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.
                                                                   LBD05427-05-3

        A. 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, and

        A. 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.
feedback