Bill Text: NY S03510 | 2011-2012 | General Assembly | Introduced

New York Senate Bill 3510 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft

Bill Title: Prohibits health insurers from requiring that the insured purchase prescribed drugs from a mail order pharmacy or pay a co-payment fee when such purchases are not made from a mail order pharmacy if a similar fee is not charged for drugs from a mail order pharmacy.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2011-06-20 - SUBSTITUTED BY A5502B [S03510 Detail]

Download: New_York-2011-S03510-Introduced.html

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         3510
                              2011-2012 Regular Sessions
                                   I N  S E N A T E
                                   February 24, 2011
                                      ___________
       Introduced  by  Sens. MAZIARZ, BRESLIN, BONACIC, GOLDEN, GRIFFO, HANNON,
         KLEIN, LANZA, MARCELLINO, MONTGOMERY -- read twice and ordered  print-
         ed, 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.  Subsection  (i)  of  section 3216 of the insurance law is
    2  amended by adding a new paragraph 28 to read as follows:
    3    (28) NO POLICY WHICH PROVIDES  COVERAGE  FOR  PRESCRIBED  DRUGS  SHALL
    4  MANDATE  THAT  THE  SAME  BE  PURCHASED BY THE INSURED FROM A MAIL ORDER
    5  PHARMACY, NOR MAY SUCH POLICY IMPOSE A CO-PAYMENT FEE OR OTHER CONDITION
    6  ON ANY INSURED WHO ELECTS TO PURCHASE DRUGS FROM OTHER THAN A MAIL ORDER
    7  PHARMACY WHICH IS NOT ALSO IMPOSED  ON  INSUREDS  ELECTING  TO  PURCHASE
    8  DRUGS FROM A DESIGNATED MAIL ORDER PHARMACY; PROVIDED, HOWEVER, THAT THE
    9  PROVISIONS OF THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF A COLLECTIVE
   10  BARGAINING  AGREEMENT  OR  APPLY  TO  A  POLICY  THAT IS THE RESULT OF A
   11  COLLECTIVE BARGAINING AGREEMENT BETWEEN AN EMPLOYER AND A RECOGNIZED  OR
   12  CERTIFIED  EMPLOYEE  ORGANIZATION. NOTHING IN THIS PARAGRAPH SHALL ALTER
   13  ANY PROVISIONS OF SECTIONS  THIRTEEN  AND  THIRTEEN-O  OF  THE  WORKERS'
   14  COMPENSATION  LAW  REGARDING  THE PURCHASE OF PRESCRIPTION DRUGS AND THE
   15  USE OF MAIL ORDER PHARMACY.
   16    S 2. Subsection (1) of section 3221 of the insurance law is amended by
   17  adding a new paragraph 18 to read as follows:
   18    (18) NO INSURER DELIVERING A GROUP OR  BLANKET  POLICY  OR  ISSUING  A
   19  GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE WHICH PROVIDES COVER-
   20  AGE FOR PRESCRIBED DRUGS SHALL MANDATE THAT THE SAME BE PURCHASED BY THE
   21  INSURED FROM A MAIL ORDER PHARMACY, NOR MAY SUCH POLICY IMPOSE A CO-PAY-
   22  MENT  FEE OR OTHER CONDITION ON ANY INSURED WHO ELECTS TO PURCHASE DRUGS
   23  FROM OTHER THAN A MAIL ORDER PHARMACY  WHICH  IS  NOT  ALSO  IMPOSED  ON
   24  INSUREDS ELECTING TO PURCHASE DRUGS FROM A DESIGNATED MAIL ORDER PHARMA-
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD09145-01-1
       S. 3510                             2
    1  CY;  PROVIDED,  HOWEVER,  THAT  THE PROVISIONS OF THIS SECTION SHALL NOT
    2  SUPERSEDE THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT OR APPLY  TO  A
    3  POLICY  THAT  IS THE RESULT OF A COLLECTIVE BARGAINING AGREEMENT BETWEEN
    4  AN EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGANIZATION. NOTHING
    5  IN  THIS  PARAGRAPH  SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND
    6  THIRTEEN-O OF THE WORKERS' COMPENSATION LAW REGARDING  THE  PURCHASE  OF
    7  PRESCRIPTION DRUGS AND THE USE OF MAIL ORDER PHARMACY.
    8    S  3.  Section  4303  of  the insurance law is amended by adding a new
    9  subsection (hh) to read as follows:
   10    (HH) NO POLICY ISSUED BY A MEDICAL EXPENSE  INDEMNITY  CORPORATION,  A
   11  HOSPITAL  SERVICE  CORPORATION  OR  A  HEALTH SERVICES CORPORATION WHICH
   12  PROVIDES COVERAGE FOR PRESCRIBED DRUGS SHALL MANDATE THAT  THE  SAME  BE
   13  PURCHASED BY THE INSURED FROM A MAIL ORDER PHARMACY, NOR MAY SUCH POLICY
   14  IMPOSE  A CO-PAYMENT FEE OR OTHER CONDITION ON ANY INSURED WHO ELECTS TO
   15  PURCHASE DRUGS FROM OTHER THAN A MAIL ORDER PHARMACY WHICH IS  NOT  ALSO
   16  IMPOSED  ON  INSUREDS  ELECTING TO PURCHASE DRUGS FROM A DESIGNATED MAIL
   17  ORDER PHARMACY; PROVIDED, HOWEVER, THAT THE PROVISIONS OF  THIS  SECTION
   18  SHALL  NOT  SUPERSEDE  THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT OR
   19  APPLY TO A POLICY THAT IS THE RESULT OF A COLLECTIVE  BARGAINING  AGREE-
   20  MENT  BETWEEN  AN EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGAN-
   21  IZATION. NOTHING IN  THIS  SUBSECTION  SHALL  ALTER  ANY  PROVISIONS  OF
   22  SECTIONS  THIRTEEN  AND  THIRTEEN-O  OF  THE  WORKERS'  COMPENSATION LAW
   23  REGARDING THE PURCHASE OF PRESCRIPTION DRUGS AND THE USE OF  MAIL  ORDER
   24  PHARMACY.
   25    S  4.  The  opening  paragraph  of  paragraph  25 of subsection (b) of
   26  section 4322 of the insurance law, as amended by chapter 554 of the laws
   27  of 2002, is amended to read as follows:
   28    Prescription drugs, including contraceptive drugs or devices  approved
   29  by  the  federal  food  and  drug  administration or generic equivalents
   30  approved as substitutes by such food and drug administration and  nutri-
   31  tional supplements (formulas) for the therapeutic treatment of phenylke-
   32  tonuria,  branched-chain  ketonuria,  galactosemia  and  homocystinuria,
   33  obtained at a participating pharmacy under a prescription written by  an
   34  in-plan  or  out-of-plan  provider. Health maintenance organizations, in
   35  addition to providing coverage for prescription drugs at a participating
   36  pharmacy, may utilize a mail order prescription drug program.   HOWEVER,
   37  NO HEALTH MAINTENANCE ORGANIZATION SHALL MANDATE THAT PRESCRIPTION DRUGS
   38  BE PURCHASED BY THE INSURED FROM A MAIL ORDER PHARMACY; PROVIDED, HOWEV-
   39  ER, THAT THE PROVISIONS OF THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF
   40  A  COLLECTIVE  BARGAINING  AGREEMENT  OR  APPLY  TO A POLICY THAT IS THE
   41  RESULT OF A COLLECTIVE BARGAINING AGREEMENT BETWEEN AN  EMPLOYER  AND  A
   42  RECOGNIZED OR CERTIFIED EMPLOYEE ORGANIZATION. NOTHING IN THIS PARAGRAPH
   43  SHALL  ALTER  ANY  PROVISIONS OF SECTIONS THIRTEEN AND THIRTEEN-O OF THE
   44  WORKERS' COMPENSATION LAW REGARDING THE PURCHASE OF  PRESCRIPTION  DRUGS
   45  AND THE USE OF MAIL ORDER PHARMACY. Health maintenance organizations may
   46  provide prescription drugs pursuant to a drug formulary; however, health
   47  maintenance  organizations must implement an appeals process so that the
   48  use of non-formulary prescription drugs may be requested by a  physician
   49  or other provider.
   50    S 5. If any clause, subparagraph, subsection, section or other part of
   51  this  act, or the  application thereof be held to be invalid, such hold-
   52  ing shall not affect, impair or invalidate the remainder of this act, or
   53  the application of such section or part of a section held invalid.
   54    S 6. This act shall take effect on the thirtieth day  after  it  shall
   55  have  become a law and shall apply to all policies and contracts issued,
   56  renewed, modified, altered or amended on or after such effective date.