The New York State Senate

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2200
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 23, 2023
                                ___________
 
 Introduced by M. of A. McDONALD -- read once and referred to the Commit-
   tee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to  patient  prescription  pricing transparency; and to repeal certain
   provisions of the insurance law related thereto

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. Subsection 341-a of the insurance law, as added by a chap-
 ter of the laws of 2022 amending the insurance law relating to  enacting
 the  "patient  Rx  information and choice expansion act", as proposed in
 legislative bills numbers S. 4620-C and A. 5411-D, is REPEALED.
   § 2. Section 3217-a of the insurance law is amended by  adding  a  new
 subsection (g) to read as follows:
   (G) (1) AS USED IN THIS SUBSECTION:
   (A)  "PHARMACY  BENEFIT  MANAGER" SHALL HAVE THE MEANINGS SET FORTH IN
 SECTION TWO HUNDRED EIGHTY-A OF THE PUBLIC HEALTH LAW.
   (B) "COST-SHARING INFORMATION" MEANS THE AMOUNT AN INSURED IS REQUIRED
 TO PAY TO RECEIVE A DRUG THAT IS COVERED UNDER THE  INSURED'S  INSURANCE
 POLICY.
   (C)  "COVERED/COVERAGE"  MEANS  THOSE HEALTH CARE SERVICES TO WHICH AN
 INSURED IS ENTITLED UNDER THE TERMS OF THE INSURANCE POLICY.
   (D) "ELECTRONIC HEALTH RECORD" MEANS A DIGITAL VERSION OF A  PATIENT'S
 PAPER  CHART  AND  MEDICAL  HISTORY  THAT  MAKES  INFORMATION  AVAILABLE
 INSTANTLY AND SECURELY TO AUTHORIZED USERS.
   (E) "ELECTRONIC PRESCRIBING SYSTEM" MEANS A SYSTEM THAT ENABLES  PRES-
 CRIBERS  TO  ENTER PRESCRIPTION INFORMATION INTO A COMPUTER PRESCRIPTION
 DEVICE AND SECURELY TRANSMIT THE  PRESCRIPTION  TO  PHARMACIES  USING  A
 SPECIAL SOFTWARE PROGRAM AND CONNECTIVITY TO A TRANSMISSION NETWORK.
   (F)  "ELECTRONIC  PRESCRIPTION"  MEANS  AN  ELECTRONIC PRESCRIPTION AS
 DEFINED IN SECTION THIRTY-THREE HUNDRED TWO OF THE PUBLIC HEALTH LAW.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04034-01-3
 A. 2200                             2

 
   (G) "PRESCRIBER" MEANS A HEALTH CARE PROVIDER  LICENSED  TO  PRESCRIBE
 MEDICATION OR MEDICAL DEVICES IN THIS STATE.
   (H)   "REAL-TIME   BENEFIT   TOOL"   OR  "RTBT"  MEANS  AN  ELECTRONIC
 PRESCRIPTION DECISION SUPPORT TOOL THAT: (I) IS CAPABLE  OF  INTEGRATING
 WITH  PRESCRIBERS' ELECTRONIC PRESCRIBING SYSTEM AND, IF FEASIBLE, ELEC-
 TRONIC HEALTH RECORD SYSTEMS; AND (II) COMPLIES WITH THE TECHNICAL STAN-
 DARDS ADOPTED BY AN AMERICAN NATIONAL STANDARDS INSTITUTE (ANSI) ACCRED-
 ITED STANDARDS DEVELOPMENT ORGANIZATION.
   (I) "AUTHORIZED THIRD PARTY"  SHALL  INCLUDE  A  THIRD  PARTY  LEGALLY
 AUTHORIZED  UNDER  STATE  OR  FEDERAL  LAW SUBJECT TO A HEALTH INSURANCE
 PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) BUSINESS ASSOCIATE AGREEMENT.
   (2) THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO ANY HEALTH  PLAN
 THAT  EXCLUSIVELY  SERVES  INDIVIDUALS ENROLLED PURSUANT TO A FEDERAL OR
 STATE INSURANCE AFFORDABILITY PROGRAM, INCLUDING THE MEDICAL  ASSISTANCE
 PROGRAM  UNDER  TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW,
 CHILD HEALTH PLUS UNDER SECTION TWENTY-FIVE HUNDRED ELEVEN OF THE PUBLIC
 HEALTH LAW, THE BASIC HEALTH PROGRAM UNDER SECTION THREE HUNDRED  SIXTY-
 NINE-GG  OF  THE SOCIAL SERVICES LAW, OR A PLAN PROVIDING SERVICES UNDER
 TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT.
   (3) AN INSURER SUBJECT TO THIS ARTICLE  OR  PHARMACY  BENEFIT  MANAGER
 SHALL,  UPON REQUEST OF THE INSURED, THE INSURED'S HEALTH CARE PROVIDER,
 OR AN AUTHORIZED THIRD PARTY ON THE INSURED'S BEHALF, MADE TO THE INSUR-
 ER OR PHARMACY BENEFIT MANAGER, FURNISH THE COST, BENEFIT, AND  COVERAGE
 DATA  REQUIRED  BY  THIS SUBSECTION TO THE INSURED, THE INSURED'S HEALTH
 CARE PROVIDER, OR THE AUTHORIZED THIRD PARTY AND SHALL ENSURE THAT  SUCH
 DATA  IS: (A) CURRENT NO LATER THAN ONE BUSINESS DAY AFTER ANY CHANGE TO
 THE COST, BENEFIT, OR COVERAGE DATA IS MADE;  (B)  PROVIDED  THROUGH  AN
 RTBT WHEN THE REQUEST IS MADE BY THE INSURED'S HEALTH CARE PROVIDER; AND
 (C) IN A FORMAT THAT IS EASILY ACCESSIBLE TO THE REQUESTOR.
   (4)  WHEN  PROVIDING  THE  DATA  REQUIRED  BY  PARAGRAPH THREE OF THIS
 SUBSECTION, THE INSURER OR PHARMACY BENEFIT  MANAGER  SHALL  USE  ESTAB-
 LISHED INDUSTRY CONTENT AND TRANSPORT STANDARDS PUBLISHED BY:
   (A)  A  STANDARDS  DEVELOPING  ORGANIZATION ACCREDITED BY THE AMERICAN
 NATIONAL STANDARDS INSTITUTE (ANSI), INCLUDING, THE NATIONAL COUNCIL FOR
 PRESCRIPTION DRUG PROGRAMS (NCPDP), ASC X12, HEALTH LEVEL 7; OR
   (B) A RELEVANT FEDERAL OR STATE GOVERNING BODY, INCLUDING  THE  CENTER
 FOR MEDICARE & MEDICAID SERVICES OR THE OFFICE OF THE NATIONAL COORDINA-
 TOR FOR HEALTH INFORMATION TECHNOLOGY; OR
   (C)  ANOTHER FORMAT DEEMED ACCEPTABLE TO THE DEPARTMENT WHICH PROVIDES
 THE DATA PRESCRIBED IN PARAGRAPH THREE OF THIS  SUBSECTION  AND  IN  THE
 SAME TIMELINESS AS REQUIRED BY THIS SECTION.
   (5)  A  FACSIMILE  SHALL  NOT  BE  CONSIDERED AN ACCEPTABLE ELECTRONIC
 FORMAT PURSUANT TO THIS SUBSECTION.
   (6)  UPON  A  REQUEST  MADE  PURSUANT  TO  PARAGRAPH  THREE  OF   THIS
 SUBSECTION,  THE  INSURER  OR PHARMACY BENEFIT MANAGER SHALL PROVIDE THE
 FOLLOWING DATA FOR ANY DRUG COVERED UNDER THE INSURED'S INSURANCE  POLI-
 CY:
   (A) INSURED-SPECIFIC ELIGIBILITY INFORMATION;
   (B)  INSURED-SPECIFIC  PRESCRIPTION  COST  AND  BENEFIT  DATA, SUCH AS
 APPLICABLE FORMULARY, BENEFIT, COVERAGE AND COST-SHARING  DATA  FOR  THE
 PRESCRIBED  DRUG AND CLINICALLY-APPROPRIATE ALTERNATIVES, WHEN APPROPRI-
 ATE;
   (C) INSURED-SPECIFIC COST-SHARING INFORMATION THAT DESCRIBES  VARIANCE
 IN  COST-SHARING BASED ON THE PHARMACY DISPENSING THE PRESCRIBED DRUG OR
 ITS ALTERNATIVES, AND IN RELATION TO THE INSURED'S BENEFIT; AND
   (D) APPLICABLE UTILIZATION MANAGEMENT REQUIREMENTS.
 A. 2200                             3
 
   (7) ANY INSURER OR PHARMACY BENEFIT MANAGER SHALL FURNISH THE DATA  AS
 REQUIRED  WHETHER  THE  REQUEST  IS MADE USING THE DRUG'S UNIQUE BILLING
 CODE, SUCH AS A NATIONAL DRUG CODE OR HEALTHCARE COMMON PROCEDURE CODING
 SYSTEM CODE OR DESCRIPTIVE TERM. AN INSURER OR PHARMACY BENEFIT  MANAGER
 SHALL NOT DENY OR UNREASONABLY DELAY PROCESSING A REQUEST.
   (8)  AN  INSURER AND PHARMACY BENEFIT MANAGER SHALL NOT, EXCEPT AS MAY
 BE REQUIRED OR AUTHORIZED BY LAW, INTERFERE WITH, PREVENT, OR MATERIALLY
 DISCOURAGE ACCESS, EXCHANGE, OR USE OF THE DATA AS REQUIRED;  NOR  SHALL
 AN  INSURER  OR PHARMACY BENEFIT MANAGER PENALIZE A HEALTH CARE PROVIDER
 FOR DISCLOSING SUCH INFORMATION TO AN INSURED  OR  LEGALLY  PRESCRIBING,
 ADMINISTERING,  OR ORDERING A LOWER COST CLINICALLY APPROPRIATE ALTERNA-
 TIVE.
   (9) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO LIMIT  ACCESS  TO
 THE  MOST  UP-TO-DATE  INSURED-SPECIFIC  ELIGIBILITY OR INSURED-SPECIFIC
 PRESCRIPTION COST AND BENEFIT DATA BY THE INSURER  OR  PHARMACY  BENEFIT
 MANAGER.
   (10)  NOTHING  IN  THIS SUBSECTION SHALL INTERFERE WITH INSURED CHOICE
 AND A HEALTH CARE  PROVIDER'S  ABILITY  TO  CONVEY  THE  FULL  RANGE  OF
 PRESCRIPTION  DRUG  COST  OPTIONS  TO  AN INSURED. INSURERS AND PHARMACY
 BENEFIT MANAGERS SHALL NOT RESTRICT A HEALTH CARE PROVIDER FROM COMMUNI-
 CATING TO THE INSURED PRESCRIPTION COST OPTIONS.
   § 3. Section 4324 of the insurance law is  amended  by  adding  a  new
 subsection (g) to read as follows:
   (G) (1) AS USED IN THIS SUBSECTION:
   (A)  "PHARMACY  BENEFIT  MANAGER"  SHALL HAVE THE MEANING SET FORTH IN
 SECTION TWO HUNDRED EIGHTY-A OF THE PUBLIC HEALTH LAW.
   (B) "COST-SHARING  INFORMATION"  MEANS  THE  AMOUNT  A  SUBSCRIBER  IS
 REQUIRED TO PAY TO RECEIVE A DRUG THAT IS COVERED UNDER THE SUBSCRIBER'S
 INSURANCE CONTRACT.
   (C)  "COVERED/COVERAGE"  MEANS  THOSE  HEALTH CARE SERVICES TO WHICH A
 SUBSCRIBER IS ENTITLED UNDER THE TERMS OF THE INSURANCE CONTRACT.
   (D) "ELECTRONIC HEALTH RECORD" MEANS A DIGITAL VERSION OF A  PATIENT'S
 PAPER  CHART  AND  MEDICAL  HISTORY  THAT  MAKES  INFORMATION  AVAILABLE
 INSTANTLY AND SECURELY TO AUTHORIZED USERS.
   (E) "ELECTRONIC PRESCRIBING SYSTEM" MEANS A SYSTEM THAT ENABLES  PRES-
 CRIBERS  TO  ENTER PRESCRIPTION INFORMATION INTO A COMPUTER PRESCRIPTION
 DEVICE AND SECURELY TRANSMIT THE  PRESCRIPTION  TO  PHARMACIES  USING  A
 SPECIAL SOFTWARE PROGRAM AND CONNECTIVITY TO A TRANSMISSION NETWORK.
   (F)  "ELECTRONIC  PRESCRIPTION"  SHALL  HAVE  THE MEANING SET FORTH IN
 SECTION THIRTY-THREE HUNDRED TWO OF THE PUBLIC HEALTH LAW.
   (G) "PRESCRIBER" MEANS A HEALTH CARE PROVIDER  LICENSED  TO  PRESCRIBE
 MEDICATION OR MEDICAL DEVICES IN THIS STATE.
   (H)   "REAL-TIME   BENEFIT   TOOL"   OR  "RTBT"  MEANS  AN  ELECTRONIC
 PRESCRIPTION DECISION SUPPORT TOOL THAT: (I) IS CAPABLE  OF  INTEGRATING
 WITH  PRESCRIBERS' ELECTRONIC PRESCRIBING SYSTEM AND, IF FEASIBLE, ELEC-
 TRONIC HEALTH RECORD SYSTEMS; AND (II) COMPLIES WITH THE TECHNICAL STAN-
 DARDS ADOPTED BY AN AMERICAN NATIONAL STANDARDS INSTITUTE (ANSI) ACCRED-
 ITED STANDARDS DEVELOPMENT ORGANIZATION.
   (I) "AUTHORIZED THIRD PARTY"  SHALL  INCLUDE  A  THIRD  PARTY  LEGALLY
 AUTHORIZED  UNDER  STATE  OR  FEDERAL  LAW SUBJECT TO A HEALTH INSURANCE
 PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) BUSINESS ASSOCIATE AGREEMENT.
   (2) THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO ANY HEALTH  PLAN
 THAT  EXCLUSIVELY  SERVES  INDIVIDUALS ENROLLED PURSUANT TO A FEDERAL OR
 STATE INSURANCE AFFORDABILITY PROGRAM, INCLUDING THE MEDICAL  ASSISTANCE
 PROGRAM  UNDER  TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW,
 CHILD HEALTH PLUS UNDER SECTION TWENTY-FIVE HUNDRED ELEVEN OF THE PUBLIC
 A. 2200                             4
 
 HEALTH LAW, THE BASIC HEALTH PROGRAM UNDER SECTION THREE HUNDRED  SIXTY-
 NINE-GG  OF  THE SOCIAL SERVICES LAW, OR A PLAN PROVIDING SERVICES UNDER
 TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT.
   (3)  A  HEALTH SERVICE, HOSPITAL SERVICE, OR MEDICAL EXPENSE INDEMNITY
 CORPORATION SUBJECT TO THIS ARTICLE OR PHARMACY BENEFIT  MANAGER  SHALL,
 UPON  REQUEST  OF THE SUBSCRIBER, THE SUBSCRIBER'S HEALTH CARE PROVIDER,
 OR AN AUTHORIZED THIRD PARTY ON THE SUBSCRIBER'S  BEHALF,  MADE  TO  THE
 HEALTH  SERVICE,  HOSPITAL  SERVICE, OR MEDICAL EXPENSE INDEMNITY CORPO-
 RATION OR PHARMACY BENEFIT  MANAGER,  FURNISH  THE  COST,  BENEFIT,  AND
 COVERAGE  DATA  REQUIRED  BY  THIS  SUBSECTION  TO  THE  SUBSCRIBER, THE
 SUBSCRIBER'S HEALTH CARE PROVIDER, OR THE  AUTHORIZED  THIRD  PARTY  AND
 SHALL  ENSURE  THAT SUCH DATA IS: (A) CURRENT NO LATER THAN ONE BUSINESS
 DAY AFTER ANY CHANGE TO THE COST, BENEFIT, OR COVERAGE DATA IS MADE; (B)
 PROVIDED THROUGH A RTBT WHEN THE REQUEST IS  MADE  BY  THE  SUBSCRIBER'S
 HEALTH  CARE  PROVIDER; AND (C) IN A FORMAT THAT IS EASILY ACCESSIBLE TO
 THE REQUESTOR.
   (4) WHEN PROVIDING THE  DATA  REQUIRED  BY  PARAGRAPH  THREE  OF  THIS
 SUBSECTION,  THE  HEALTH  SERVICE,  HOSPITAL SERVICE, OR MEDICAL EXPENSE
 INDEMNITY CORPORATION OR PHARMACY BENEFIT MANAGER SHALL USE  ESTABLISHED
 INDUSTRY CONTENT AND TRANSPORT STANDARDS PUBLISHED BY:
   (A)  A  STANDARDS  DEVELOPING  ORGANIZATION ACCREDITED BY THE AMERICAN
 NATIONAL STANDARDS INSTITUTE (ANSI), INCLUDING, THE NATIONAL COUNCIL FOR
 PRESCRIPTION DRUG PROGRAMS (NCPDP), ASC X12, HEALTH LEVEL 7; OR
   (B) A RELEVANT FEDERAL OR STATE GOVERNING BODY, INCLUDING  THE  CENTER
 FOR MEDICARE & MEDICAID SERVICES OR THE OFFICE OF THE NATIONAL COORDINA-
 TOR FOR HEALTH INFORMATION TECHNOLOGY.
   (C)  ANOTHER FORMAT DEEMED ACCEPTABLE TO THE DEPARTMENT WHICH PROVIDES
 THE DATA PRESCRIBED IN PARAGRAPH THREE OF THIS  SUBSECTION  AND  IN  THE
 SAME TIMELINESS AS REQUIRED BY THIS SECTION.
   (5)  A  FACSIMILE  SHALL  NOT  BE  CONSIDERED AN ACCEPTABLE ELECTRONIC
 FORMAT PURSUANT TO THIS SUBSECTION.
   (6)  UPON  A  REQUEST  MADE  PURSUANT  TO  PARAGRAPH  THREE  OF   THIS
 SUBSECTION,  THE  HEALTH  SERVICE,  HOSPITAL SERVICE, OR MEDICAL EXPENSE
 INDEMNITY CORPORATION OR PHARMACY  BENEFIT  MANAGER  SHALL  PROVIDE  THE
 FOLLOWING  DATA  FOR  ANY  DRUG COVERED UNDER THE SUBSCRIBER'S INSURANCE
 CONTRACT:
   (A) SUBSCRIBER-SPECIFIC ELIGIBILITY INFORMATION;
   (B) SUBSCRIBER-SPECIFIC PRESCRIPTION COST AND BENEFIT  DATA,  SUCH  AS
 APPLICABLE  FORMULARY,  BENEFIT, COVERAGE, AND COST-SHARING DATA FOR THE
 PRESCRIBED DRUG AND CLINICALLY-APPROPRIATE ALTERNATIVES, WHEN  APPROPRI-
 ATE;
   (C)  SUBSCRIBER-SPECIFIC COST-SHARING INFORMATION THAT DESCRIBES VARI-
 ANCE IN COST-SHARING BASED ON THE  PHARMACY  DISPENSING  THE  PRESCRIBED
 DRUG OR ITS ALTERNATIVES, AND IN RELATION TO THE INSURED'S BENEFIT; AND
   (D) APPLICABLE UTILIZATION MANAGEMENT REQUIREMENTS.
   (7)  A  HEALTH SERVICE, HOSPITAL SERVICE, OR MEDICAL EXPENSE INDEMNITY
 CORPORATION OR PHARMACY  BENEFIT  MANAGER  SHALL  FURNISH  THE  DATA  AS
 REQUIRED  WHETHER  THE  REQUEST  IS MADE USING THE DRUG'S UNIQUE BILLING
 CODE, SUCH AS A NATIONAL DRUG CODE OR HEALTHCARE COMMON PROCEDURE CODING
 SYSTEM CODE OR DESCRIPTIVE TERM. A HEALTH SERVICE, HOSPITAL SERVICE,  OR
 MEDICAL  EXPENSE INDEMNITY CORPORATION OR PHARMACY BENEFIT MANAGER SHALL
 NOT DENY OR UNREASONABLY DELAY PROCESSING A REQUEST.
   (8) A HEALTH SERVICE, HOSPITAL SERVICE, OR MEDICAL  EXPENSE  INDEMNITY
 CORPORATION  AND  PHARMACY  BENEFIT  MANAGER SHALL NOT, EXCEPT AS MAY BE
 REQUIRED OR AUTHORIZED BY LAW, INTERFERE WITH,  PREVENT,  OR  MATERIALLY
 DISCOURAGE ACCESS, EXCHANGE, OR USE OF THE DATA AS REQUIRED; NOR SHALL A
 A. 2200                             5
 
 HEALTH  SERVICE,  HOSPITAL  SERVICE, OR MEDICAL EXPENSE INDEMNITY CORPO-
 RATION OR PHARMACY BENEFIT MANAGER PENALIZE A HEALTH CARE  PROVIDER  FOR
 DISCLOSING  SUCH  INFORMATION  TO  A  SUBSCRIBER OR LEGALLY PRESCRIBING,
 ADMINISTERING, OR ORDERING A LOWER COST, CLINICALLY APPROPRIATE ALTERNA-
 TIVE.
   (9)  NOTHING  IN THIS SUBSECTION SHALL BE CONSTRUED TO LIMIT ACCESS TO
 THE MOST UP-TO-DATE SUBSCRIBER-SPECIFIC ELIGIBILITY  OR  SUBSCRIBER-SPE-
 CIFIC PRESCRIPTION COST AND BENEFIT DATA BY THE HEALTH SERVICE, HOSPITAL
 SERVICE,  OR  MEDICAL  EXPENSE INDEMNITY CORPORATION OR PHARMACY BENEFIT
 MANAGER.
   (10) NOTHING IN THIS SUBSECTION SHALL INTERFERE WITH SUBSCRIBER CHOICE
 AND A HEALTH CARE  PROVIDER'S  ABILITY  TO  CONVEY  THE  FULL  RANGE  OF
 PRESCRIPTION DRUG COST OPTIONS TO A SUBSCRIBER. HEALTH SERVICE, HOSPITAL
 SERVICE,  OR MEDICAL EXPENSE INDEMNITY CORPORATIONS AND PHARMACY BENEFIT
 MANAGERS SHALL NOT RESTRICT A HEALTH CARE PROVIDER FROM COMMUNICATING TO
 THE SUBSCRIBER PRESCRIPTION COST OPTIONS.
   § 4. Section 4408 of the public health law is amended by adding a  new
 subdivision 8 to read as follows:
   8. (A) AS USED IN THIS SUBDIVISION:
   (I)  "PHARMACY  BENEFIT  MANAGER"  SHALL HAVE THE MEANING SET FORTH IN
 SECTION TWO HUNDRED EIGHTY-A OF THIS CHAPTER.
   (II) "COST-SHARING INFORMATION"  MEANS  THE  AMOUNT  A  SUBSCRIBER  IS
 REQUIRED TO PAY TO RECEIVE A DRUG THAT IS COVERED UNDER THE SUBSCRIBER'S
 INSURANCE CONTRACT.
   (III)  "COVERED/COVERAGE"  MEANS THOSE HEALTH CARE SERVICES TO WHICH A
 SUBSCRIBER IS ENTITLED UNDER THE TERMS OF THE SUBSCRIBER CONTRACT.
   (IV) "ELECTRONIC HEALTH RECORD" MEANS A DIGITAL VERSION OF A PATIENT'S
 PAPER  CHART  AND  MEDICAL  HISTORY  THAT  MAKES  INFORMATION  AVAILABLE
 INSTANTLY AND SECURELY TO AUTHORIZED USERS.
   (V)  "ELECTRONIC PRESCRIBING SYSTEM" MEANS A SYSTEM THAT ENABLES PRES-
 CRIBERS TO ENTER PRESCRIPTION INFORMATION INTO A  COMPUTER  PRESCRIPTION
 DEVICE  AND  SECURELY  TRANSMIT  THE  PRESCRIPTION TO PHARMACIES USING A
 SPECIAL SOFTWARE PROGRAM AND CONNECTIVITY TO A TRANSMISSION NETWORK.
   (VI) "ELECTRONIC PRESCRIPTION" SHALL HAVE THE  MEANING  SET  FORTH  IN
 SECTION THIRTY-THREE HUNDRED TWO OF THIS CHAPTER.
   (VII)  "PRESCRIBER" MEANS A HEALTH CARE PROVIDER LICENSED TO PRESCRIBE
 MEDICATION OR MEDICAL DEVICES IN THIS STATE.
   (VIII)  "REAL-TIME  BENEFIT  TOOL"  OR  "RTBT"  MEANS  AN   ELECTRONIC
 PRESCRIPTION  DECISION  SUPPORT TOOL THAT: (1) IS CAPABLE OF INTEGRATING
 WITH PRESCRIBERS' ELECTRONIC PRESCRIBING SYSTEM AND, IF FEASIBLE,  ELEC-
 TRONIC HEALTH RECORD SYSTEMS; AND (2) COMPLIES WITH THE TECHNICAL STAND-
 ARDS  ADOPTED BY AN AMERICAN NATIONAL STANDARDS INSTITUTE (ANSI) ACCRED-
 ITED STANDARDS DEVELOPMENT ORGANIZATION.
   (IX) "AUTHORIZED THIRD PARTY" SHALL  INCLUDE  A  THIRD  PARTY  LEGALLY
 AUTHORIZED  UNDER  STATE  OR  FEDERAL  LAW SUBJECT TO A HEALTH INSURANCE
 PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) BUSINESS ASSOCIATE AGREEMENT.
   (B) THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO ANY HEALTH  PLAN
 THAT  EXCLUSIVELY  SERVES  INDIVIDUALS ENROLLED PURSUANT TO A FEDERAL OR
 STATE INSURANCE AFFORDABILITY PROGRAM, INCLUDING THE MEDICAL  ASSISTANCE
 PROGRAM  UNDER  TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW,
 CHILD HEALTH PLUS UNDER SECTION TWENTY-FIVE HUNDRED ELEVEN OF THIS CHAP-
 TER, THE BASIC HEALTH PROGRAM UNDER SECTION THREE HUNDRED  SIXTY-NINE-GG
 OF  THE  SOCIAL  SERVICES  LAW, OR A PLAN PROVIDING SERVICES UNDER TITLE
 XVIII OF THE FEDERAL SOCIAL SECURITY ACT.
   (C) A HEALTH MAINTENANCE  ORGANIZATION  OR  PHARMACY  BENEFIT  MANAGER
 SHALL,  UPON  REQUEST  OF  THE  SUBSCRIBER, THE SUBSCRIBER'S HEALTH CARE
 A. 2200                             6
 
 PROVIDER, OR AN AUTHORIZED THIRD PARTY ON THE SUBSCRIBER'S BEHALF,  MADE
 TO  THE  HEALTH  MAINTENANCE  ORGANIZATION  OR PHARMACY BENEFIT MANAGER,
 FURNISH THE COST, BENEFIT, AND COVERAGE DATA REQUIRED BY  THIS  SUBDIVI-
 SION  TO  THE  SUBSCRIBER, THE SUBSCRIBER'S HEALTH CARE PROVIDER, OR THE
 AUTHORIZED THIRD PARTY AND SHALL ENSURE THAT SUCH DATA IS:  (I)  CURRENT
 NO LATER THAN ONE BUSINESS DAY AFTER ANY CHANGE TO THE COST, BENEFIT, OR
 COVERAGE  DATA IS MADE; (II) PROVIDED THROUGH A RTBT WHEN THE REQUEST IS
 MADE BY THE SUBSCRIBER'S HEALTH CARE PROVIDER; AND  (III)  IN  A  FORMAT
 THAT IS EASILY ACCESSIBLE TO THE REQUESTOR.
   (D) WHEN PROVIDING THE DATA REQUIRED BY PARAGRAPH (C) OF THIS SUBDIVI-
 SION,  THE  HEALTH  MAINTENANCE ORGANIZATION OR PHARMACY BENEFIT MANAGER
 SHALL USE ESTABLISHED INDUSTRY CONTENT AND TRANSPORT STANDARDS PUBLISHED
 BY:
   (I) A STANDARDS DEVELOPING ORGANIZATION  ACCREDITED  BY  THE  AMERICAN
 NATIONAL STANDARDS INSTITUTE (ANSI), INCLUDING, THE NATIONAL COUNCIL FOR
 PRESCRIPTION DRUG PROGRAMS (NCPDP), ASC X12, HEALTH LEVEL 7; OR
   (II)  A RELEVANT FEDERAL OR STATE GOVERNING BODY, INCLUDING THE CENTER
 FOR MEDICARE & MEDICAID SERVICES OR THE OFFICE OF THE NATIONAL COORDINA-
 TOR FOR HEALTH INFORMATION TECHNOLOGY.
   (III)  ANOTHER  FORMAT  DEEMED  ACCEPTABLE  TO  THE  DEPARTMENT  WHICH
 PROVIDES THE DATA PRESCRIBED IN PARAGRAPH (C) OF THIS SUBDIVISION AND IN
 THE SAME TIMELINESS AS REQUIRED BY THIS SECTION.
   (E)  A  FACSIMILE  SHALL  NOT  BE  CONSIDERED AN ACCEPTABLE ELECTRONIC
 FORMAT PURSUANT TO THIS SUBDIVISION.
   (F) UPON A REQUEST MADE PURSUANT TO PARAGRAPH (C) OF THIS SUBDIVISION,
 THE HEALTH MAINTENANCE ORGANIZATION OR PHARMACY  BENEFIT  MANAGER  SHALL
 PROVIDE  THE  FOLLOWING DATA FOR ANY DRUG COVERED UNDER THE SUBSCRIBER'S
 SUBSCRIBER CONTRACT:
   (I) SUBSCRIBER-SPECIFIC ELIGIBILITY INFORMATION;
   (II) SUBSCRIBER-SPECIFIC PRESCRIPTION COST AND BENEFIT DATA,  SUCH  AS
 APPLICABLE  FORMULARY,  BENEFIT, COVERAGE, AND COST-SHARING DATA FOR THE
 PRESCRIBED DRUG AND CLINICALLY-APPROPRIATE ALTERNATIVES, WHEN  APPROPRI-
 ATE;
   (III)  SUBSCRIBER-SPECIFIC  COST-SHARING  INFORMATION  THAT  DESCRIBES
 VARIANCE IN COST-SHARING BASED ON THE PHARMACY DISPENSING THE PRESCRIBED
 DRUG OR ITS ALTERNATIVES, AND IN RELATION TO THE INSURED'S BENEFIT; AND
   (IV) APPLICABLE UTILIZATION MANAGEMENT REQUIREMENTS.
   (G) A HEALTH MAINTENANCE  ORGANIZATION  OR  PHARMACY  BENEFIT  MANAGER
 SHALL FURNISH THE DATA AS REQUIRED WHETHER THE REQUEST IS MADE USING THE
 DRUG'S  UNIQUE  BILLING CODE, SUCH AS A NATIONAL DRUG CODE OR HEALTHCARE
 COMMON PROCEDURE CODING SYSTEM CODE OR DESCRIPTIVE TERM. A HEALTH  MAIN-
 TENANCE  ORGANIZATION  OR  PHARMACY  BENEFIT  MANAGER  SHALL NOT DENY OR
 UNREASONABLY DELAY PROCESSING A REQUEST.
   (H) A HEALTH MAINTENANCE ORGANIZATION  AND  PHARMACY  BENEFIT  MANAGER
 SHALL  NOT,  EXCEPT  AS  MAY BE REQUIRED OR AUTHORIZED BY LAW, INTERFERE
 WITH, PREVENT, OR MATERIALLY DISCOURAGE ACCESS, EXCHANGE, OR USE OF  THE
 DATA AS REQUIRED; NOR SHALL A HEALTH MAINTENANCE ORGANIZATION OR PHARMA-
 CY  BENEFIT  MANAGER PENALIZE A HEALTH CARE PROVIDER FOR DISCLOSING SUCH
 INFORMATION TO A SUBSCRIBER OR LEGALLY  PRESCRIBING,  ADMINISTERING,  OR
 ORDERING A LOWER COST, CLINICALLY APPROPRIATE ALTERNATIVE.
   (I)  NOTHING IN THIS SUBDIVISION SHALL BE CONSTRUED TO LIMIT ACCESS TO
 THE MOST UP-TO-DATE SUBSCRIBER-SPECIFIC ELIGIBILITY  OR  SUBSCRIBER-SPE-
 CIFIC  PRESCRIPTION  COST  AND  BENEFIT  DATA  BY THE HEALTH MAINTENANCE
 ORGANIZATION OR PHARMACY BENEFIT MANAGER.
   (J) NOTHING IN THIS SUBDIVISION SHALL INTERFERE WITH SUBSCRIBER CHOICE
 AND A HEALTH CARE  PROVIDER'S  ABILITY  TO  CONVEY  THE  FULL  RANGE  OF
 A. 2200                             7
 
 PRESCRIPTION  DRUG  COST  OPTIONS  TO  A  SUBSCRIBER. HEALTH MAINTENANCE
 ORGANIZATIONS AND PHARMACY BENEFIT MANAGERS SHALL NOT RESTRICT A  HEALTH
 CARE  PROVIDER  FROM  COMMUNICATING  TO THE SUBSCRIBER PRESCRIPTION COST
 OPTIONS.
   § 5. Severability. If any provision of this act, or any application of
 any  provision  of  this act, is held to be invalid, or to violate or be
 inconsistent with any federal law or regulation, that shall  not  affect
 the  validity or effectiveness of any other provision of this act, or of
 any other application of any provision of this act, which can  be  given
 effect  without  that  provision  or  application;  and to that end, the
 provisions and applications of this act are severable.
   § 6. This act shall take effect on the  same  date  and  in  the  same
 manner  as  a  chapter  of  the  laws of 2022 amending the insurance law
 relating to enacting the "patient Rx information  and  choice  expansion
 act",  as proposed in legislative bills numbers S. 4620-C and A. 5411-D,
 takes effect.