Bill Text: NY S07191 | 2017-2018 | General Assembly | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relates to enhancing pharmaceutical transparency and consumer protection between pharmacies and pharmacy benefit managers.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2018-02-08 - PRINT NUMBER 7191A [S07191 Detail]
Download: New_York-2017-S07191-Introduced.html
Bill Title: Relates to enhancing pharmaceutical transparency and consumer protection between pharmacies and pharmacy benefit managers.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2018-02-08 - PRINT NUMBER 7191A [S07191 Detail]
Download: New_York-2017-S07191-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 7191 IN SENATE (Prefiled) January 3, 2018 ___________ Introduced by Sen. GRIFFO -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the public health law and the insurance law, in relation to contracts between pharmacies and pharmacy benefit managers The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The public health law is amended by adding a new section 2 280-c to read as follows: 3 § 280-c. Contracts between pharmacies and pharmacy benefit managers. 4 1. On and after January first, two thousand eighteen, no contract for 5 pharmacy services entered into in the state between a health insurance 6 carrier or a pharmacy benefit manager, as defined in section two hundred 7 eighty-a of this article, and a pharmacy, pharmacist or a pharmacy's 8 contracting agent, such as a pharmacy services administrative organiza- 9 tion, shall contain a provision prohibiting or penalizing, including 10 through increased utilization review, reduced payments or other finan- 11 cial disincentives, a pharmacist's disclosure to an individual purchas- 12 ing prescription medication of information regarding (a) the cost of the 13 prescription medication to the individual, or (b) the availability of 14 any therapeutically equivalent alternative medications or alternative 15 methods of purchasing the prescription medication, including, but not 16 limited to, paying a cash price, that are less expensive than the cost 17 of the prescription medication to the individual. 18 2. On and after January first, two thousand eighteen, no health insur- 19 ance carrier or pharmacy benefit manager shall require an individual to 20 make a payment at the point of sale for a covered prescription medica- 21 tion in an amount greater than the lesser of (a) the applicable copay- 22 ment for such prescription medication, (b) the allowable claim amount 23 for the prescription medication, or (c) the amount an individual would 24 pay for the prescription medication if the individual purchased the 25 prescription medication without using a health benefit plan or any other 26 source of prescription medication benefits or discounts. For the 27 purposes of this section, "allowable claim amount" means the amount the EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD13660-02-7S. 7191 2 1 health insurance carrier or pharmacy benefit manager has agreed to pay 2 the pharmacy for the prescription medication. 3 3. Any provision of a contract that violates the provisions of this 4 section shall be void and unenforceable. Any general business practice 5 that violates the provisions of this section shall constitute an unfair 6 trade practice pursuant to section three hundred forty of the general 7 business law. The invalidity or unenforceability of any contract 8 provision under this subsection shall not affect any other provision of 9 such contract. 10 4. The superintendent, as defined in section one hundred seven of the 11 insurance law, may enforce the provisions of this section, and upon 12 request, audit a contract for pharmacy services for compliance with the 13 provisions of this section. 14 5. In any action brought under section three hundred forty of the 15 general business law, a defendant that sells, distributes or otherwise 16 disposes of any drug or device, as defined in 21 USC 321 may not assert 17 as a defense that the defendant did not deal directly with the person on 18 whose behalf the action is brought and may, in order to avoid duplica- 19 tive liability, prove, as a partial or complete defense against a damage 20 claim, that all or any part of an alleged overcharge for a drug or 21 device ultimately was passed on to another person by a purchaser or a 22 seller in the chain of manufacture, production or distribution of the 23 drug or device that paid the alleged overcharge. 24 § 2. Section 3217-b of the insurance law is amended by adding a new 25 subsection (l) to read as follows: 26 (l) (1) No insurer subject to this article shall by contract, written 27 policy or written procedure prohibit or restrict any health care provid- 28 er from disclosure of (i) billed or allowed amounts, reimbursement rates 29 or out-of-pocket costs, or (ii) any data to the all payor database 30 (APD). Such information may be used to assist consumers and institu- 31 tional purchasers in making informed decisions regarding their health 32 care and informed choices among health care providers and allow compar- 33 isons between prices paid by various health carriers to health care 34 providers. 35 (2) No contract entered into under this article between a health care 36 provider, or any agent or vendor retained by the health care provider to 37 provide data or analytical services to evaluate and manage health care 38 services provided to the insurer's plan participants, and the insurer 39 shall contain a provision prohibiting disclosure of (i) billed or 40 allowed amounts, reimbursement rates or out-of-pocket costs, or (ii) any 41 data to the all payor database (APD). Such information may be used to 42 assist consumers and institutional purchasers in making informed deci- 43 sions regarding their health care and informed choices among health care 44 providers and allow comparisons between prices paid by various health 45 carriers to health care providers. 46 (3) If a contract described in paragraph one or two of this 47 subsection, whichever is applicable, contains a provision prohibited 48 under the applicable paragraphs, such provision shall be void and unen- 49 forceable. The invalidity or unenforceability of any contract provision 50 under this subsection shall not affect any other provision of such 51 contract. 52 § 3. Section 4325 of the insurance law is amended by adding a new 53 subsection (m) to read as follows: 54 (m) (1) No corporation organized under this article shall by contract, 55 written policy or written procedure prohibit or restrict any health care 56 provider from disclosure of (i) billed or allowed amounts, reimbursementS. 7191 3 1 rates or out-of-pocket costs, or (ii) any data to the all payor database 2 (APD). Such information may be used to assist consumers and institu- 3 tional purchasers in making informed decisions regarding their health 4 care and informed choices among health care providers and allow compar- 5 isons between prices paid by various health carriers to health care 6 providers. 7 (2) No contract or agreement entered into under this article between a 8 health care provider, or any agent or vendor retained by the health care 9 provider to provide data or analytical services to evaluate and manage 10 health care services provided to the insurer's plan participants, and 11 the insurer shall contain a provision prohibiting disclosure of (A) 12 billed or allowed amounts, reimbursement rates or out-of-pocket costs, 13 or (B) any data to the all payor database (APD). Such information may be 14 used to assist consumers and institutional purchasers in making informed 15 decisions regarding their health care and informed choices among health 16 care providers and allow comparisons between prices paid by various 17 health carriers to health care providers. 18 (3) If a contract described in paragraph one or two of this 19 subsection, whichever is applicable, contains a provision prohibited 20 under the applicable paragraphs, such provision shall be void and unen- 21 forceable. The invalidity or unenforceability of any policy provision 22 under this subsection shall not affect any other provision of such 23 contract. 24 § 4. This act shall take effect immediately and shall apply to all 25 policies and contracts issued, renewed, modified, altered or amended on 26 or after such date.