Bill Text: NY A04494 | 2023-2024 | General Assembly | Introduced

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Bill Title: Provides that every insurance policy which provides coverage for prescription drugs shall insure that there is continuous coverage of a single source drug that is part of a prescribed therapy until such prescribed therapy is no longer medically necessary for the enrollee of such policy; defines "single source drug".

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2024-01-03 - referred to insurance [A04494 Detail]

Download: New_York-2023-A04494-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          4494

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                    February 16, 2023
                                       ___________

        Introduced  by M. of A. RAMOS -- read once and referred to the Committee
          on Insurance

        AN ACT to amend the insurance law, in relation to  coverage  for  single
          source drugs

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
     2  amended by adding a new paragraph 39 to read as follows:
     3    (39) Every individual or blanket policy delivered or issued for deliv-
     4  ery  in this state providing coverage for prescription drugs through the
     5  use of a drug formulary shall include a provision which, in the event of
     6  a change to such formulary, allows a covered  person  who  is  taking  a
     7  single  source drug covered under such policy that is no longer included
     8  in or preferred under such formulary and has filed  a  grievance  or  an
     9  appeal  of  the denial of access to the drug with the insurer or a state
    10  or federal agency or designee of  such  agency,  to  continue  receiving
    11  coverage  for  such  drug  under  the same terms and conditions as would
    12  apply under the policy were such drug still  included  in  or  preferred
    13  under the formulary, until a final decision is rendered on the appeal or
    14  grievance. For the purpose of this paragraph, "single source drug" means
    15  a brandname drug for which there is no generic equivalent.
    16    § 2. Subsection (k) of section 3221 of the insurance law is amended by
    17  adding a new paragraph 23 to read as follows:
    18    (23) Every group or blanket policy delivered or issued for delivery in
    19  this  state providing coverage for prescription drugs through the use of
    20  a drug formulary shall include a provision which,  in  the  event  of  a
    21  change to such formulary, allows a covered person who is taking a single
    22  source  drug  covered under such policy that is no longer included in or
    23  preferred under such formulary and has filed a grievance or an appeal of
    24  the denial of access to the drug with the insurer or a state or  federal
    25  agency  or  designee  of such agency, to continue receiving coverage for

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD08121-01-3
        A. 4494                             2

     1  such drug under the same terms and conditions as would apply  under  the
     2  policy  were  such  drug still included in or preferred under the formu-
     3  lary, until a final decision is rendered on the appeal or grievance. For
     4  the  purpose  of  this paragraph, "single source drug" means a brandname
     5  drug for which there is no generic equivalent.
     6    § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
     7  subsection (uu) to read as follows:
     8    (uu)  Every  contract  delivered  or issued for delivery in this state
     9  providing coverage for prescription drugs through  the  use  of  a  drug
    10  formulary  shall  include a provision which, in the event of a change to
    11  such formulary, allows a covered person who is taking  a  single  source
    12  drug  covered  under  such  contract  that  is  no longer included in or
    13  preferred under such formulary and has filed a grievance or an appeal of
    14  the denial of access to the drug with the insurer corporation or  organ-
    15  ization  certified  pursuant  to article forty-four of the public health
    16  law or a state or federal agency or designee of such agency, to continue
    17  receiving coverage for such drug under the same terms and conditions  as
    18  would  apply  under  the  contract  were  such drug still included in or
    19  preferred under the formulary, until a final decision is rendered on the
    20  appeal or grievance. For the purpose of this subsection, "single  source
    21  drug" means a brandname drug for which there is no generic equivalent.
    22    §  4.  This  act  shall take effect on the first of the calendar month
    23  next succeeding the sixtieth day after  it  shall  have  become  a  law;
    24  provided,  however,  that  this  act  shall  apply  only to policies and
    25  contracts issued, renewed or amended on or after such effective date.