Bill Text: NY A07707 | 2015-2016 | General Assembly | Amended

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Bill Title: Relates to prescription drug formulary changes during a contract year.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Engrossed - Dead) 2016-06-17 - REFERRED TO RULES [A07707 Detail]

Download: New_York-2015-A07707-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                         7707--A
                                                                Cal. No. 606
                               2015-2016 Regular Sessions
                   IN ASSEMBLY
                                      May 26, 2015
                                       ___________
        Introduced  by M. of A. PEOPLES-STOKES, HARRIS -- read once and referred
          to the Committee on Insurance -- ordered to a third reading -- commit-
          ted to the Committee on Insurance in accordance with Assembly Rule  3,
          sec.  2  --  reported  from  committee,  advanced  to a third reading,
          amended and ordered reprinted, retaining its place  on  the  order  of
          third reading
        AN  ACT  to  amend  the  insurance 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) A  health  care  plan
     4  required  to  provide  essential  health  benefits  shall not, except as
     5  otherwise  provided  in  subsection  (b)  of  this  section,  remove   a
     6  prescription drug from a formulary:
     7    (i)  if the formulary includes two or more tiers of benefits providing
     8  for different deductibles, copayments or coinsurance applicable  to  the
     9  prescription  drugs  in  each  tier, move a drug to a tier with a larger
    10  deductible, copayment or coinsurance, or
    11    (ii) add utilization management  restrictions  to  a  formulary  drug,
    12  unless  such  changes  occur  at  the  time of enrollment or issuance of
    13  coverage.  Such prohibition shall apply beginning on the date  on  which
    14  open  enrollment  begins for a plan year and through the end of the plan
    15  year to which such open enrollment period applies.
    16    (b) (i) A health care plan with a formulary that includes two or  more
    17  tiers  of  benefits  providing  for different deductibles, copayments or
    18  coinsurance applicable to prescription drugs in each  tier  may  move  a
    19  prescription  drug to a tier with a larger deducible, copayment or coin-
    20  surance if an AB-rated generic drug for such prescription drug is  added
    21  to the formulary at the same time.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11110-02-6
        A. 7707--A                          2
     1    (ii)  A  health care plan may remove a prescription drug from a formu-
     2  lary if the federal food and drug administration  determines  that  such
     3  drug should be removed from the market.
     4    §  2.  This  act  shall take effect on the sixtieth day after it shall
     5  have become a law; provided, however, that  effective  immediately,  the
     6  addition,  amendment  and/or  repeal of any rule or regulation necessary
     7  for the implementation of this act on its effective date are  authorized
     8  to  be made and completed by the superintendent of financial services on
     9  or before such date.