Bill Text: NY A10185 | 2023-2024 | General Assembly | Introduced

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Bill Title: Requires insurers to cover the substitution of a brand name prescription drug when the federal food and drug administration has declared that there is a supply issue with a generic drug.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-05-10 - referred to insurance [A10185 Detail]

Download: New_York-2023-A10185-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          10185

                   IN ASSEMBLY

                                      May 10, 2024
                                       ___________

        Introduced  by COMMITTEE ON RULES -- (at request of M. of A. Forrest) --
          read once and referred to the Committee on Insurance

        AN ACT to amend the insurance law, in  relation  to  substituting  brand
          name prescription drugs in the case of a drug shortage

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

     1    Section 1. Section 3242 of the insurance law is amended  by  adding  a
     2  new subsection (d) to read as follows:
     3    (d) (1) As used in this subsection:
     4    (A)  "Eligible  prescription  drug" means a prescription drug approved
     5  under 21 U.S.C. 355(c) that is not under patent.
     6    (B) "Generic drug" means a drug that is approved pursuant to an appli-
     7  cation referencing an eligible prescription drug that is submitted under
     8  subsection (j) of Section 505 of the Federal Food,  Drug,  and  Cosmetic
     9  Act, 21 U.S.C. 355.
    10    (C)  "Supply  issue" means a drug shortage or meaningful disruption as
    11  defined in 21 U.S.C. 356(c).
    12    (2) In the event an AB-rated  generic  equivalent  or  interchangeable
    13  biological  product  for  an eligible prescription drug is covered in an
    14  insurer's formulary and such generic drug equivalent is unavailable  due
    15  to a supply issue which has been recognized by the federal food and drug
    16  administration  pursuant  to  21  U.S.C.  356e  and the dosage cannot be
    17  adjusted, an insurer that delivers or issues for delivery in this  state
    18  a  policy  that  provides  coverage for prescription drugs shall provide
    19  coverage for a brand name eligible prescription drug to an  insured  who
    20  is  already  receiving such prescription drug as a generic equivalent or
    21  has been diagnosed with or presented with a condition on or prior to the
    22  start of the plan year that is treated  by  such  eligible  prescription
    23  drug or is an eligible prescription drug that is or would be part of the
    24  insured's treatment regimen for such condition. Such brand name eligible
    25  prescription  drug shall be covered at the same level of coverage as the
    26  generic drug in the insurer's formulary until such time  as  the  supply
    27  issue  is  resolved  and the drug has been removed from the federal food
    28  and drug administration's shortage list.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD15336-01-4
        A. 10185                            2

     1    § 2. Section 4329 of the insurance law is  amended  by  adding  a  new
     2  subsection (d) to read as follows:
     3    (d) (1) As used in this subsection:
     4    (A)  "Eligible  prescription  drug" means a prescription drug approved
     5  under 21 U.S.C. 355(c) that is not under patent.
     6    (B) "Generic drug" means a drug that is approved pursuant to an appli-
     7  cation referencing an eligible prescription drug that is submitted under
     8  subsection (j) of Section 505 of the Federal Food,  Drug,  and  Cosmetic
     9  Act, 21 U.S.C. 355.
    10    (C)  "Supply  issue" means a drug shortage or meaningful disruption as
    11  defined in 21 U.S.C. 356(c).
    12    (2) In the event an AB-rated  generic  equivalent  or  interchangeable
    13  biological  product  for  an eligible prescription drug is covered in an
    14  insurer's formulary and such generic drug equivalent is unavailable  due
    15  to a supply issue which has been recognized by the federal food and drug
    16  administration  pursuant  to  21  U.S.C.  356e  and the dosage cannot be
    17  adjusted, a corporation subject to the provisions of this  article  that
    18  issues  a  contract  that provides coverage for prescription drugs shall
    19  provide coverage for a brand  name  eligible  prescription  drug  to  an
    20  insured  who  is  already  receiving such prescription drug as a generic
    21  equivalent or has been diagnosed with or presented with a  condition  on
    22  or  prior to the start of the plan year that is treated by such eligible
    23  prescription drug or is an eligible prescription drug that is  or  would
    24  be  part  of  the  insured's  treatment regimen for such condition. Such
    25  brand name eligible prescription drug shall be covered at the same level
    26  of coverage as the generic drug in the insurer's  formulary  until  such
    27  time  as the supply issue is resolved and the drug has been removed from
    28  the federal food and drug administration's shortage list.
    29    § 3. This act shall take effect immediately.