Bill Text: NY A05787 | 2021-2022 | General Assembly | Introduced

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Bill Title: Provides that prescriptions covered by insurance, that would otherwise be required to be filled by mail order, may be filled at a retail pharmacy under certain circumstances.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced - Dead) 2022-01-05 - referred to insurance [A05787 Detail]

Download: New_York-2021-A05787-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          5787

                               2021-2022 Regular Sessions

                   IN ASSEMBLY

                                    February 25, 2021
                                       ___________

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

        AN  ACT  to  amend  the  insurance  law,  in  relation  to  coverage  of
          prescriptions obtained by mail order or at a non-retail pharmacy

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

     1    Section 1. The opening paragraph of paragraph 28 of subsection (i)  of
     2  section  3216  of the insurance law, as added by chapter 589 of the laws
     3  of 2011, is designated subparagraph (A) and a new  subparagraph  (B)  is
     4  added to read as follows:
     5    (B)  Notwithstanding any other provision of this paragraph, if a pres-
     6  criber, after consulting with the insurer regarding the  appropriateness
     7  of  mail order delivery given: (i) the residence or delivery location of
     8  the insured; (ii) the medical condition of the insured; (iii) the  stor-
     9  age  requirements  of  the drug; (iv) the availability of the insured to
    10  receive the prescription; or (v) the  insured's  ability  to  comprehend
    11  pharmaceutical  guidance and support over the telephone, determines that
    12  a drug as prescribed on an individual basis is most appropriately filled
    13  at a retail location, provided that an in-network retail pharmacy of the
    14  patient's choosing agrees to the same reimbursement amount and  is  able
    15  to fill the prescription, the prescriber's determination shall be final.
    16    §  2.  The  opening  paragraph  of  paragraph  18 of subsection (l) of
    17  section 3221 of the insurance law is designated subparagraph (A)  and  a
    18  new subparagraph (B) is added to read as follows:
    19    (B)  Notwithstanding any other provision of this paragraph, if a pres-
    20  criber, after consulting with the insurer regarding the  appropriateness
    21  of  mail order delivery given: (i) the residence or delivery location of
    22  the insured; (ii) the medical condition of the insured; (iii) the  stor-
    23  age  requirements  of  the drug; (iv) the availability of the insured to
    24  receive the prescription; or (v) the  insured's  ability  to  comprehend
    25  pharmaceutical  guidance and support over the telephone, determines that

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD03532-01-1
        A. 5787                             2

     1  a drug as prescribed on an individual basis is most appropriately filled
     2  at a retail location, provided that an in-network retail pharmacy of the
     3  patient's choosing agrees to the same reimbursement amount and  is  able
     4  to fill the prescription, the prescriber's determination shall be final.
     5    §  3.  The opening paragraph of subsection (kk) of section 4303 of the
     6  insurance law is designated paragraph 1 and a new paragraph 2  is  added
     7  to read as follows:
     8    (2) Notwithstanding any other provision of this subsection, if a pres-
     9  criber,  after consulting with the insurer regarding the appropriateness
    10  of mail order delivery given: (A) the residence or delivery location  of
    11  the covered person; (B) the medical condition of the covered person; (C)
    12  the  storage  requirements  of  the  drug;  (D)  the availability of the
    13  covered person to receive the prescription; or (E) the covered  person's
    14  ability to comprehend pharmaceutical guidance and support over the tele-
    15  phone,  determines  that  a drug as prescribed on an individual basis is
    16  most appropriately filled at a retail location, provided that an in-net-
    17  work retail pharmacy of  the  patient's  choosing  agrees  to  the  same
    18  reimbursement   amount  and  is  able  to  fill  the  prescription,  the
    19  prescriber's determination shall be final.
    20    § 4. This act shall take effect immediately.