LEGISLATIVE RESOLUTION urging the appropriate New York State regulatory
agencies to implement the Health Insurer "Code of Conduct" established
by the American Medical Association (AMA)

WHEREAS, There are numerous challenges facing the citizens of New York
pertaining to health insurance, including those with full coverage,
those with less than adequate coverage, and those without coverage; and
WHEREAS, In uncertain economic times, affording health insurance is
becoming more difficult for many businesses and citizens; and
WHEREAS, Providers of health care, particularly physicians and hospi-
tals, are subjected to health plan intrusions into clinical decision-
making that compromises the clinical autonomy of physicians and is not
in the best interest of the patient, resulting in significant increases
in the cost of health care; and
WHEREAS, These intrusions include, but are not limited to, diagnostic
studies and limitations, therapeutic requirements that may involve ques-
tionable payments to physicians and others, and restrictive formularies
and prescribing practices; and
WHEREAS, To help curtail skyrocketing health care costs, the time has
come for the health insurance industry to establish policies and prac-
tices to: allow physicians and others to make decisions based on patient
needs without creating roadblocks to appropriate treatment; ease the
denial and preauthorization process resulting in burdensome costs to
physicians, hospitals and providers; become more transparent by disclos-
ing factors relating to ranking and tiering systems, incentives to
health plan employees, providers and contractors, and factors affecting
requests to change prescription medicines; and create transparency
around health plan benefits and polices to ensure integrity at every
level of the health insurance business model; and
WHEREAS, The American Medical Association (AMA) unanimously adopted a
resolution calling for a Health Insurer Code of Conduct setting forth
principles to address both medical care policies and payment issues,
seeking concurrence among health insurers in complying with this Code of
Conduct; and
WHEREAS, As a result of inappropriate insurer practices, 16 Attorneys
General on March 6, 2009, signed a letter to the Centers for Medicare
and Medicaid Services (CMS) calling on CMS to prohibit insurers from
requiring off-label medicines before providing access by enrollees to
FDA approved medicines; and
WHEREAS, A "Code of Conduct" can be a valuable tool for our citizens
and businesses to provide information that would affect decision-making
with respect to choices of insurers; and
WHEREAS, Health plans are not bound by a code of conduct while many
other industry stakeholders have adopted codes of conduct and/or ethical
guidelines that cover such interactions, such as: the American Medical
Association (AMA) "Principles of Medical Ethics;" Hippocratic Oath for
physicians basic code of conduct; Advanced Medical Technology Associ-
ation (AdvaMed) Code of Ethics on Interactions with Health Care Profes-
sionals; Pharmaceutical industry's "PhRMA (Pharmaceutical Research and
Manufacturers Association) Code on Interactions with Healthcare Profes-
sionals"; and American College of Clinical Pharmacy "Pharmacists and
Industry: Guidelines for Ethical Interactions"; and
WHEREAS, The adoption of a Health Insurer "Code of Conduct" would
benefit patients, physicians, and other health care providers by chal-
lenging health plans to modify their restrictive practices and make such
practices transparent to patients without the need for legislative or
judicial intervention; and

WHEREAS, A voluntary "Code of Conduct" is not intended to unravel the
practices of managed care, but to level the playing field so that physi-
cians feel empowered to act in the best interests of their patients
without fear of retribution; and
WHEREAS, Monitoring compliance with a Health Insurer "Code of Conduct"
could provide valuable data to inform the public and to generate public
support for advocacy efforts; and
WHEREAS, Such data could provide consumers with an additional tool for
comparing health plans during enrollment periods and understand all the
factors that go into the choices their physicians make when prescribing
medicines, and stimulate health plans to both make their practices tran-
sparent to patients and to modify unacceptable practices; now, there-
fore, be it
RESOLVED, That this Legislative Body pause in its deliberations to
urge the appropriate New York State regulatory agencies to implement the
Health Insurer "Code of Conduct" established by the American Medical
Association that will attempt to set forth clear and concise principles
addressing both medical and health care policies and payment issues; and
be it further
RESOLVED, That this Legislative Body pause further to commend the
American Medical Association's insight and leadership in taking action
and moving the health care agenda forward in a positive manner; and be
it further
RESOLVED, That copies of this Resolution, suitably engrossed, be tran-
smitted to the aforementioned appropriate New York State regulatory
agencies.