Bill Text: NY A05854 | 2021-2022 | General Assembly | Amended
Bill Title: Relates to the purchase of prescription drugs by pharmacies; establishes the same reimbursement amount shall be provided to all pharmacies.
Spectrum: Partisan Bill (Democrat 10-0)
Status: (Introduced - Dead) 2021-06-08 - substituted by s3566 [A05854 Detail]
Download: New_York-2021-A05854-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 5854--A 2021-2022 Regular Sessions IN ASSEMBLY March 1, 2021 ___________ Introduced by M. of A. JOYNER, COOK, AUBRY, LAVINE, RODRIGUEZ, SIMON, STECK, GALEF -- read once and referred to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to the purchase of prescription drugs The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 28 of subsection (i) of section 3216 of the 2 insurance law, as amended by chapter 11 of the laws of 2012, is amended 3 to read as follows: 4 (28) (A) Definitions. For the purpose of this paragraph: 5 (i) "Same reimbursement amount" shall mean that any coverage described 6 under subparagraph (B) of this paragraph shall provide the same bench- 7 mark index, including the same average wholesale price, maximum allow- 8 able cost and national prescription drug codes to reimburse all pharma- 9 cies participating in the insurance network regardless of whether a 10 pharmacy is a mail order pharmacy or a non-mail order pharmacy. 11 (ii) "Mail order pharmacy" means a pharmacy whose primary business is 12 to receive prescriptions by mail, telefax or through electronic 13 submissions and to dispense medication to patients through the use of 14 the United States mail or other common or contract carrier services and 15 provides any consultation with patients electronically rather than face- 16 to-face. 17 (B) Any policy that provides coverage for prescription drugs shall 18 permit each insured to fill any covered prescription that may be 19 obtained at a network participating mail order or other non-retail phar- 20 macy, at the insured's option, at a network participating non-mail order 21 retail pharmacy provided that the network participating non-mail order 22 retail pharmacy agrees [in advance, through a contractual network agree-23ment,] to the same reimbursement amount[, as well as the same applicableEXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD03918-03-1A. 5854--A 2 1terms and conditions,] that the insurer has established for the network 2 participating mail order or other non-retail pharmacy. In such a case, 3 the policy shall not impose a co-payment fee or other condition on any 4 insured who elects to purchase prescription drugs from a network partic- 5 ipating non-mail order retail pharmacy which is not also imposed on 6 insureds electing to purchase drugs from a network participating mail 7 order or other non-retail pharmacy; provided, however, that the 8 provisions of this subparagraph shall not supersede the terms of a 9 collective bargaining agreement or apply to a policy that is a result of 10 a collective bargaining agreement between an employer and a recognized 11 or certified employee organization. 12 § 2. Paragraph 18 of subsection (l) of section 3221 of the insurance 13 law, as amended by chapter 11 of the laws of 2012, is amended to read as 14 follows: 15 (18) (A) Definitions. For the purpose of this paragraph: 16 (i) "Same reimbursement amount" shall mean that any coverage described 17 under subparagraph (B) of this paragraph shall provide the same bench- 18 mark index, including the same average wholesale price, maximum allow- 19 able cost and national prescription drug codes to reimburse all pharma- 20 cies participating in the insurance network regardless of whether a 21 pharmacy is a mail order pharmacy or a non-mail order pharmacy. 22 (ii) "Mail order pharmacy" means a pharmacy whose primary business is 23 to receive prescriptions by mail, telefax or through electronic 24 submissions and to dispense medication to patients through the use of 25 the United States mail or other common or contract carrier services and 26 provides any consultation with patients electronically rather than face- 27 to-face. 28 (B) Any insurer delivering a group or blanket policy or issuing a 29 group or blanket policy for delivery in this state that provides cover- 30 age for prescription drugs shall permit each insured to fill any covered 31 prescription that may be obtained at a network participating mail order 32 or other non-retail pharmacy, at the insured's option, at a network 33 participating non-mail order retail pharmacy provided that the network 34 participating non-mail order retail pharmacy agrees [in advance, through35a contractual network agreement,] to the same reimbursement amount[, as36well as the same applicable terms and conditions,] that the insurer has 37 established for the network participating mail order or other non-retail 38 pharmacy. In such a case, the policy shall not impose a co-payment fee 39 or other condition on any insured who elects to purchase drugs from a 40 network participating non-mail order retail pharmacy which is not also 41 imposed on insureds electing to purchase drugs from a network partic- 42 ipating mail order or other non-retail pharmacy; provided, however, that 43 the provisions of this section shall not supersede the terms of a 44 collective bargaining agreement or apply to a policy that is the result 45 of a collective bargaining agreement between an employer and a recog- 46 nized or certified employee organization. 47 § 3. Subsection (kk) of section 4303 of the insurance law, as amended 48 by chapter 11 of the laws of 2012 and as relettered by section 55 of 49 part D of chapter 56 of the laws of 2013, is amended to read as follows: 50 (kk) (1) Definitions. For the purpose of this subsection: 51 (A) "Same reimbursement amount" shall mean that any coverage described 52 under paragraph two of this subsection shall provide the same benchmark 53 index, including the same average wholesale price, maximum allowable 54 cost and national prescription drug codes to reimburse all pharmacies 55 participating in the health benefit plan regardless of whether a pharma- 56 cy is a mail order pharmacy or a non-mail order pharmacy.A. 5854--A 3 1 (B) "Mail order pharmacy" means a pharmacy whose primary business is 2 to receive prescriptions by mail, telefax or through electronic 3 submissions and to dispense medication to patients through the use of 4 the United States mail or other common or contract carrier services and 5 provides any consultation with patients electronically rather than face- 6 to-face. 7 (2) Any contract issued by a medical expense indemnity corporation, a 8 hospital service corporation or a health services corporation that 9 provides coverage for prescription drugs shall permit each covered 10 person to fill any covered prescription that may be obtained at a 11 network participating mail order or other non-retail pharmacy, at the 12 covered person's option, at a network participating non-mail order 13 retail pharmacy provided that the network participating non-mail order 14 retail pharmacy agrees [in advance, through a contractual network agree-15ment,] to the same reimbursement amount[, as well as the same applicable16terms and conditions,] that the corporation has established for the 17 network participating mail order or other non-retail pharmacy. In such 18 a case, the contract shall not impose a copayment fee or other condition 19 on any covered person who elects to purchase drugs from a network 20 participating non-mail order retail pharmacy which is not also imposed 21 on covered persons electing to purchase drugs from a network participat- 22 ing mail order or other non-retail pharmacy; provided, however, that the 23 provisions of this section shall not supersede the terms of a collective 24 bargaining agreement or apply to a contract that is the result of a 25 collective bargaining agreement between an employer and a recognized or 26 certified employee organization. 27 § 4. This act shall take effect immediately.