NY State Senate Bill 2023-S3370

Senate Bill S3370

2023-2024 Legislative Session

Provides that prescriptions covered by insurance, that would otherwise be required to be filled by mail order, may be filled at a retail pharmacy under certain circumstances

download bill text pdf

Current Bill Status - Stricken

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

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Feb 26, 2024	recommit, enacting clause stricken
Jan 03, 2024	referred to insurance
Jan 31, 2023	referred to insurance

2023-S3370 (ACTIVE) - Details

Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2019-2020: S6296
2021-2022: S1772

2023-S3370 (ACTIVE) - Summary

Provides that prescriptions covered by insurance, that would otherwise be required to be filled by mail order, may be filled at a retail pharmacy under certain circumstances.

2023-S3370 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S3370

SPONSOR: SKOUFIS
 
TITLE OF BILL:

An act to amend the insurance law, in relation to coverage of
prescriptions obtained by mail order or at a non-retail pharmacy

 
PURPOSE:

Ensure patient access to retail pharmacies upon the prescriber's deter-
mination that mail order delivery would not be appropriate.

 
SUMMARY OF PROVISIONS:

Sections one, two and three amend Insurance Law S§ 3216, 3221 and 4303
respectively to provide that a prescriber, after consultation with the
patient's insurer, may determine that mail order delivery of
prescription medication is not appropriate given the patient's resi-
dence, medical condition, storage requirements of the drug, availability
of the insured to receive the prescription or the patient's ability to
understand guidance and support over the telephone. Provided the retail

pharmacy agrees to the same reimbursement amount and is able to fill the
prescription, the prescriber's determination shall be final.

Section four provides that the act take effect immediately.

 
JUSTIFICATION:

While recognizing the value of mail order pharmacies and the convenience
they provide for many, not all patients have the same needs. For many
patients, especially those with complex medical conditions, access to
local pharmacies for their medications can be essential for their health
and wellbeing. Patients may have residences lacking secure deliver
locations, be on specific treatment regimens that may be disrupted if
the medications are not promptly received, take medications that need
special handling, or need the in person counseling of a pharmacist.There
are many different reasons why an individual may benefit from access to
a retail pharmacy rather than a mail order pharmacy. That decision
should be made between the patient and his or her prescriber. The Legis-
lature has already acknowledged the need to ensure patient access to
pharmacy options.  This legislation will expand upon the 2011 provisions
to ensure a prescriber, considering all factors relevant to the patient,
can determine when mail order is not appropriate. The bill also ensures
that cost is not affected, by requiring the retail pharmacy to agree to
the same reimbursement amount.

 
LEGISLATIVE HISTORY:

Senate

2016- S7595A, Referred to Insurance

2020 - S6296, Referred to Insurance

2021-2022- S1772, Referred to Insurance

Assembly

2016- A10290A, Referred to Insurance

201-2018- A1929, Referred to Insurance

2020- A347, Referred to Insurance

2021-2022- A5787, Referred to Insurance

 
FISCAL IMPLICATIONS:

None to the state.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S3370 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3370
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 31, 2023
                                ___________
 
 Introduced  by  Sen. SKOUFIS -- 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  coverage  of
   prescriptions obtained by mail order or at a non-retail pharmacy
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The opening paragraph of paragraph 28 of subsection (i)  of
 section  3216 of the insurance law, is designated subparagraph (A) and a
 new subparagraph (B) is added to read as follows:
   (B) NOTWITHSTANDING ANY OTHER PROVISION OF THIS PARAGRAPH, IF A  PRES-
 CRIBER,  AFTER CONSULTING WITH THE INSURER REGARDING THE APPROPRIATENESS
 OF MAIL ORDER DELIVERY GIVEN: (I) THE RESIDENCE OR DELIVERY LOCATION  OF
 THE  INSURED; (II) THE MEDICAL CONDITION OF THE INSURED; (III) THE STOR-
 AGE REQUIREMENTS OF THE DRUG; (IV) THE AVAILABILITY OF  THE  INSURED  TO
 RECEIVE  THE  PRESCRIPTION;  OR  (V) THE INSURED'S ABILITY TO COMPREHEND
 PHARMACEUTICAL GUIDANCE AND SUPPORT OVER THE TELEPHONE, DETERMINES  THAT
 A DRUG AS PRESCRIBED ON AN INDIVIDUAL BASIS IS MOST APPROPRIATELY FILLED
 AT A RETAIL LOCATION, PROVIDED THAT AN IN-NETWORK RETAIL PHARMACY OF THE
 PATIENT'S  CHOOSING  AGREES TO THE SAME REIMBURSEMENT AMOUNT AND IS ABLE
 TO FILL THE PRESCRIPTION, THE PRESCRIBER'S DETERMINATION SHALL BE FINAL.
   § 2. Paragraph 18 of subsection (l) of section 3221 of  the  insurance
 law is amended by adding a new subparagraph (C) to read as follows:
   (C)  NOTWITHSTANDING ANY OTHER PROVISION OF THIS PARAGRAPH, IF A PRES-
 CRIBER, AFTER CONSULTING WITH THE INSURER REGARDING THE  APPROPRIATENESS
 OF  MAIL ORDER DELIVERY GIVEN: (I) THE RESIDENCE OR DELIVERY LOCATION OF
 THE INSURED; (II) THE MEDICAL CONDITION OF THE INSURED; (III) THE  STOR-
 AGE  REQUIREMENTS  OF  THE DRUG; (IV) THE AVAILABILITY OF THE INSURED TO
 RECEIVE THE PRESCRIPTION; OR (V) THE  INSURED'S  ABILITY  TO  COMPREHEND
 PHARMACEUTICAL  GUIDANCE AND SUPPORT OVER THE TELEPHONE, DETERMINES THAT
 A DRUG AS PRESCRIBED ON AN INDIVIDUAL BASIS IS MOST APPROPRIATELY FILLED
 AT A RETAIL LOCATION, PROVIDED THAT AN IN-NETWORK RETAIL PHARMACY OF THE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04814-01-3

 S. 3370                             2
 
 PATIENT'S CHOOSING AGREES TO THE SAME REIMBURSEMENT AMOUNT AND  IS  ABLE
 TO FILL THE PRESCRIPTION, THE PRESCRIBER'S DETERMINATION SHALL BE FINAL.
   §  3.  Subsection (kk) of section 4303 of the insurance law is amended
 by adding a new paragraph 3 to read as follows:
   (3) NOTWITHSTANDING ANY OTHER PROVISION OF THIS SUBSECTION, IF A PRES-
 CRIBER, AFTER CONSULTING WITH THE INSURER REGARDING THE  APPROPRIATENESS
 OF  MAIL ORDER DELIVERY GIVEN: (A) THE RESIDENCE OR DELIVERY LOCATION OF
 THE COVERED PERSON; (B) THE MEDICAL CONDITION OF THE COVERED PERSON; (C)
 THE STORAGE REQUIREMENTS OF  THE  DRUG;  (D)  THE  AVAILABILITY  OF  THE
 COVERED  PERSON TO RECEIVE THE PRESCRIPTION; OR (E) THE COVERED PERSON'S
 ABILITY TO COMPREHEND PHARMACEUTICAL GUIDANCE AND SUPPORT OVER THE TELE-
 PHONE, DETERMINES THAT A DRUG AS PRESCRIBED ON AN  INDIVIDUAL  BASIS  IS
 MOST APPROPRIATELY FILLED AT A RETAIL LOCATION, PROVIDED THAT AN IN-NET-
 WORK  RETAIL  PHARMACY  OF  THE  PATIENT'S  CHOOSING  AGREES TO THE SAME
 REIMBURSEMENT  AMOUNT  AND  IS  ABLE  TO  FILL  THE  PRESCRIPTION,   THE
 PRESCRIBER'S DETERMINATION SHALL BE FINAL.
   § 4. This act shall take effect immediately.

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