Bill Text: NY S07180 | 2011-2012 | General Assembly | Introduced

New York Senate Bill 7180 (Prior Session Legislation)

Introduced

Bill Title: Provides that every insurance policy which provides coverage for prescription drugs shall insure that there is continuous coverage of a single source drug that is part of a prescribed therapy until such prescribed therapy is no longer medically necessary for the enrollee of such policy; defines "single source drug".

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2012-05-01 - REFERRED TO INSURANCE [S07180 Detail]

Download: New_York-2011-S07180-Introduced.html

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         7180
                                   I N  S E N A T E
                                      May 1, 2012
                                      ___________
       Introduced  by  Sen.  AVELLA -- 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  coverage  for  single
         source 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 29 to read as follows:
    3    (29) EVERY INDIVIDUAL OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIV-
    4  ERY  IN THIS STATE PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH THE
    5  USE OF A DRUG FORMULARY SHALL INCLUDE A PROVISION WHICH, IN THE EVENT OF
    6  A CHANGE TO SUCH FORMULARY, ALLOWS A COVERED  PERSON  WHO  IS  TAKING  A
    7  SINGLE  SOURCE DRUG COVERED UNDER SUCH POLICY THAT IS NO LONGER INCLUDED
    8  IN OR PREFERRED UNDER SUCH FORMULARY AND HAS FILED  A  GRIEVANCE  OR  AN
    9  APPEAL  OF  THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER OR A STATE
   10  OR FEDERAL AGENCY OR DESIGNEE OF  SUCH  AGENCY,  TO  CONTINUE  RECEIVING
   11  COVERAGE  FOR  SUCH  DRUG  UNDER  THE SAME TERMS AND CONDITIONS AS WOULD
   12  APPLY UNDER THE POLICY WERE SUCH DRUG STILL  INCLUDED  IN  OR  PREFERRED
   13  UNDER THE FORMULARY, UNTIL A FINAL DECISION IS RENDERED ON THE APPEAL OR
   14  GRIEVANCE. FOR THE PURPOSE OF THIS PARAGRAPH, "SINGLE SOURCE DRUG" MEANS
   15  A BRANDNAME DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
   16    S 2. Subsection (k) of section 3221 of the insurance law is amended by
   17  adding a new paragraph 18 to read as follows:
   18    (18) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN
   19  THIS  STATE PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH THE USE OF
   20  A DRUG FORMULARY SHALL INCLUDE A PROVISION WHICH,  IN  THE  EVENT  OF  A
   21  CHANGE TO SUCH FORMULARY, ALLOWS A COVERED PERSON WHO IS TAKING A SINGLE
   22  SOURCE  DRUG  COVERED UNDER SUCH POLICY THAT IS NO LONGER INCLUDED IN OR
   23  PREFERRED UNDER SUCH FORMULARY AND HAS FILED A GRIEVANCE OR AN APPEAL OF
   24  THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER OR A STATE OR  FEDERAL
   25  AGENCY  OR  DESIGNEE  OF SUCH AGENCY, TO CONTINUE RECEIVING COVERAGE FOR
   26  SUCH DRUG UNDER THE SAME TERMS AND CONDITIONS AS WOULD APPLY  UNDER  THE
   27  POLICY  WERE  SUCH  DRUG STILL INCLUDED IN OR PREFERRED UNDER THE FORMU-
   28  LARY, UNTIL A FINAL DECISION IS RENDERED ON THE APPEAL OR GRIEVANCE. FOR
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD08466-02-2
       S. 7180                             2
    1  THE PURPOSE OF THIS PARAGRAPH, "SINGLE SOURCE DRUG"  MEANS  A  BRANDNAME
    2  DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
    3    S  3.  Section  4303  of  the insurance law is amended by adding a new
    4  subsection (ii) to read as follows:
    5    (II) EVERY CONTRACT DELIVERED OR ISSUED FOR  DELIVERY  IN  THIS  STATE
    6  PROVIDING  COVERAGE  FOR  PRESCRIPTION  DRUGS  THROUGH THE USE OF A DRUG
    7  FORMULARY SHALL INCLUDE A PROVISION WHICH, IN THE EVENT OF A  CHANGE  TO
    8  SUCH  FORMULARY,  ALLOWS  A COVERED PERSON WHO IS TAKING A SINGLE SOURCE
    9  DRUG COVERED UNDER SUCH CONTRACT  THAT  IS  NO  LONGER  INCLUDED  IN  OR
   10  PREFERRED UNDER SUCH FORMULARY AND HAS FILED A GRIEVANCE OR AN APPEAL OF
   11  THE  DENIAL OF ACCESS TO THE DRUG WITH THE INSURER CORPORATION OR ORGAN-
   12  IZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF  THE  PUBLIC  HEALTH
   13  LAW OR A STATE OR FEDERAL AGENCY OR DESIGNEE OF SUCH AGENCY, TO CONTINUE
   14  RECEIVING  COVERAGE FOR SUCH DRUG UNDER THE SAME TERMS AND CONDITIONS AS
   15  WOULD APPLY UNDER THE CONTRACT WERE  SUCH  DRUG  STILL  INCLUDED  IN  OR
   16  PREFERRED UNDER THE FORMULARY, UNTIL A FINAL DECISION IS RENDERED ON THE
   17  APPEAL  OR GRIEVANCE. FOR THE PURPOSE OF THIS SUBSECTION, "SINGLE SOURCE
   18  DRUG" MEANS A BRANDNAME DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
   19    S 4. This act shall take effect on the first  of  the  calendar  month
   20  next  succeeding  the  sixtieth  day  after  it shall have become a law;
   21  provided, however, that this  act  shall  apply  only  to  policies  and
   22  contracts issued, renewed or amended on or after such effective date.