Bill Text: NY S03510 | 2011-2012 | General Assembly | Amended
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-Amended.html
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-Amended.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 3510--A 2011-2012 Regular Sessions I N S E N A T E February 24, 2011 ___________ Introduced by Sens. MAZIARZ, BRESLIN, ADDABBO, AVELLA, BALL, BONACIC, DUANE, GALLIVAN, GOLDEN, GRIFFO, HANNON, HUNTLEY, JOHNSON, KLEIN, KRUEGER, KRUGER, LANZA, LARKIN, LAVALLE, LIBOUS, MARCELLINO, MARTINS, MONTGOMERY, OPPENHEIMER, PERALTA, PERKINS, RANZENHOFER, STAVISKY, ZELDIN -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said commit- tee 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) ANY POLICY WHICH PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL 4 PERMIT EACH PARTICIPANT TO FILL ANY MAIL ORDER COVERED PRESCRIPTION, AT 5 HIS OR HER OPTION, AT ANY MAIL ORDER PHARMACY OR NETWORK PARTICIPATING 6 NON-MAIL ORDER RETAIL PHARMACY IF THE NETWORK PARTICIPATING NON-MAIL 7 ORDER RETAIL PHARMACY OFFERS TO ACCEPT A PRICE THAT IS COMPARABLE TO 8 THAT OF THE MAIL ORDER PHARMACY. ANY POLICY WHICH PROVIDES COVERAGE FOR 9 PRESCRIPTION DRUGS SHALL NOT IMPOSE A CO-PAYMENT FEE OR OTHER CONDITION 10 ON ANY INSURED WHO ELECTS TO PURCHASE DRUGS FROM A NETWORK PARTICIPATING 11 NON-MAIL ORDER RETAIL PHARMACY WHICH IS NOT ALSO IMPOSED ON INSUREDS 12 ELECTING TO PURCHASE DRUGS FROM A DESIGNATED MAIL ORDER PHARMACY; 13 PROVIDED, HOWEVER, THAT THE PROVISIONS OF THIS SECTION SHALL NOT SUPER- 14 SEDE THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT OR APPLY TO A POLICY 15 THAT IS THE RESULT OF A COLLECTIVE BARGAINING AGREEMENT BETWEEN AN 16 EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGANIZATION. NOTHING IN 17 THIS PARAGRAPH SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND THIR- 18 TEEN-O OF THE WORKERS' COMPENSATION LAW REGARDING THE PURCHASE OF 19 PRESCRIPTION DRUGS AND THE USE OF MAIL ORDER PHARMACY. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD09145-05-1 S. 3510--A 2 1 S 2. Subsection (1) of section 3221 of the insurance law is amended by 2 adding a new paragraph 18 to read as follows: 3 (18) ANY INSURER DELIVERING A GROUP OR BLANKET POLICY OR ISSUING A 4 GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE WHICH PROVIDES COVER- 5 AGE FOR PRESCRIPTION DRUGS SHALL PERMIT EACH PARTICIPANT TO FILL ANY 6 MAIL ORDER COVERED PRESCRIPTION, AT HIS OR HER OPTION, AT ANY MAIL ORDER 7 PHARMACY OR NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY IF THE 8 NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY OFFERS TO ACCEPT A 9 PRICE THAT IS COMPARABLE TO THAT OF THE MAIL ORDER PHARMACY. ANY POLICY 10 WHICH PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL NOT IMPOSE A 11 CO-PAYMENT FEE OR OTHER CONDITION ON ANY INSURED WHO ELECTS TO PURCHASE 12 DRUGS FROM A NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY WHICH 13 IS NOT ALSO IMPOSED ON INSUREDS ELECTING TO PURCHASE DRUGS FROM A DESIG- 14 NATED MAIL ORDER PHARMACY; PROVIDED, HOWEVER, THAT THE PROVISIONS OF 15 THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF A COLLECTIVE BARGAINING 16 AGREEMENT OR APPLY TO A POLICY THAT IS THE RESULT OF A COLLECTIVE 17 BARGAINING AGREEMENT BETWEEN AN EMPLOYER AND A RECOGNIZED OR CERTIFIED 18 EMPLOYEE ORGANIZATION. NOTHING IN THIS PARAGRAPH SHALL ALTER ANY 19 PROVISIONS OF SECTIONS THIRTEEN AND THIRTEEN-O OF THE WORKERS' COMPEN- 20 SATION LAW REGARDING THE PURCHASE OF PRESCRIPTION DRUGS AND THE USE OF 21 MAIL ORDER PHARMACY. 22 S 3. Section 4303 of the insurance law is amended by adding a new 23 subsection (hh) to read as follows: 24 (HH) ANY POLICY ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION, A 25 HOSPITAL SERVICE CORPORATION OR A HEALTH SERVICES CORPORATION WHICH 26 PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL PERMIT EACH PARTICIPANT 27 TO FILL ANY MAIL ORDER COVERED PRESCRIPTION, AT HIS OR HER OPTION, AT 28 ANY MAIL ORDER PHARMACY OR NETWORK PARTICIPATING NON-MAIL ORDER RETAIL 29 PHARMACY IF THE NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY 30 OFFERS TO ACCEPT A PRICE THAT IS COMPARABLE TO THAT OF THE MAIL ORDER 31 PHARMACY. ANY POLICY WHICH PROVIDES COVERAGE FOR PRESCRIPTION DRUGS 32 SHALL NOT IMPOSE A COPAYMENT FEE OR OTHER CONDITION ON ANY INSURED WHO 33 ELECTS TO PURCHASE DRUGS FROM A NETWORK PARTICIPATING NON-MAIL ORDER 34 RETAIL PHARMACY WHICH IS NOT ALSO IMPOSED ON INSUREDS ELECTING TO 35 PURCHASE DRUGS FROM A DESIGNATED MAIL ORDER PHARMACY; PROVIDED, HOWEVER, 36 THAT THE PROVISIONS OF THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF A 37 COLLECTIVE BARGAINING AGREEMENT OR APPLY TO A POLICY THAT IS THE RESULT 38 OF A COLLECTIVE BARGAINING AGREEMENT BETWEEN AN EMPLOYER AND A RECOG- 39 NIZED OR CERTIFIED EMPLOYEE ORGANIZATION. NOTHING IN THIS SUBSECTION 40 SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND THIRTEEN-O OF THE 41 WORKERS' COMPENSATION LAW REGARDING THE PURCHASE OF PRESCRIPTION DRUGS 42 AND THE USE OF MAIL ORDER PHARMACY. 43 S 4. The opening paragraph of paragraph 25 of subsection (b) of 44 section 4322 of the insurance law, as amended by chapter 554 of the laws 45 of 2002, is amended to read as follows: 46 Prescription drugs, including contraceptive drugs or devices approved 47 by the federal food and drug administration or generic equivalents 48 approved as substitutes by such food and drug administration and nutri- 49 tional supplements (formulas) for the therapeutic treatment of phenylke- 50 tonuria, branched-chain ketonuria, galactosemia and homocystinuria, 51 obtained at a participating pharmacy under a prescription written by an 52 in-plan or out-of-plan provider. Health maintenance organizations, in 53 addition to providing coverage for prescription drugs at a participating 54 pharmacy, may utilize a mail order prescription drug program. HOWEVER, 55 NO HEALTH MAINTENANCE ORGANIZATION SHALL MANDATE THAT PRESCRIPTION DRUGS 56 BE PURCHASED BY THE INSURED FROM A MAIL ORDER PHARMACY IF A NETWORK S. 3510--A 3 1 PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY OFFERS TO ACCEPT A PRICE 2 THAT IS COMPARABLE TO THAT OF THE MAIL ORDER PHARMACY. NO HEALTH MAIN- 3 TENANCE ORGANIZATION SHALL IMPOSE A CO-PAYMENT FEE OR OTHER CONDITION ON 4 ANY INSURED WHO ELECTS TO PURCHASE DRUGS FROM A NETWORK PARTICIPATING 5 NON-MAIL ORDER RETAIL PHARMACY. THE PROVISIONS OF THIS SECTION SHALL 6 NOT SUPERSEDE THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT OR APPLY TO 7 A POLICY THAT IS THE RESULT OF A COLLECTIVE BARGAINING AGREEMENT BETWEEN 8 AN EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGANIZATION. NOTHING 9 IN THIS PARAGRAPH SHALL ALTER ANY PROVISIONS OF SECTIONS THIRTEEN AND 10 THIRTEEN-O OF THE WORKERS' COMPENSATION LAW REGARDING THE PURCHASE OF 11 PRESCRIPTION DRUGS AND THE USE OF MAIL ORDER PHARMACY. Health mainte- 12 nance organizations may provide prescription drugs pursuant to a drug 13 formulary; however, health maintenance organizations must implement an 14 appeals process so that the use of non-formulary prescription drugs may 15 be requested by a physician or other provider. 16 S 5. If any clause, subparagraph, subsection, section or other part of 17 this act, or the application thereof be held to be invalid, such hold- 18 ing shall not affect, impair or invalidate the remainder of this act, or 19 the application of such section or part of a section held invalid. 20 S 6. This act shall take effect on the thirtieth day after it shall 21 have become a law and shall apply to all policies and contracts issued, 22 renewed, modified, altered or amended on or after such effective date.