Bill Text: NY A00863 | 2011-2012 | General Assembly | Introduced
Bill Title: Requires the use of uniform prescription drug information cards or technology for claims processing in a form approved by the national council for prescription drug programs and acceptable to the commissioner.
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Introduced - Dead) 2012-01-04 - referred to insurance [A00863 Detail]
Download: New_York-2011-A00863-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
863
2011-2012 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 5, 2011
___________
Introduced by M. of A. COLTON -- Multi-Sponsored by -- M. of A. CLARK,
PHEFFER, J. RIVERA, WRIGHT -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to uniform prescription
drug information cards
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. The insurance law is amended by adding a new section 3240
2 to read as follows:
3 S 3240. UNIFORM PRESCRIPTION DRUG INFORMATION CARDS. (A) ANY INSURER
4 OR ORGANIZATION OR CORPORATION LICENSED, ORGANIZED OR CERTIFIED PURSUANT
5 TO THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW WHICH
6 PROVIDES COVERAGE FOR PRESCRIPTION DRUGS OR DEVICES AND WHICH ISSUES,
7 USES, REQUIRES, AND/OR CONTRACTS WITH OR DELEGATES TO ANOTHER ENTITY,
8 INCLUDING, BUT NOT LIMITED TO A PHARMACY BENEFIT MANAGER, FOR THE ISSUE,
9 USE OR REQUIREMENT OF A CARD OR OTHER TECHNOLOGY FOR CLAIMS PROCESSING,
10 AND AN ADMINISTRATOR OF SUCH AN INSURER, ORGANIZATION OR CORPORATION
11 INCLUDING, BUT NOT LIMITED TO, THIRD PARTY ADMINISTRATORS FOR SELF-IN-
12 SURED PLANS, PHARMACY BENEFITS MANAGERS AND STATE ADMINISTERED PLANS,
13 SHALL ISSUE, USE, REQUIRE, AND/OR CONTRACT WITH OR REQUIRE FROM THE
14 OTHER ENTITY, INCLUDING, BUT NOT LIMITED TO A PHARMACY BENEFIT MANAGER,
15 FOR ITS INSUREDS A UNIFORM CARD OR OTHER TECHNOLOGY CONTAINING UNIFORM
16 PRESCRIPTION DRUG INFORMATION. THE UNIFORM PRESCRIPTION DRUG INFORMATION
17 CARD OR TECHNOLOGY SHALL BE IN THE FORMAT APPROVED BY THE NATIONAL COUN-
18 CIL FOR PRESCRIPTION DRUG PROGRAMS (NCPDP) AND SHALL INCLUDE ALL OF THE
19 FIELDS REQUIRED BY THE INSURER, ORGANIZATION OR CORPORATION TO SUBMIT A
20 CLAIM AND CONFORM TO THE MOST RECENT PHARMACY INFORMATION CARD OR TECH-
21 NOLOGY IMPLEMENTATION GUIDE PRODUCED BY NCPDP OR CONFORM TO A NATIONAL
22 FORMAT ACCEPTABLE TO THE SUPERINTENDENT. ALL INFORMATION THAT IS NECES-
23 SARY FOR CLAIMS SUBMISSION OF PRESCRIPTION DRUG BENEFITS, EXCLUSIVE OF
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04973-01-1
A. 863 2
1 INFORMATION PROVIDED ON THE PRESCRIPTION AS REQUIRED BY LAW OR REGU-
2 LATION, SHALL BE INCLUDED IN A CLEAR, READABLE AND UNDERSTANDABLE MANNER
3 ON THE CARD OR OTHER TECHNOLOGY ISSUED BY THE PLAN TO THE INSURED FOR
4 CLAIMS PROCESSING. ALL INFORMATION INCLUDED ON THE CARD OR OTHER TECH-
5 NOLOGY AS REQUIRED BY THIS SECTION BUT NOT SPECIFIED BY THE NCPDP SHALL
6 CONFORM TO A CONTENT AND FORMAT ACCEPTABLE TO THE SUPERINTENDENT. ALL
7 INFORMATION ON THE CARD MUST BE FORMATTED AND ARRANGED IN A MANNER THAT
8 CORRESPONDS BOTH IN CONTENT AND FORMAT TO THE CURRENT CONTENT AND FORMAT
9 REQUIRED BY THE PLAN TO PROCESS THE CLAIM. IF AN INSURER OR ORGANIZATION
10 OR CORPORATION LICENSED, ORGANIZED OR CERTIFIED PURSUANT TO THIS CHAPTER
11 OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW REQUIRES A CONDITIONAL OR
12 SITUATIONAL FIELD AS DEFINED BY THE NCPDP, IT SHALL CONFORM TO THE MOST
13 RECENT PHARMACY INFORMATION CARD OR TECHNOLOGY IMPLEMENTATION GUIDE
14 PRODUCED BY THE NCPDP OR CONFORM TO A NATIONAL FORMAT ACCEPTABLE TO THE
15 SUPERINTENDENT.
16 (B) A NEW UNIFORM PRESCRIPTION DRUG INFORMATION CARD OR OTHER TECHNOL-
17 OGY, AS REQUIRED UNDER SUBSECTION (A) OF THIS SECTION SHALL BE ISSUED,
18 USED, AND/OR REQUIRED BY AN INSURER OR ORGANIZATION OR CORPORATION
19 LICENSED, ORGANIZED OR CERTIFIED PURSUANT TO THIS CHAPTER OR ARTICLE
20 FORTY-FOUR OF THE PUBLIC HEALTH LAW, AND/OR BY THE INSURER'S, ORGANIZA-
21 TION'S OR CORPORATION'S CONTRACTS WITH OR REQUIREMENT FROM THE OTHER
22 ENTITY, INCLUDING, BUT NOT LIMITED TO, A PHARMACY BENEFIT MANAGER, UPON
23 ENROLLMENT AND REISSUED OR REQUIRED UPON ANY CHANGE IN THE CERTIFICATE
24 HOLDER'S COVERAGE THAT IMPACTS DATA IN CONTENT OR FORMAT AS CONTAINED ON
25 THE CARD THAT AFFECTS THE DATA CONTENT OR FORMAT REQUIRED TO BE ON THE
26 CARD OR OTHER TECHNOLOGY AS REQUIRED BY SUBSECTION (A) OF THIS SECTION
27 OR UPON A CHANGE IN THE NCPDP IMPLEMENTATION GUIDE OR SUCCESSOR DOCUMENT
28 THAT AFFECTS DATA CONTENT OR FORMAT CONTAINED ON THE CARD OR OTHER TECH-
29 NOLOGY AS REQUIRED BY SUBSECTION (A) OF THIS SECTION. NEWLY ISSUED, USED
30 OR REQUIRED CARDS OR OTHER TECHNOLOGY SHALL BE UPDATED WITH THE LATEST
31 COVERAGE INFORMATION AND SHALL CONFORM TO THE NCPDP STANDARDS THEN IN
32 EFFECT AND TO THE IMPLEMENTATION GUIDE THEN IN USE OR THE FORMAT SPECI-
33 FIED BY THE SUPERINTENDENT. PROVIDED, HOWEVER, THAT ANY SUCH INSURER,
34 ORGANIZATION OR CORPORATION OR ANY ENTITY THAT THE INSURER, ORGANIZATION
35 OR CORPORATION CONTRACTS WITH OR REQUIRES FROM PURSUANT TO THE REQUIRE-
36 MENTS OF THIS SECTION MAY ISSUE STICKERS OR OTHER METHODOLOGIES TO
37 UPDATE CARDS TEMPORARILY AS MAY BE ACCEPTABLE TO THE SUPERINTENDENT.
38 (C) THE CARD OR OTHER TECHNOLOGY MAY BE USED FOR ANY AND ALL HEALTH
39 INSURANCE COVERAGE. NOTHING IN THIS SECTION REQUIRES ANY PERSON ISSUING,
40 USING OR REQUIRING THE CARD OR THEIR TECHNOLOGY TO ISSUE, USE OR REQUIRE
41 A SEPARATE CARD FOR PRESCRIPTION COVERAGE, PROVIDED THAT THE CARD OR
42 OTHER TECHNOLOGY CAN ACCOMMODATE THE INFORMATION NECESSARY TO PROCESS
43 THE CLAIM AS REQUIRED BY SUBSECTION (A) OF THIS SECTION.
44 S 2. Subsection (a) of section 1109 of the insurance law, as amended
45 by chapter 246 of the laws of 2005, is amended to read as follows:
46 (a) An organization complying with the provisions of article forty-
47 four of the public health law may operate without being licensed under
48 this chapter and without being subject to any provisions of this chap-
49 ter, except: (1) to the extent that such organization must comply with
50 the provisions of this chapter by virtue of such article, and (2) the
51 provisions of sections three hundred eight, three hundred thirteen,
52 three hundred thirty-two, one thousand three hundred one, one thousand
53 three hundred two, one thousand three hundred seven, two thousand one
54 hundred three, two thousand one hundred twelve, two thousand one hundred
55 fourteen, two thousand one hundred fifteen, two thousand one hundred
56 seventeen, two thousand one hundred twenty-three, two thousand six
A. 863 3
1 hundred eight-a, two thousand six hundred twelve, three thousand two
2 hundred twenty-four-a, THREE THOUSAND TWO HUNDRED FORTY, four thousand
3 three hundred eight, four thousand three hundred seventeen, four thou-
4 sand three hundred eighteen, four thousand three hundred twenty, four
5 thousand three hundred twenty-one, four thousand three hundred twenty-
6 two and four thousand three hundred twenty-three of this chapter.
7 S 3. This act shall take effect January 1, 2012 and shall apply to all
8 policies issued, renewed, altered, or modified on or after such date.
