Bill Text: NY S02530 | 2015-2016 | General Assembly | Introduced
Bill Title: Relates to the purchase of prescription drugs.
Sponsorship: Bipartisan Bill
Status: (Introduced - Dead) 2016-01-06 - REFERRED TO INSURANCE [S02530 Detail]
Download: New_York-2015-S02530-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
2530
2015-2016 Regular Sessions
I N S E N A T E
January 26, 2015
___________
Introduced by Sen. GOLDEN -- 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
16 FACE-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
25 participating mail order or other non-retail pharmacy. In such a case,
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01495-01-5
S. 2530 2
1 the policy shall not impose a co-payment fee or other condition on any
2 insured who elects to purchase prescription drugs from a network partic-
3 ipating non-mail order retail pharmacy which is not also imposed on
4 insureds electing to purchase drugs from a network participating mail
5 order or other non-retail pharmacy.
6 S 2. Paragraph 18 of subsection (l) of section 3221 of the insurance
7 law, as amended by chapter 11 of the laws of 2012, is amended to read as
8 follows:
9 (18) (A) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
10 (1) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
11 UNDER SUBPARAGRAPH (B) OF THIS PARAGRAPH SHALL PROVIDE THE SAME BENCH-
12 MARK INDEX, INCLUDING THE SAME AVERAGE WHOLESALE PRICE, MAXIMUM ALLOW-
13 ABLE COST AND NATIONAL PRESCRIPTION DRUG CODES TO REIMBURSE ALL PHARMA-
14 CIES PARTICIPATING IN THE INSURANCE NETWORK REGARDLESS OF WHETHER A
15 PHARMACY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
16 (2) "MAIL ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY BUSINESS IS
17 TO RECEIVE PRESCRIPTIONS BY MAIL, TELEFAX OR THROUGH ELECTRONIC
18 SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
19 THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
20 PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN
21 FACE-TO-FACE.
22 (B) Any insurer delivering a group or blanket policy or issuing a
23 group or blanket policy for delivery in this state that provides cover-
24 age for prescription drugs shall permit each insured to fill any covered
25 prescription that may be obtained at a network participating mail order
26 or other non-retail pharmacy, at the insured's option, at a network
27 participating non-mail order retail pharmacy provided that the network
28 participating non-mail order retail pharmacy agrees [in advance, through
29 a contractual network agreement,] to the same reimbursement amount[, as
30 well as the same applicable terms and conditions,] that the insurer has
31 established for the network participating mail order or other non-retail
32 pharmacy. In such a case, the policy shall not impose a co-payment fee
33 or other condition on any insured who elects to purchase drugs from a
34 network participating non-mail order retail pharmacy which is not also
35 imposed on insureds electing to purchase drugs from a network partic-
36 ipating mail order or other non-retail pharmacy; provided, however, that
37 the provisions of this section shall not supersede the terms of a
38 collective bargaining agreement or apply to a policy that is the result
39 of a collective bargaining agreement between an employer and a recog-
40 nized or certified employee organization.
41 S 3. Subsection (kk) of section 4303 of the insurance law, as amended
42 by chapter 11 of the laws of 2012 and as relettered by section 55 of
43 part D of chapter 56 of the laws of 2013, is amended to read as follows:
44 (kk) (1) DEFINITIONS. FOR THE PURPOSE OF THIS SUBSECTION:
45 (A) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
46 UNDER PARAGRAPH TWO OF THIS SUBSECTION SHALL PROVIDE THE SAME BENCHMARK
47 INDEX, INCLUDING THE SAME AVERAGE WHOLESALE PRICE, MAXIMUM ALLOWABLE
48 COST AND NATIONAL PRESCRIPTION DRUG CODES TO REIMBURSE ALL PHARMACIES
49 PARTICIPATING IN THE HEALTH BENEFIT PLAN REGARDLESS OF WHETHER A PHARMA-
50 CY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
51 (B) "MAIL ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY BUSINESS IS
52 TO RECEIVE PRESCRIPTIONS BY MAIL, TELEFAX OR THROUGH ELECTRONIC
53 SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
54 THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
55 PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN
56 FACE-TO-FACE.
S. 2530 3
1 (2) Any contract issued by a medical expense indemnity corporation, a
2 hospital service corporation or a health services corporation that
3 provides coverage for prescription drugs shall permit each covered
4 person to fill any covered prescription that may be obtained at a
5 network participating mail order or other non-retail pharmacy, at the
6 covered person's option, at a network participating non-mail order
7 retail pharmacy provided that the network participating non-mail order
8 retail pharmacy agrees [in advance, through a contractual network agree-
9 ment,] to the same reimbursement amount[, as well as the same applicable
10 terms and conditions,] that the corporation has established for the
11 network participating mail order or other non-retail pharmacy. In such
12 a case, the contract shall not impose a copayment fee or other condition
13 on any covered person who elects to purchase drugs from a network
14 participating non-mail order retail pharmacy which is not also imposed
15 on covered persons electing to purchase drugs from a network participat-
16 ing mail order or other non-retail pharmacy; provided, however, that the
17 provisions of this section shall not supersede the terms of a collective
18 bargaining agreement or apply to a contract that is the result of a
19 collective bargaining agreement between an employer and a recognized or
20 certified employee organization.
21 S 4. This act shall take effect immediately.
