Bill Text: NY S05586 | 2017-2018 | General Assembly | Amended
Bill Title: Relates to prescription drugs.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2018-02-09 - PRINT NUMBER 5586A [S05586 Detail]
Download: New_York-2017-S05586-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 5586--A 2017-2018 Regular Sessions IN SENATE April 18, 2017 ___________ Introduced by Sen. LAVALLE -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, the public health law, and the educa- tion law, in relation to 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 two new paragraphs 28-a and 28-b to read as follows: 3 (28-a) (A) Any policy that provides coverage for prescription drugs 4 and also provides coverage for cancer chemotherapy treatment shall 5 permit each insured to fill any covered prescription under paragraph 6 twelve-a of this subsection that may be obtained at a network partic- 7 ipating mail order or other non-retail pharmacy, at the insured's 8 option, from a network participating oncologist providing services in 9 accordance with section sixty-eight hundred seven of the education law. 10 Any policy providing such coverage shall not impose a co-payment fee or 11 other condition on any insured who elects to purchase oral anticancer 12 medications from a prescribing network participating oncologist which is 13 not also imposed on insureds electing to purchase drugs from a network 14 participating mail order or other non-retail pharmacy. The policy shall 15 not exclude from network participation any oncologist dispensing or 16 involved in the provision of pharmacy services in accordance with 17 section sixty-eight hundred seven of the education law due to their 18 dispensing or the provision of said pharmacy services. This paragraph 19 shall also apply to any pharmacy benefits manager as defined in section 20 two hundred eighty-a of the public health law. 21 (B) For the purposes of this paragraph, "oncologist" shall mean a 22 licensed or registered physician who is board certified or board eligi- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD10670-02-8S. 5586--A 2 1 ble in medical oncology, radiation oncology, hematology, or another 2 oncology specialty recognized by the American board of medical special- 3 ties, or a surgeon who consults predominantly with patients who have a 4 cancer diagnosis. 5 (28-b) (A) Any policy that provides coverage for prescription drugs 6 and also provides coverage for human immunodeficiency virus infection 7 and acquired immune deficiency syndrome treatment shall permit each 8 insured to fill any covered prescription that may be obtained at a 9 network participating mail order or other non-retail pharmacy, at the 10 insured's option, from a network participating physician providing 11 services in accordance with section sixty-eight hundred seven of the 12 education law. Any policy providing such coverage shall not impose a 13 co-payment fee or other condition on any insured who elects to purchase 14 antiretroviral medications from a prescribing network participating 15 physician which is not also imposed on insureds electing to purchase 16 drugs from a network participating mail order or other non-retail phar- 17 macy. The policy shall not exclude from network participation any physi- 18 cian dispensing or involved in the provision of pharmacy services in 19 accordance with section sixty-eight hundred seven of the education law 20 due to their dispensing or the provision of said pharmacy services. This 21 paragraph shall also apply to any pharmacy benefits manager as defined 22 in section two hundred eighty-a of the public health law. 23 (B) For the purposes of this paragraph, "antiretroviral medication" 24 shall mean a drug used in the treatment of human immunodeficiency virus 25 infection and acquired immune deficiency syndrome. 26 § 2. Subsection (l) of section 3221 of the insurance law is amended by 27 adding two new paragraphs 18-a and 18-b to read as follows: 28 (18-a) (A) Any policy that provides coverage for prescription drugs 29 and also provides coverage for cancer chemotherapy treatment shall 30 permit each insured to fill any covered prescription under paragraph 31 twelve-a of this subsection that may be obtained at a network partic- 32 ipating mail order or other non-retail pharmacy, at the insured's 33 option, from a network participating oncologist providing services in 34 accordance with section sixty-eight hundred seven of the education law. 35 Any policy providing such coverage shall not impose a co-payment fee or 36 other condition on any insured who elects to purchase oral anticancer 37 medications from a prescribing network participating oncologist which is 38 not also imposed on insureds electing to purchase drugs from a network 39 participating mail order or other non-retail pharmacy. The policy shall 40 not exclude from network participation any oncologist dispensing or 41 involved in the provision of pharmacy services in accordance with 42 section sixty-eight hundred seven of the education law due to their 43 dispensing or the provision of said pharmacy services. This paragraph 44 shall also apply to any pharmacy benefits manager as defined in section 45 two hundred eighty-a of the public health law. 46 (B) For the purposes of this paragraph, "oncologist" shall mean a 47 licensed or registered physician who is board certified or board eligi- 48 ble in medical oncology, radiation oncology, hematology, or another 49 oncology specialty recognized by the American board of medical special- 50 ties, or a surgeon who consults predominantly with patients who have a 51 cancer diagnosis. 52 (18-b) (A) Any policy that provides coverage for prescription drugs 53 and also provides coverage for human immunodeficiency virus infection 54 and acquired immune deficiency syndrome treatment shall permit each 55 insured to fill any covered prescription that may be obtained at a 56 network participating mail order or other non-retail pharmacy, at theS. 5586--A 3 1 insured's option, from a network participating physician providing 2 services in accordance with section sixty-eight hundred seven of the 3 education law. Any policy providing such coverage shall not impose a 4 co-payment fee or other condition on any insured who elects to purchase 5 antiretroviral medications from a prescribing network participating 6 physician which is not also imposed on insureds electing to purchase 7 drugs from a network participating mail order or other non-retail phar- 8 macy. The policy or a pharmacy benefit manager, as defined in section 9 two hundred eighty-a of the public health law, shall not exclude from 10 network participation any physician dispensing or involved in the 11 provision of pharmacy services in accordance with section sixty-eight 12 hundred seven of the education law due to their dispensing or the 13 provision of said pharmacy services. This paragraph shall also apply to 14 any pharmacy benefits manager as defined in section two hundred eighty-a 15 of the public health law. 16 (B) For the purposes of this paragraph, "antiretroviral medication" 17 shall mean a drug used in the treatment of human immunodeficiency virus 18 infection and acquired immune deficiency syndrome. 19 § 3. Section 4303 of the insurance law is amended by adding two new 20 subsections (kk-1) and (kk-2) to read as follows: 21 (kk-1) (A) Any contract that provides coverage for prescription drugs 22 and also provides coverage for cancer chemotherapy treatment shall 23 permit each insured to fill any covered prescription under subsection 24 (q-1) of this section that may be obtained at a network participating 25 mail order or other non-retail pharmacy, at the insured's option, from a 26 network participating oncologist providing services in accordance with 27 section sixty-eight hundred seven of the education law. Any policy 28 providing such coverage shall not impose a co-payment fee or other 29 condition on any insured who elects to purchase oral anticancer medica- 30 tions from a prescribing network participating oncologist which is not 31 also imposed on insureds electing to purchase drugs from a network 32 participating mail order or other non-retail pharmacy. The policy shall 33 not exclude from network participation any oncologist dispensing or 34 involved in the provision of pharmacy services in accordance with 35 section sixty-eight hundred seven of the education law due to their 36 dispensing or the provision of said pharmacy services. This paragraph 37 shall also apply to any pharmacy benefits manager as defined in section 38 two hundred eighty-a of the public health law. 39 (B) For the purposes of this paragraph, "oncologist" shall mean a 40 licensed or registered physician who is board certified or board eligi- 41 ble in medical oncology, radiation oncology, hematology, or another 42 oncology specialty recognized by the American board of medical special- 43 ties, or a surgeon who consults predominantly with patients who have a 44 cancer diagnosis. 45 (kk-2) (A) Any contract that provides coverage for prescription drugs 46 and also provides coverage for human immunodeficiency virus infection 47 and acquired immune deficiency syndrome treatment shall permit each 48 insured to fill any covered prescription that may be obtained at a 49 network participating mail order or other non-retail pharmacy, at the 50 insured's option, from a network participating physician providing 51 services in accordance with section sixty-eight hundred seven of the 52 education law. Any contract providing such coverage shall not impose a 53 co-payment fee or other condition on any insured who elects to purchase 54 antiretroviral medications from a prescribing network participating 55 physician which is not also imposed on insureds electing to purchase 56 drugs from a network participating mail order or other non-retail phar-S. 5586--A 4 1 macy. The contract or a pharmacy benefit manager, as defined in section 2 two hundred eighty-a of the public health law, shall not exclude from 3 network participation any physician dispensing or involved in the 4 provision of pharmacy services in accordance with section sixty-eight 5 hundred seven of the education law due to their dispensing or the 6 provision of said pharmacy services. This paragraph shall also apply to 7 any pharmacy benefits manager as defined in section two hundred eighty-a 8 of the public health law. 9 (B) For the purposes of this paragraph, "antiretroviral medication" 10 shall mean a drug used in the treatment of human immunodeficiency virus 11 infection and acquired immune deficiency syndrome. 12 § 4. Subdivisions 11, 12, 13, 14, 15, 16, and 17 of section 238 of the 13 public health law are renumbered subdivisions 13, 14, 15, 16, 17, 18, 14 and 19 and two new subdivisions 11 and 12 are added to read as follows: 15 11. "Oncologist" shall mean a licensed or registered physician who is 16 board certified or board eligible in medical oncology, radiation oncolo- 17 gy, hematology, or another oncology specialty recognized by the American 18 board of medical specialties, or a surgeon who consults predominantly 19 with patients who have a cancer diagnosis. 20 12. "Oncology group practice" shall mean a group practice in which 21 each practitioner who is a member of the group is an oncologist. 22 § 5. Subdivision 4 of section 238-a of the public health law, as added 23 by chapter 803 of the laws of 1992, paragraphs (a), (b), and (c) as 24 amended by chapter 591 of the laws of 2000, and paragraph (d) as amended 25 by chapter 443 of the laws of 1993, is amended to read as follows: 26 4. An ownership interest or an investment interest shall not be 27 subject to subdivision one of this section if: 28 (a) the health care provider authorized to provide clinical laboratory 29 services, pharmacy services, radiation therapy services, physical thera- 30 py services or x-ray or imaging services is in a rural area and the 31 referring practitioner or the patient is in such rural area; or 32 (b) the clinical laboratory services, pharmacy services, radiation 33 therapy services, physical therapy services or x-ray or imaging services 34 are provided by a general hospital, the referring practitioner is 35 authorized to perform services at such general hospital and the owner- 36 ship or investment interest is in the general hospital itself and not 37 merely in a subdivision thereof; or 38 (c) the clinical laboratory services, pharmacy services, radiation 39 therapy services, physical therapy services or x-ray or imaging services 40 are provided by an ambulatory surgical center issued an operating 41 certificate pursuant to article twenty-eight of this chapter in conjunc- 42 tion with a surgical procedure performed by the referring practitioner 43 at the ambulatory surgical center; or 44 (d) the pharmacy services are provided to a cancer patient of an 45 oncology group practice by a pharmacy licensed under subdivision two of 46 section sixty-eight hundred eight of the education law, the ownership or 47 investment interest of which is held exclusively by practitioners of the 48 oncology group practice, of which the prescribing practitioner is a 49 member; or 50 (e) the pharmacy services are provided to a human immunodeficiency 51 virus infection or acquired immune deficiency syndrome patient of a 52 group practice by a pharmacy licensed under subdivision two of section 53 sixty-eight hundred eight of the education law, the ownership or invest- 54 ment interest of which is held exclusively by practitioners of the group 55 practice, of which the prescribing practitioner is a member;S. 5586--A 5 1 [(d)] (f) and if each practitioner who is an interested investor in a 2 health care provider within a category specified in paragraph (a), (b) 3 [or], (c), (d) or (e) of this subdivision and who makes a referral of a 4 patient to such health care provider discloses to the patient, in a 5 brief and reasonable form and manner specified in regulations proposed 6 by the commissioner after consultation with representatives of consumer 7 and physician organizations and adopted by the public health council, 8 subject to approval by the commissioner, the practitioner's, or family 9 member's ownership interest or investment interest in the health care 10 provider and the patient's right to utilize a specifically identified 11 alternative health care provider if any such alternative is reasonably 12 available. 13 § 6. Section 6509-a of the education law, as amended by chapter 555 of 14 the laws of 1993, is amended to read as follows: 15 § 6509-a. Additional definition of professional misconduct; limited 16 application. Notwithstanding any inconsistent provision of this article 17 or of any other provision of law to the contrary, the license or regis- 18 tration of a person subject to the provisions of articles one hundred 19 thirty-two, one hundred thirty-three, one hundred thirty-six, one 20 hundred thirty-seven, one hundred thirty-nine, one hundred forty-one, 21 one hundred forty-three, one hundred forty-four, one hundred fifty-six, 22 one hundred fifty-nine and one hundred sixty-four of this chapter may be 23 revoked, suspended or annulled or such person may be subject to any 24 other penalty provided in section sixty-five hundred eleven of this 25 article in accordance with the provisions and procedure of this article 26 for the following: 27 That any person subject to the above enumerated articles, has directly 28 or indirectly requested, received or participated in the division, 29 transference, assignment, rebate, splitting or refunding of a fee for, 30 or has directly requested, received or profited by means of a credit or 31 other valuable consideration as a commission, discount or gratuity in 32 connection with the furnishing of professional care, or service, includ- 33 ing x-ray examination and treatment, or for or in connection with the 34 sale, rental, supplying or furnishing of clinical laboratory services or 35 supplies, x-ray laboratory services or supplies, inhalation therapy 36 service or equipment, ambulance service, hospital or medical supplies, 37 physiotherapy or other therapeutic service or equipment, artificial 38 limbs, teeth or eyes, orthopedic or surgical appliances or supplies, 39 optical appliances, supplies or equipment, devices for aid of hearing, 40 drugs, medication or medical supplies or any other goods, services or 41 supplies prescribed for medical diagnosis, care or treatment under this 42 chapter, except payment, not to exceed thirty-three and one-third per 43 centum of any fee received for x-ray examination, diagnosis or treat- 44 ment, to any hospital furnishing facilities for such examination, diag- 45 nosis or treatment. Nothing contained in this section shall prohibit 46 such persons from practicing as partners, in groups or as a professional 47 corporation or as a university faculty practice corporation nor from 48 pooling fees and moneys received, either by the partnerships, profes- 49 sional corporations, university faculty practice corporations or groups 50 by the individual members thereof, for professional services furnished 51 by any individual professional member, or employee of such partnership, 52 corporation or group, nor shall the professionals constituting the part- 53 nerships, corporations or groups be prohibited from sharing, dividing or 54 apportioning the fees and moneys received by them or by the partnership, 55 corporation or group in accordance with a partnership or other agree- 56 ment; provided that no such practice as partners, corporations or inS. 5586--A 6 1 groups or pooling of fees or moneys received or shared, division or 2 apportionment of fees shall be permitted with respect to care and treat- 3 ment under the workers' compensation law except as expressly authorized 4 by the workers' compensation law. Nothing contained in this chapter 5 shall prohibit a medical or dental expense indemnity corporation pursu- 6 ant to its contract with the subscriber from prorationing a medical or 7 dental expense indemnity allowance among two or more professionals in 8 proportion to the services rendered by each such professional at the 9 request of the subscriber, provided that prior to payment thereof such 10 professionals shall submit both to the medical or dental expense indem- 11 nity corporation and to the subscriber statements itemizing the services 12 rendered by each such professional and the charges therefor. Nothing in 13 this section shall prohibit any person subject to the above enumerated 14 articles from participating in an arrangement permitted in section two 15 hundred thirty-eight-a of the public health law. 16 § 7. Subdivision 18 of section 6530 of the education law, as added by 17 chapter 606 of the laws of 1991, is amended to read as follows: 18 18. Directly or indirectly offering, giving, soliciting, or receiving 19 or agreeing to receive, any fee or other consideration to or from a 20 third party for the referral of a patient or in connection with the 21 performance of professional services. This prohibition shall not include 22 arrangements permitted in section two hundred thirty-eight-a of the 23 public health law; 24 § 8. Section 6802 of the education law is amended by adding three new 25 subdivisions 29, 30, and 31 to read as follows: 26 29. "Oncologist" shall mean a licensed or registered physician who is 27 board certified or board eligible in medical oncology, radiation oncolo- 28 gy, hematology, or another oncology specialty recognized by the American 29 board of medical specialties, or a surgeon who consults predominantly 30 with patients who have a cancer diagnosis. 31 30. "Oncology group practice" shall mean a group practice in which 32 each practitioner who is a member of the group is an oncologist. 33 31. "Group practice" shall mean a group of two or more practitioners 34 organized as a partnership, professional corporation, foundation, not- 35 for-profit corporation, faculty practice plan or similar association. 36 § 9. Section 6807 of the education law, as amended by chapter 881 of 37 the laws of 1972, the section heading as amended and subdivision 3 as 38 added by chapter 573 of the laws of 1999, subdivision 1 as designated 39 and subdivision 2 as added by chapter 18 of the laws of 1990, paragraph 40 b of subdivision 1 and paragraph a of subdivision 2 as amended by chap- 41 ter 538 of the laws of 2001, is amended to read as follows: 42 § 6807. Exempt persons; special provisions. 1. This article shall not 43 be construed to affect or prevent: 44 a. Unlicensed assistants from being employed in licensed pharmacies 45 for purposes other than the practice of pharmacy; 46 b. Any physician, dentist, veterinarian or other licensed health care 47 provider legally authorized to prescribe drugs under this title [who is48not the owner of a pharmacy or who is not in the employ of such owner], 49 from supplying his patients with such drugs as the physician, dentist, 50 veterinarian or other licensed health care provider legally authorized 51 to prescribe drugs under this title deems proper in connection with his 52 practice, provided, however, that all such drugs shall be dispensed in a 53 container labeled with the name and address of the dispenser and 54 patient, directions for use, and date of delivery, and in addition, such 55 drug shall bear a label containing the proprietary or brand name of the 56 drug and, if applicable, the strength of the contents, unless the personS. 5586--A 7 1 issuing the prescription specifically states on the prescription in his 2 own handwriting, that the name of the drug and the strength thereof 3 should not appear on the label; provided further that if such drugs are 4 controlled substances, they shall be dispensed pursuant to the require- 5 ments of article thirty-three of the public health law; 6 c. Any merchant from selling proprietary medicines, except those which 7 are poisonous, deleterious or habit forming, or materials and devices 8 specifically exempted by regulations of the department or by the public 9 health law; 10 d. Any personnel in an institution of higher learning from using pres- 11 cription-required drugs on the premises for authorized research, exper- 12 iments or instruction, in accordance with the department's regulations 13 and, if such drugs are controlled substances, in accordance with title 14 III of article thirty-three of the public health law; or 15 e. The necessary and ordinary activities of manufacturers and whole- 16 salers, subject to the provisions of article thirty-three of the public 17 health law. 18 2. a. Notwithstanding the provisions of paragraph b of subdivision 19 one of this section, [no] a prescriber [who is not the owner of a phar-20macy or who is not in the employ of such owner, may] shall not dispense 21 more than a seventy-two hour supply of drugs, except for: 22 (1) persons practicing in hospitals as defined in section twenty-eight 23 hundred one of the public health law; 24 (2) the dispensing of drugs at no charge to their patients; 25 (3) persons whose practices are situated ten miles or more from a 26 registered pharmacy; 27 (4) the dispensing of drugs in a clinic, infirmary or health service 28 that is operated by or affiliated with a post-secondary institution; 29 (5) persons licensed pursuant to article one hundred thirty-five of 30 this title; 31 (6) the dispensing of drugs in a medical emergency as defined in 32 subdivision six of section sixty-eight hundred ten of this article; 33 (7) the dispensing of drugs that are diluted, reconstituted or 34 compounded by a prescriber; 35 (8) the dispensing of allergenic extracts; or 36 (9) the dispensing of drugs pursuant to an oncological or AIDS proto- 37 col. 38 b. This subdivision shall not be construed to affect or prevent: 39 (1) An oncology group practice from holding an ownership or investment 40 interest in a pharmacy licensed under subdivision two of section sixty- 41 eight hundred eight of this article, the ownership or investment inter- 42 est of which is held exclusively by practitioners of the oncology group 43 practice, to dispense drugs, pursuant to an oncological protocol, to a 44 patient of the oncology group practice; or 45 (2) A group practice from holding an ownership or investment interest 46 in a pharmacy licensed under subdivision two of section sixty-eight 47 hundred eight of this article, the ownership or investment interest of 48 which is held exclusively by practitioners of the group practice, to 49 dispense drugs, pursuant to a human immunodeficiency virus infection and 50 acquired immune deficiency syndrome protocol, to a patient of the group 51 practice. 52 c. The commissioner, in consultation with the commissioner of health, 53 may promulgate regulations to implement this subdivision and may, by 54 regulation, establish additional renewable exemptions for a period not 55 to exceed one year from the provisions of paragraph a of this subdivi- 56 sion.S. 5586--A 8 1 3. A pharmacist may dispense drugs and devices to a registered profes- 2 sional nurse, and a registered professional nurse may possess and admin- 3 ister, drugs and devices, pursuant to a non-patient specific regimen 4 prescribed or ordered by a licensed physician or certified nurse practi- 5 tioner, pursuant to regulations promulgated by the commissioner and the 6 public health law. 7 § 10. This act shall take effect immediately.
