Bill Text: NY S03543 | 2019-2020 | General Assembly | Introduced
Bill Title: Relates to the definition of over the counter contraceptive products and voluntary sterilization procedures.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2020-01-08 - REFERRED TO WOMEN'S ISSUES [S03543 Detail]
Download: New_York-2019-S03543-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 3543 2019-2020 Regular Sessions IN SENATE February 8, 2019 ___________ Introduced by Sen. SALAZAR -- read twice and ordered printed, and when printed to be committed to the Committee on Women's Issues AN ACT to amend the insurance law, in relation to the definition of over the counter contraceptive products and voluntary sterilization proce- dures The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subparagraph (A) of paragraph 16 of subsection (l) of 2 section 3221 of the insurance law, as amended by a chapter of the laws 3 of 2019 amending the insurance law and the social services law, relating 4 to requiring health insurance policies to include coverage of all 5 FDA-approved contraceptive drugs, devices, and products, as well as 6 voluntary sterilization procedures, contraceptive education and coun- 7 seling, and related follow up services and prohibiting a health insur- 8 ance policy from imposing any cost-sharing requirements or other 9 restrictions or delays with respect to this coverage, as proposed in 10 legislative bills numbers S. 659-A and A. 585-A, is amended and a new 11 subparagraph (H) is added to read as follows: 12 (A) Every group or blanket policy that provides medical, major 13 medical, or similar comprehensive-type coverage that is issued, amended, 14 renewed, effective or delivered on or after January first, two thousand 15 twenty, shall provide coverage for all of the following services and 16 contraceptive methods: 17 (1) All FDA-approved contraceptive drugs, devices, and other products. 18 This includes all FDA-approved over-the-counter contraceptive drugs, 19 devices, and products as prescribed or as otherwise authorized under 20 state or federal law. The following applies to this coverage: 21 (a) where the FDA has approved one or more therapeutic and pharmaceu- 22 tical equivalent, as defined by the FDA, versions of a contraceptive 23 drug, device, or product, a group or blanket policy is not required to 24 include all such therapeutic and pharmaceutical equivalent versions in EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD09525-01-9S. 3543 2 1 its formulary, so long as at least one is included and covered without 2 cost-sharing and in accordance with this paragraph; 3 (b) if the covered therapeutic and pharmaceutical equivalent versions 4 of a drug, device, or product are not available or are deemed medically 5 inadvisable a group or blanket policy shall provide coverage for an 6 alternate therapeutic and pharmaceutical equivalent version of the 7 contraceptive drug, device, or product without cost-sharing. If the 8 attending health care provider, in his or her reasonable professional 9 judgment, determines that the use of a non-covered therapeutic or phar- 10 maceutical equivalent of a drug, device, or product is warranted, the 11 health care provider's determination shall be final. The superintendent 12 shall promulgate regulations establishing a process, including time- 13 frames, for an insured, an insured's designee or an insured's health 14 care provider to request coverage of a non-covered contraceptive drug, 15 device, or product. Such regulations shall include a requirement that 16 insurers use an exception form that shall meet criteria established by 17 the superintendent; 18 (c) this coverage shall include emergency contraception without cost- 19 sharing when provided pursuant to a prescription or order under section 20 sixty-eight hundred thirty-one of the education law or when lawfully 21 provided over the counter; and 22 (d) this coverage must allow for the dispensing of up to twelve months 23 worth of a contraceptive at one time; 24 (2) Voluntary sterilization procedures; provided, however, until Janu- 25 ary first of the year following the date that vasectomies are not an 26 essential health benefit that are required to be covered pursuant to 42 27 U.S.C. § 18022, the term "voluntary sterilization procedures" for small 28 group policies shall be defined as those procedures identified in the 29 comprehensive guidelines supported by the health resources and services 30 administration as of January twenty-first, two thousand nineteen; 31 (3) Patient education and counseling on contraception; and 32 (4) Follow-up services related to the drugs, devices, products, and 33 procedures covered under this paragraph, including, but not limited to, 34 management of side effects, counseling for continued adherence, and 35 device insertion and removal. 36 (H) For purposes of this paragraph, over the counter contraceptive 37 products shall mean those products provided for in comprehensive guide- 38 lines supported by the health resources and services administration as 39 of January twenty-first, two thousand nineteen. 40 § 2. Paragraph 1 of subsection (cc) of section 4303 of the insurance 41 law, as amended by a chapter of the laws of 2019 amending the insurance 42 law and social services law, relating to requiring health insurance 43 policies to include coverage of all FDA-approved contraceptive drugs, 44 devices, and products, as well as voluntary sterilization procedures, 45 contraceptive education and counseling, and related follow up services 46 and prohibiting a health insurance policy from imposing any cost-sharing 47 requirements or other restrictions or delays with respect to this cover- 48 age, as proposed in legislative bills numbers S. 659-A and A. 585-A, is 49 amended and a new paragraph 8 is added as follows: 50 (1) Every contract that provides medical, major medical, or similar 51 comprehensive type coverage that is issued, amended, renewed, effective 52 or delivered on or after January first, two thousand twenty, shall 53 provide coverage for all of the following services and contraceptive 54 methods: 55 (A) All FDA-approved contraceptive drugs, devices, and other products. 56 This includes all FDA-approved over-the-counter contraceptive drugs,S. 3543 3 1 devices, and products as prescribed or as otherwise authorized under 2 state or federal law. The following applies to this coverage: 3 (i) where the FDA has approved one or more therapeutic and pharmaceu- 4 tical equivalent, as defined by the FDA, versions of a contraceptive 5 drug, device, or product, a contract is not required to include all such 6 therapeutic and pharmaceutical equivalent versions in its formulary, so 7 long as at least one is included and covered without cost-sharing and in 8 accordance with this subsection; 9 (ii) if the covered therapeutic and pharmaceutical equivalent versions 10 of a drug, device, or product are not available or are deemed medically 11 inadvisable a contract shall provide coverage for an alternate therapeu- 12 tic and pharmaceutical equivalent version of the contraceptive drug, 13 device, or product without cost-sharing. If the attending health care 14 provider, in his or her reasonable professional judgment, determines 15 that the use of a non-covered therapeutic or pharmaceutical equivalent 16 of a drug, device, or product is warranted, the health care provider's 17 determination shall be final. The superintendent shall promulgate regu- 18 lations establishing a process, including timeframes, for an insured, an 19 insured's designee or an insured's health care provider to request 20 coverage of a non-covered contraceptive drug, device, or product. Such 21 regulations shall include a requirement that insurers use an exception 22 form that shall meet criteria established by the superintendent; 23 (iii) this coverage shall include emergency contraception without 24 cost-sharing when provided pursuant to a prescription or order under 25 section sixty-eight hundred thirty-one of the education law or when 26 lawfully provided over the counter; and 27 (iv) this coverage must allow for the dispensing of up to twelve 28 months worth of a contraceptive at one time; 29 (B) Voluntary sterilization procedures; provided, however, until Janu- 30 ary first of the year following the date that vasectomies are not an 31 essential health benefit that are required to be covered pursuant to 42 32 U.S.C. § 18022, the term "voluntary sterilization procedures" for indi- 33 vidual and small group policies shall be defined as those procedures 34 identified in the comprehensive guidelines supported by the health 35 resources and services administration as of January twenty-first, two 36 thousand nineteen; 37 (C) Patient education and counseling on contraception; and 38 (D) Follow-up services related to the drugs, devices, products, and 39 procedures covered under this subsection, including, but not limited to, 40 management of side effects, counseling for continued adherence, and 41 device insertion and removal. 42 (8) For purposes of this subsection, over the counter contraceptive 43 products shall mean those products provided for in comprehensive guide- 44 lines supported by the health resources and services administration as 45 of January twenty-first, two thousand nineteen. 46 § 3. Clause (v) of subparagraph (E) of paragraph 17 of subsection (i) 47 of section 3216 of the insurance law, as added by a chapter of the laws 48 of 2019 amending the insurance law and the social services law, relating 49 to requiring health insurance policies to include coverage of all 50 FDA-approved contraceptive drugs, devices, and products, as well as 51 voluntary sterilization procedures, contraceptive education and coun- 52 seling, and related follow up services and prohibiting a health insur- 53 ance policy from imposing any cost-sharing requirements or other 54 restrictions or delays with respect to this coverage, as proposed in 55 legislative bills numbers S. 659-A and A. 585-A, is amended to read as 56 follows:S. 3543 4 1 (v) all FDA-approved contraceptive drugs, devices, and other products, 2 including all over-the-counter contraceptive drugs, devices, and 3 products as prescribed or as otherwise authorized under state or federal 4 law; voluntary sterilization procedures; provided, however, until Janu- 5 ary first of the year following the date that vasectomies are not an 6 essential health benefit that are required to be covered pursuant to 42 7 U.S.C. § 18022, the term "voluntary sterilization procedures" for indi- 8 vidual policies shall be defined as those procedures identified in the 9 comprehensive guidelines supported by the health resources and services 10 administration as of January twenty-first, two thousand nineteen; 11 patient education and counseling on contraception; and follow-up 12 services related to the drugs, devices, products, and procedures covered 13 under this clause, including, but not limited to, management of side 14 effects, counseling for continued adherence, and device insertion and 15 removal. Except as otherwise authorized under this clause, a contract 16 shall not impose any restrictions or delays on the coverage required 17 under this clause. However, where the FDA has approved one or more ther- 18 apeutic and pharmaceutical equivalent, as defined by the FDA, versions 19 of a contraceptive drug, device, or product, a contract is not required 20 to include all such therapeutic and pharmaceutical equivalent versions 21 in its formulary, so long as at least one is included and covered with- 22 out cost-sharing and in accordance with this clause. If the covered 23 therapeutic and pharmaceutical equivalent versions of a drug, device, or 24 product are not available or are deemed medically inadvisable a contract 25 shall provide coverage for an alternate therapeutic and pharmaceutical 26 equivalent version of the contraceptive drug, device, or product without 27 cost-sharing. (a) This coverage shall include emergency contraception 28 without cost sharing when provided pursuant to a prescription, or order 29 under section sixty-eight hundred thirty-one of the education law or 30 when lawfully provided over-the-counter. (b) If the attending health 31 care provider, in his or her reasonable professional judgment, deter- 32 mines that the use of a non-covered therapeutic or pharmaceutical equiv- 33 alent of a drug, device, or product is warranted, the health care 34 provider's determination shall be final. The superintendent shall 35 promulgate regulations establishing a process, including timeframes, for 36 an insured, an insured's designee or an insured's health care provider 37 to request coverage of a non-covered contraceptive drug, device, or 38 product. Such regulations shall include a requirement that insurers use 39 an exception form that shall meet criteria established by the super- 40 intendent. (c) This coverage must allow for the dispensing of up to 41 twelve months worth of a contraceptive at one time. (d) For purposes of 42 this clause, over-the-counter contraceptive products shall mean those 43 products provided for in comprehensive guidelines supported by the 44 health resources and services administration as of January twenty-first, 45 two thousand nineteen. 46 § 4. This act shall take effect on the same date and in the same 47 manner as a chapter of the laws of 2019 amending the insurance law and 48 the social services law, relating to requiring health insurance policies 49 to include coverage of all FDA-approved contraceptive drugs, devices, 50 and products, as well as voluntary sterilization procedures, contracep- 51 tive education and counseling, and related follow up services and 52 prohibiting a health insurance policy from imposing any cost-sharing 53 requirements or other restrictions or delays with respect to this cover- 54 age, as proposed in legislative bills numbers S. 659-A and A. 585-A, 55 takes effect.
