  AN  INDIVIDUAL  PRODUCT,  THERAPEUTIC  CLASS OF
 PRODUCTS, OR MANUFACTURER, OR IN A MANNER THAT WOULD HAVE THE  POTENTIAL
 TO  COMPROMISE THE FINANCIAL, COMPETITIVE, OR PROPRIETARY NATURE OF SUCH
 INFORMATION.  AN   ORGANIZATION   SHALL   IMPOSE   THE   CONFIDENTIALITY
 PROTECTIONS  OF THIS SUBDIVISION ON ANY VENDOR OR DOWNSTREAM THIRD-PARTY
 THAT PERFORMS HEALTH CARE OR ADMINISTRATIVE SERVICES ON  BEHALF  OF  THE
 ORGANIZATION THAT MAY RECEIVE OR HAVE ACCESS TO REBATE INFORMATION.
   §  4.  This  act  shall take effect immediately and apply to contracts
 issued, renewed or amended on or after January 1, 2023.