NY State Senate Bill 2023-S2393B

Senate Bill S2393B

2023-2024 Legislative Session

Relates 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

download bill text pdf

Current Bill Status - In Senate Committee Insurance Committee

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

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2024	referred to insurance
Oct 04, 2023	print number 2393b
Oct 04, 2023	amend (t) and recommit to insurance
May 25, 2023	print number 2393a
May 25, 2023	amend and recommit to insurance
Jan 20, 2023	referred to insurance

Bill Amendments

Original

B (Active)

co-Sponsors

2023-S2393 - Details

See Assembly Version of this Bill:: A1962
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Add §§3246 & 4331, Ins L; add §4417, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2019-2020: S6489, A8310
2021-2022: S2006, A5218

2023-S2393 - Summary

Requires certain health insurance issuers to certify that at least a majority of prescription drug rebates are provided to patients at the point of sale.

2023-S2393 - Sponsor Memo

                                 
BILL NUMBER: S2393

SPONSOR: JACKSON
 
TITLE OF BILL:

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

 
PURPOSE:

To ensure patients benefit from substantial discounts that exist within
the prescription drug supply chain.

 
SUMMARY OF PROVISIONS:

Section 1 adds a new subparagraph (C) to subsection (e) of Section 3231
of the Insurance Law to require individual and small group carriers to
certify that at least a majority (greater than 50%) of prescription drug
rebates are provided to patients at the point of sale.

Section 2 amends subsection (b) of Section 3221 of the Insurance Law to
require group and blanket accident and health carriers to certify that
at least a majority (greater than 50%) of prescription drug rebates are
provided to patients at the point of sale.

Section 3 is the effective date.

 
JUSTIFICATION:

The difference between list prices of prescription drugs and the net
prices paid by pharmacy benefit managers and health insurers has been
growing exponentially in recent years. While many entities benefit from
these large negotiated discounts - estimated at $166 billion in 2018 -
one group gets the short end of the stick: patients.

As more and more health insurance benefit designs rely on coinsurance
and deductibles, patients end up paying cost sharing on the list price
of the drug even as their health plan is reaping significant discounts.
Unlike negotiated discounts on other services like hospital care, these
savings are not shared with patients in the deducible phase of a plan
and patients often end up paying more than their health plan for a drug.
Plans argue that the discounts are used to lower premiums for everyone,
but patients with complex and chronic conditions end up carrying the
biggest burden - exactly the opposite of how insurance should work. This
bill strikes a careful balance, allowing rebates and discounts to be
socialized and keep premiums down to a point, but also making sure some
of those significant discounts are passed along to the place they're
most important to patients - at the pharmacy counter.

Many health plans have already implemented this option and have marketed
this approach as good for patients and "worth it."

 
LEGISLATIVE HISTORY:

2021-2022: S.2006 - Referred to Insurance/A.5218-A - Referred to Insur-
ance

2019-2020: S.6489 - Referred to Insurance/A.8310 - Referred to Insurance

 
STATE AND LOCAL FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S2393 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2393
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 20, 2023
                                ___________
 
 Introduced  by  Sen. JACKSON -- 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  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, as added by chapter 501 of the laws of  1992,  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 SHARE INFORMATION REGARDING THE ACTUAL AMOUNT OF REBATES
 THE ISSUER RECEIVED ON A PRODUCT-,  MANUFACTURER-  OR  PHARMACY-SPECIFIC
 BASIS  WITH  THE  DEPARTMENT  AND  THE AMOUNT THAT WAS PASSED THROUGH TO
 CONSUMERS. ANY INFORMATION  SHARED  UNDER  THIS  SUBPARAGRAPH  SHALL  BE
 CONFIDENTIAL AND NOT SUBJECT TO DISCLOSURE BY THE DEPARTMENT.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05427-01-3

 S. 2393                             2
 
   § 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 SHARE INFORMATION REGARDING THE ACTUAL  AMOUNT  OF  REBATES
 THE  ISSUER  RECEIVED  ON A PRODUCT-, MANUFACTURER- OR PHARMACY-SPECIFIC
 BASIS WITH THE DEPARTMENT AND THE AMOUNT  THAT  WAS  PASSED  THROUGH  TO
 CONSUMERS.  ANY  INFORMATION  SHARED  UNDER  THIS  SUBPARAGRAPH SHALL BE
 CONFIDENTIAL AND NOT SUBJECT TO DISCLOSURE BY THE DEPARTMENT.
   § 3. This act shall take effect immediately.

co-Sponsors

2023-S2393A - Details

See Assembly Version of this Bill:: A1962
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Add §§3246 & 4331, Ins L; add §4417, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2019-2020: S6489, A8310
2021-2022: S2006, A5218

2023-S2393A - Summary

Requires certain health insurance issuers to certify that at least a majority of prescription drug rebates are provided to patients at the point of sale.

2023-S2393A - Sponsor Memo

                                 
BILL NUMBER: S2393A

SPONSOR: JACKSON
 
TITLE OF BILL:

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

 
PURPOSE:

To ensure patients benefit from substantial discounts that exist within
the prescription drug supply chain.

 
SUMMARY OF PROVISIONS:

Section 1 adds a new subparagraph (C) to subsection (e) of Section 3231
of the Insurance Law to require individual and small group carriers to
certify that at least a majority (greater than 50%) of prescription drug
rebates are provided to patients at the point of sale.

Section 2 amends subsection (b) of Section 3221 of the Insurance Law to
require group and blanket accident and health carriers to certify that
at least a majority (greater than 50%) of prescription drug rebates are
provided to patients at the point of sale.

Section 3 is the effective date.

 
JUSTIFICATION:

The difference between list prices of prescription drugs and the net
prices paid by pharmacy benefit managers and health insurers has been
growing exponentially in recent years. While many entities benefit from
these large negotiated discounts - estimated at $166 billion in 2018 one
group gets the short end of the stick: patients.

As more and more health insurance benefit designs rely on coinsurance
and deductibles, patients end up paying cost sharing on the list price
of the drug even as their health plan is reaping significant discounts.
Unlike negotiated discounts on other services like hospital care, these
savings are not shared with patients in the deductible phase of a plan
and patients often end up paying more than their health plan for a drug.
Plans argue that the discounts are used to lower premiums for everyone,
but patients with complex and chronic conditions end up carrying the
biggest burden - exactly the opposite of how insurance should work. This
bill strikes a careful balance, allowing rebates and discounts to be
socialized and keep premiums down to a point, but also making sure some
of those significant discounts are passed along to the place they're
most important to patients - at the pharmacy counter.

Many health plans have already implemented this option and have marketed
this approach as good for patients and "worth it."

 
LEGISLATIVE HISTORY:

2021-2022: S.2006 - Referred to Insurance/A.5218-A - Referred to Insur-
ance

2019-2020: S.6489 - Referred to Insurance/A.8310 - Referred to Insurance

 
STATE AND LOCAL FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S2393A - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  2393--A
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 20, 2023
                                ___________
 
 Introduced  by  Sens.  JACKSON,  HOYLMAN-SIGAL -- read twice and ordered
   printed, and when printed to be committed to the Committee  on  Insur-
   ance  --  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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05427-03-3

 S. 2393--A                          2
 
 LAW AND SHALL NOT BE DISCLOSED DIRECTLY OR INDIRECTLY. AN INSURER  SHALL
 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 SUBDIVISION, 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 SUBDIVISION 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.

co-Sponsors

2023-S2393B (ACTIVE) - Details

See Assembly Version of this Bill:: A1962
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Add §§3246 & 4331, Ins L; add §4417, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2019-2020: S6489, A8310
2021-2022: S2006, A5218

2023-S2393B (ACTIVE) - Summary

Requires certain health insurance issuers to certify that at least a majority of prescription drug rebates are provided to patients at the point of sale.

2023-S2393B (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S2393B

SPONSOR: JACKSON
 
TITLE OF BILL:

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

 
PURPOSE:

To ensure patients benefit from substantial discounts that exist within
the prescription drug supply chain.

 
SUMMARY OF PROVISIONS:

Section 1 adds a new Section 3245 to Article 32 of the Insurance Law,
defining "Defined cost sharing," "Insurer," "Price Protection Rebate,"
and "Rebate;" requiring individual and small group carriers to certify
that at least a majority (greater than 85%) of prescription drug rebates
are provided to patients at the point of sale.

Section 2 adds a new Section 4331 to Article 43 of the Insurance Law,
defining "Defined cost sharing," "Insurer," "Price Protection Rebate,"
and "Rebate;" requiring individual and small group carriers to certify
that at least a majority (greater than 85%) of prescription drug rebates
are provided to patients at the point of sale.

Section 3 adds a new Section 4417 to Article 44 of the Public Health
Law, defining "Defined cost sharing," "Insurer," "Price Protection
Rebate," and "Rebate;" requiring individual and small group carriers to
certify that at least a majority (greater than 85%) of prescription drug
rebates are provided to patients at the point of sale.

Section 4 is the effective date.

 
JUSTIFICATION:

The difference between list prices of prescription drugs and the net
prices paid by pharmacy benefit managers and health insurers has been
growing exponentially in recent years. While many entities benefit from
these large negotiated discounts - estimated at $166 billion in 2018 one
group gets the short end of the stick: patients.

As more and more health insurance benefit designs rely on coinsurance
and deductibles, patients end up paying cost sharing on the list price
of the drug even as their health plan is reaping significant discounts.
Unlike negotiated discounts on other services like hospital care, these
savings are not shared with patients in the deductible phase of a plan
and patients often end up paying more than their health plan for a drug.
Plans argue that the discounts are used to lower premiums for everyone,
but patients with complex and chronic conditions end up carrying the
biggest burden - exactly the opposite of how insurance should work. This
bill strikes a careful balance, allowing rebates and discounts to be
socialized and keep premiums down to a point, but also making sure some
of those significant discounts are passed along to the place they're
most important to patients - at the pharmacy counter.

West Virginia is currently the only state requiring drug rebates to be
passed along to the patient at the point of sale. The legislation is
considered the model for other states with rebates at 100% being passed
along to patients. Many health plans have already implemented this
option and have marketed this approach as good for patients and "worth
it."

 
LEGISLATIVE HISTORY:

2021-2022: S.2006 - Referred to Insurance/A.5218-A - Referred to Insur-
ance

2019-2020: S.6489 - Referred to Insurance/A.8310 - Referred to Insurance

 
STATE AND LOCAL FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S2393B (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  2393--B
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 20, 2023
                                ___________
 
 Introduced  by  Sens.  JACKSON,  HOYLMAN-SIGAL -- read twice and ordered
   printed, and when printed to be committed to the Committee  on  Insur-
   ance  --  committee  discharged,  bill  amended,  ordered reprinted as
   amended and recommitted to said  committee  --  committee  discharged,
   bill  amended,  ordered  reprinted  as amended and recommitted to said
   committee
 
 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.
                                                            LBD05427-04-3

 S. 2393--B                          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
 S. 2393--B                          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.
 S. 2393--B                          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.

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Senate Bill S2393B

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Sponsored By

Robert Jackson

Current Bill Status - In Senate Committee Insurance Committee

Bill Amendments

co-Sponsors

Brad Hoylman-Sigal

2023-S2393 - Details

2023-S2393 - Summary

2023-S2393 - Sponsor Memo

2023-S2393 - Bill Text download pdf

co-Sponsors

Brad Hoylman-Sigal

2023-S2393A - Details

2023-S2393A - Summary

2023-S2393A - Sponsor Memo

2023-S2393A - Bill Text download pdf

co-Sponsors

Cordell Cleare

Nathalia Fernandez

Brad Hoylman-Sigal

2023-S2393B (ACTIVE) - Details

2023-S2393B (ACTIVE) - Summary

2023-S2393B (ACTIVE) - Sponsor Memo

2023-S2393B (ACTIVE) - Bill Text download pdf

Comments