Bill Text: NY A01962 | 2023-2024 | General Assembly | Amended
Bill Title: 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.
Spectrum: Partisan Bill (Democrat 18-0)
Status: (Introduced) 2024-02-06 - print number 1962a [A01962 Detail]
Download: New_York-2023-A01962-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 1962--A 2023-2024 Regular Sessions IN ASSEMBLY January 23, 2023 ___________ Introduced by M. of A. WALKER, DILAN, TAPIA, ALVAREZ, REYES, HYNDMAN, SEPTIMO, DE LOS SANTOS, ZACCARO -- read once and referred to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said commit- tee 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: 1 Section 1. The insurance law is amended by adding a new section 3246 2 to read as follows: 3 § 3246. Ensuring fairness in certain cost sharing. (a) As used in this 4 section, the following terms shall have the following meanings: 5 (1) "Defined cost sharing" means a deductible payment or coinsurance 6 amount imposed on an enrollee for a covered prescription drug under the 7 enrollee's health plan. 8 (2) "Insurer" means any health insurance issuer that is subject to 9 state law regulating insurance and offers health insurance coverage, as 10 defined in 42 U.S.C. § 300gg-91, or any state or local governmental 11 employer plan. 12 (3) "Price protection rebate" means a negotiated price concession that 13 accrues directly or indirectly to the insurer, or other party on behalf 14 of the insurer, in the event of an increase in the wholesale acquisition 15 cost of a drug above a specified threshold. 16 (4) "Rebate" means: 17 (A) Negotiated price concessions including but not limited to base 18 price concessions, whether described as a rebate or otherwise, and 19 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. LBD05427-05-3A. 1962--A 2 1 based price concessions that may accrue directly or indirectly to the 2 insurer during the coverage year from a manufacturer, dispensing pharma- 3 cy, or other party in connection with the dispensing or administration 4 of a prescription drug, and 5 (B) Reasonable estimates of any negotiated price concessions, fees and 6 other administrative costs that are passed through, or are reasonably 7 anticipated to be passed through, to the insurer and serve to reduce the 8 insurer's liabilities for a prescription drug. 9 (b) An enrollee's defined cost sharing for each prescription drug 10 shall be calculated at the point of sale based on a price that is 11 reduced by an amount equal to at least eighty-five percent of all 12 rebates received, or to be received, in connection with the dispensing 13 or administration of the prescription drug. Nothing shall preclude an 14 insurer from decreasing an enrollee's defined cost sharing by an amount 15 greater than that required under this subsection. 16 (c) An insurer shall submit to the superintendent by the first of 17 January of each year a certification in a form to be established by the 18 superintendent attesting that it has complied with the requirements of 19 subsection (b) of this section for the prior calendar year. 20 (d) In complying with the provisions of this section, an insurer or 21 its agents shall not publish or otherwise publicly reveal information 22 regarding the actual amount of rebates an insurer receives on a product 23 or therapeutic class of products, manufacturer, or pharmacy-specific 24 basis. Such information shall be exempt from disclosure under section 25 eighty-seven of the public officers law and shall not be disclosed 26 directly or indirectly, or in a manner that would allow for the iden- 27 tification of an individual product, therapeutic class of products, or 28 manufacturer, or in a manner that would have the potential to compromise 29 the financial, competitive, or proprietary nature of such information. 30 An insurer shall impose the confidentiality protections of this subdivi- 31 sion on any vendor or downstream third-party that performs health care 32 or administrative services on behalf of the insurer that may receive or 33 have access to rebate information. 34 § 2. The insurance law is amended by adding a new section 4331 to read 35 as follows: 36 § 4331. Ensuring fairness in certain cost sharing. (a) As used in this 37 section, the following terms shall have the following meanings: 38 (1) "Defined cost sharing" means a deductible payment or coinsurance 39 amount imposed on an enrollee for a covered prescription drug under the 40 enrollee's health plan. 41 (2) "Corporation" means any health insurance issuer that is subject to 42 state law regulating insurance and offers health insurance coverage, as 43 defined in 42 U.S.C. § 300gg-91, or any state or local governmental 44 employer plan. 45 (3) "Price protection rebate" means a negotiated price concession that 46 accrues directly or indirectly to the corporation, or other party on 47 behalf of the corporation, in the event of an increase in the wholesale 48 acquisition cost of a drug above a specified threshold. 49 (4) "Rebate" means: 50 (A) Negotiated price concessions including but not limited to base 51 price concessions, whether described as a rebate or otherwise, and 52 reasonable estimates of any price protection rebates and performance- 53 based price concessions that may accrue directly or indirectly to the 54 corporation during the coverage year from a manufacturer, dispensing 55 pharmacy, or other party in connection with the dispensing or adminis- 56 tration of a prescription drug, andA. 1962--A 3 1 (B) Reasonable estimates of any negotiated price concessions, fees and 2 other administrative costs that are passed through, or are reasonably 3 anticipated to be passed through, to the corporation and serve to reduce 4 the corporation's liabilities for a prescription drug. 5 (b) An enrollee's defined cost sharing for each prescription drug 6 shall be calculated at the point of sale based on a price that is 7 reduced by an amount equal to at least eighty-five percent of all 8 rebates received, or to be received, in connection with the dispensing 9 or administration of the prescription drug. Nothing shall preclude a 10 corporation from decreasing an enrollee's defined cost sharing by an 11 amount greater than that required under this subsection. 12 (c) A corporation shall submit to the superintendent by the first of 13 January of each year a certification in a form to be established by the 14 superintendent attesting that it has complied with the requirements of 15 subsection (b) of this section for the prior calendar year. 16 (d) In complying with the provisions of this section, a corporation or 17 its agents shall not publish or otherwise publicly reveal information 18 regarding the actual amount of rebates a corporation receives on a prod- 19 uct or therapeutic class of products, manufacturer, or pharmacy-specific 20 basis. Such information shall be exempt from disclosure under section 21 eighty-seven of the public officers law and shall not be disclosed 22 directly or indirectly, or in a manner that would allow for the iden- 23 tification of an individual product, therapeutic class of products, or 24 manufacturer, or in a manner that would have the potential to compromise 25 the financial, competitive, or proprietary nature of such information. A 26 corporation shall impose the confidentiality protections of this subdi- 27 vision on any vendor or downstream third-party that performs health care 28 or administrative services on behalf of the corporation that may receive 29 or have access to rebate information. 30 § 3. The public health law is amended by adding a new section 4417 to 31 read as follows: 32 § 4417. Ensuring fairness in certain cost sharing. 1. As used in this 33 section, the following terms shall have the following meanings: 34 (a) "Defined cost sharing" means a deductible payment or coinsurance 35 amount imposed on an enrollee for a covered prescription drug under the 36 enrollee's health plan. 37 (b) "Organization" means any health insurance issuer that is subject 38 to state law regulating insurance and offers health insurance coverage, 39 as defined in 42 U.S.C. § 300gg-91, or any state or local governmental 40 employer plan. 41 (c) "Price protection rebate" means a negotiated price concession that 42 accrues directly or indirectly to the organization, or other party on 43 behalf of the organization, in the event of an increase in the wholesale 44 acquisition cost of a drug above a specified threshold. 45 (d) "Rebate" means: 46 (i) Negotiated price concessions including but not limited to base 47 price concessions, whether described as a rebate or otherwise, and 48 reasonable estimates of any price protection rebates and performance- 49 based price concessions that may accrue directly or indirectly to the 50 organization during the coverage year from a manufacturer, dispensing 51 pharmacy, or other party in connection with the dispensing or adminis- 52 tration of a prescription drug, and 53 (ii) Reasonable estimates of any negotiated price concessions, fees 54 and other administrative costs that are passed through, or are reason- 55 ably anticipated to be passed through, to the organization and serve to 56 reduce the organization's liabilities for a prescription drug.A. 1962--A 4 1 2. An enrollee's defined cost sharing for each prescription drug shall 2 be calculated at the point of sale based on a price that is reduced by 3 an amount equal to at least eighty-five percent of all rebates received, 4 or to be received, in connection with the dispensing or administration 5 of the prescription drug. Nothing shall preclude an organization from 6 decreasing an enrollee's defined cost sharing by an amount greater than 7 that required under this subdivision. 8 3. An organization shall submit to the superintendent by the first of 9 January of each year a certification in a form to be established by the 10 superintendent attesting that it has complied with the requirements of 11 subdivision two of this section for the prior calendar year. 12 4. In complying with the provisions of this section, an organization 13 or its agents shall not publish or otherwise publicly reveal information 14 regarding the actual amount of rebates an organization receives on a 15 product or therapeutic class of products, manufacturer, or pharmacy-spe- 16 cific basis. Such information shall be exempt from disclosure under 17 section eighty-seven of the public officers law and shall not be 18 disclosed directly or indirectly, or in a manner that would allow for 19 the identification of an individual product, therapeutic class of 20 products, or manufacturer, or in a manner that would have the potential 21 to compromise the financial, competitive, or proprietary nature of such 22 information. An organization shall impose the confidentiality 23 protections of this subdivision on any vendor or downstream third-party 24 that performs health care or administrative services on behalf of the 25 organization that may receive or have access to rebate information. 26 § 4. This act shall take effect immediately and apply to contracts 27 issued, renewed or amended on or after January 1, 2023.
