Bill Text: NY A02969 | 2019-2020 | General Assembly | Amended


Bill Title: Prohibits a health care plan from making prescription drug formulary changes during a contract year.

Spectrum: Moderate Partisan Bill (Democrat 42-7)

Status: (Introduced) 2019-06-06 - amended on third reading 2969a [A02969 Detail]

Download: New_York-2019-A02969-Amended.html



                STATE OF NEW YORK
        ________________________________________________________________________

                                         2969--A
                                                                    R. R. 69

                               2019-2020 Regular Sessions

                   IN ASSEMBLY

                                    January 28, 2019
                                       ___________

        Introduced  by  M.  of  A.  PEOPLES-STOKES, BARRETT, NIOU, ORTIZ, GALEF,
          ABINANTI,  LAVINE,  COLTON,  JEAN-PIERRE,   TAYLOR,   BYRNE,   WEPRIN,
          SEAWRIGHT, BARRON, MOSLEY, LUPARDO, ASHBY, REYES, L. ROSENTHAL, VANEL,
          STIRPE,  D. ROSENTHAL,  GRIFFIN,  JAFFEE, BUCHWALD, GOTTFRIED, D'URSO,
          MAGNARELLI, STERN, HUNTER, JACOBSON, LiPETRI, HEVESI,  OTIS,  CARROLL,
          STECK, SIMON, MIKULIN, PICHARDO, EPSTEIN, ROZIC, WALLACE, MALLIOTAKIS,
          BUTTENSCHON,  SCHMITT  --  Multi-Sponsored by -- M. of A. ENGLEBRIGHT,
          RA, THIELE -- read once and referred to the Committee on Insurance  --
          reported  and  referred  to  the  Committee  on  Codes -- reported and
          referred to the Committee on Rules -- amended on the special order  of
          third  reading,  ordered  reprinted as amended, retaining its place on
          the special order of third reading

        AN ACT to amend the insurance law and the public health law, in relation
          to prescription drug formulary changes during a contract year

          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 4909
     2  to read as follows:
     3    § 4909. Prescription drug formulary changes. (a) Except  as  otherwise
     4  provided  in  subsection  (c)  of this section, a health care plan shall
     5  not:
     6    (i) remove a prescription drug from a formulary;
     7    (ii) move a prescription drug to a  tier  with  a  larger  deductible,
     8  copayment, or coinsurance if the formulary includes two or more tiers of
     9  benefits  providing for different deductibles, copayments or coinsurance
    10  applicable to the prescription drugs in each tier; or
    11    (iii) add utilization management restrictions to a  prescription  drug
    12  on  a  formulary, unless such changes occur at the time of enrollment or
    13  issuance of coverage.
    14    (b) Prohibitions provided in subsection  (a)  of  this  section  shall
    15  apply  beginning  on the date on which open enrollment begins for a plan

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04720-04-9

        A. 2969--A                          2

     1  year and through the end of the plan year to which such open  enrollment
     2  period applies.
     3    (c)  (i) A health care plan with a formulary that includes two or more
     4  tiers of benefits providing for  different  deductibles,  copayments  or
     5  coinsurance  applicable  to  prescription  drugs in each tier may move a
     6  prescription drug to a tier with a larger deductible, copayment or coin-
     7  surance if an AB-rated generic equivalent or interchangeable  biological
     8  product for such prescription drug is added to the formulary at the same
     9  time.
    10    (ii)  A  health care plan may remove a prescription drug from a formu-
    11  lary if the federal Food and Drug Administration  determines  that  such
    12  prescription  drug  should  be  removed  from  the market, including new
    13  utilization management restrictions issued pursuant to federal Food  and
    14  Drug Administration safety concerns.
    15    (d)  A  health  care plan shall provide notice to policyholders of the
    16  intent to remove a prescription drug from a formulary or  alter  deduct-
    17  ible,  copayment  or coinsurance requirements in the upcoming plan year,
    18  thirty days prior to the open enrollment period for the consecutive plan
    19  year. Such notice of impending formulary and  deductible,  copayment  or
    20  coinsurance  changes shall also be posted on the plan's online formulary
    21  and in any prescription drug finder system that the plan provides to the
    22  public.
    23    (e) The provisions of this section shall not supersede the terms of  a
    24  collective  bargaining  agreement, or the rights of labor representation
    25  groups to collectively bargain changes to the formularies.
    26    § 2. The public health law is amended by adding a new section 4909  to
    27  read as follows:
    28    §  4909.  Prescription  drug formulary changes. 1. Except as otherwise
    29  provided in subdivision three of this section, a health care plan  shall
    30  not:
    31    (a) remove a prescription drug from a formulary;
    32    (b)  move  a  prescription  drug  to  a tier with a larger deductible,
    33  copayment, or coinsurance if the formulary includes two or more tiers of
    34  benefits providing for different deductibles, copayments or  coinsurance
    35  applicable to the prescription drugs in each tier; or
    36    (c)  add utilization management restrictions to a prescription drug on
    37  a formulary, unless such changes occur at  the  time  of  enrollment  or
    38  issuance of coverage.
    39    2.  Prohibitions  provided  in  subdivision  one of this section shall
    40  apply beginning on the date on which open enrollment begins for  a  plan
    41  year  and through the end of the plan year to which such open enrollment
    42  period applies.
    43    3. (a) A health care plan with a formulary that includes two  or  more
    44  tiers  of  benefits  providing  for different deductibles, copayments or
    45  coinsurance applicable to prescription drugs in each  tier  may  move  a
    46  prescription drug to a tier with a larger deductible, copayment or coin-
    47  surance  if an AB-rated generic equivalent or interchangeable biological
    48  product for such prescription drug is added to the formulary at the same
    49  time.
    50    (b) A health care plan may remove a prescription drug from a formulary
    51  if the  federal  Food  and  Drug  Administration  determines  that  such
    52  prescription  drug  should  be  removed  from  the market, including new
    53  utilization management restrictions issued pursuant to federal Food  and
    54  Drug Administration safety concerns.
    55    4.  A  health  care  plan shall provide notice to policyholders of the
    56  intent to remove a prescription drug from a formulary or  alter  deduct-

        A. 2969--A                          3

     1  ible,  copayment  or coinsurance requirements in the upcoming plan year,
     2  thirty days prior to the open enrollment period for the consecutive plan
     3  year. Such notice of impending formulary and  deductible,  copayment  or
     4  coinsurance  changes shall also be posted on the plan's online formulary
     5  and in any prescription drug finder system that the plan provides to the
     6  public.
     7    5. The provisions of this section shall not supersede the terms  of  a
     8  collective  bargaining  agreement, or the rights of labor representation
     9  groups to collectively bargain changes to the formularies.
    10    § 3. This act shall take effect on the sixtieth  day  after  it  shall
    11  have  become  a  law.    Effective  immediately, the addition, amendment
    12  and/or repeal of any rule or regulation necessary for the implementation
    13  of this act on  its  effective  date  are  authorized  to  be  made  and
    14  completed on or before such effective date.
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