Bill Text: NY S01743 | 2017-2018 | General Assembly | Introduced

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Bill Title: Relates to the purchase of prescription drugs.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2018-01-03 - REFERRED TO INSURANCE [S01743 Detail]

Download: New_York-2017-S01743-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          1743
                               2017-2018 Regular Sessions
                    IN SENATE
                                    January 10, 2017
                                       ___________
        Introduced  by  Sens.  GOLDEN,  ADDABBO,  BRESLIN, LANZA, O'MARA -- read
          twice and ordered printed, and when printed to  be  committed  to  the
          Committee on Insurance
        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    (1) "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    (2)  "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-
    23  ment,] to the same reimbursement amount[, as well as the same applicable
    24  terms and conditions,] that the insurer has established for the  network
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04215-01-7
        S. 1743                             2
     1  participating  mail  order or other non-retail pharmacy. In such a case,
     2  the policy shall not impose a co-payment fee or other condition  on  any
     3  insured who elects to purchase prescription drugs from a network partic-
     4  ipating  non-mail  order  retail  pharmacy  which is not also imposed on
     5  insureds electing to purchase drugs from a  network  participating  mail
     6  order or other non-retail pharmacy.
     7    §  2.  Paragraph 18 of subsection (l) of section 3221 of the insurance
     8  law, as amended by chapter 11 of the laws of 2012, is amended to read as
     9  follows:
    10    (18) (A) Definitions. For the purpose of this paragraph:
    11    (1) "Same reimbursement amount" shall mean that any coverage described
    12  under subparagraph (B) of this paragraph shall provide the  same  bench-
    13  mark  index,  including the same average wholesale price, maximum allow-
    14  able cost and national prescription drug codes to reimburse all  pharma-
    15  cies  participating  in  the  insurance  network regardless of whether a
    16  pharmacy is a mail order pharmacy or a non-mail order pharmacy.
    17    (2) "Mail order pharmacy" means a pharmacy whose primary  business  is
    18  to   receive  prescriptions  by  mail,  telefax  or  through  electronic
    19  submissions and to dispense medication to patients through  the  use  of
    20  the  United States mail or other common or contract carrier services and
    21  provides any consultation with patients electronically rather than face-
    22  to-face.
    23    (B) Any insurer delivering a group or  blanket  policy  or  issuing  a
    24  group  or blanket policy for delivery in this state that provides cover-
    25  age for prescription drugs shall permit each insured to fill any covered
    26  prescription that may be obtained at a network participating mail  order
    27  or  other  non-retail  pharmacy,  at  the insured's option, at a network
    28  participating non-mail order retail pharmacy provided that  the  network
    29  participating non-mail order retail pharmacy agrees [in advance, through
    30  a  contractual network agreement,] to the same reimbursement amount[, as
    31  well as the same applicable terms and conditions,] that the insurer  has
    32  established for the network participating mail order or other non-retail
    33  pharmacy.  In  such a case, the policy shall not impose a co-payment fee
    34  or other condition on any insured who elects to purchase  drugs  from  a
    35  network  participating  non-mail order retail pharmacy which is not also
    36  imposed on insureds electing to purchase drugs from  a  network  partic-
    37  ipating mail order or other non-retail pharmacy; provided, however, that
    38  the  provisions  of  this  section  shall  not  supersede the terms of a
    39  collective bargaining agreement or apply to a policy that is the  result
    40  of  a  collective  bargaining agreement between an employer and a recog-
    41  nized or certified employee organization.
    42    § 3. Subsection (kk) of section 4303 of the insurance law, as  amended
    43  by  chapter  11  of  the laws of 2012 and as relettered by section 55 of
    44  part D of chapter 56 of the laws of 2013, is amended to read as follows:
    45    (kk) (1) Definitions. For the purpose of this subsection:
    46    (A) "Same reimbursement amount" shall mean that any coverage described
    47  under paragraph two of this subsection shall provide the same  benchmark
    48  index,  including  the  same  average wholesale price, maximum allowable
    49  cost and national prescription drug codes to  reimburse  all  pharmacies
    50  participating in the health benefit plan regardless of whether a pharma-
    51  cy is a mail order pharmacy or a non-mail order pharmacy.
    52    (B)  "Mail  order pharmacy" means a pharmacy whose primary business is
    53  to  receive  prescriptions  by  mail,  telefax  or  through   electronic
    54  submissions  and  to  dispense medication to patients through the use of
    55  the United States mail or other common or contract carrier services  and
        S. 1743                             3
     1  provides any consultation with patients electronically rather than face-
     2  to-face.
     3    (2)  Any contract issued by a medical expense indemnity corporation, a
     4  hospital service corporation  or  a  health  services  corporation  that
     5  provides  coverage  for  prescription  drugs  shall  permit each covered
     6  person to fill any covered  prescription  that  may  be  obtained  at  a
     7  network  participating  mail  order or other non-retail pharmacy, at the
     8  covered person's option,  at  a  network  participating  non-mail  order
     9  retail  pharmacy  provided that the network participating non-mail order
    10  retail pharmacy agrees [in advance, through a contractual network agree-
    11  ment,] to the same reimbursement amount[, as well as the same applicable
    12  terms and conditions,] that the  corporation  has  established  for  the
    13  network  participating mail order or other non-retail pharmacy.  In such
    14  a case, the contract shall not impose a copayment fee or other condition
    15  on any covered person who  elects  to  purchase  drugs  from  a  network
    16  participating  non-mail  order retail pharmacy which is not also imposed
    17  on covered persons electing to purchase drugs from a network participat-
    18  ing mail order or other non-retail pharmacy; provided, however, that the
    19  provisions of this section shall not supersede the terms of a collective
    20  bargaining agreement or apply to a contract that  is  the  result  of  a
    21  collective  bargaining agreement between an employer and a recognized or
    22  certified employee organization.
    23    § 4. This act shall take effect immediately.