Bill Text: NY S08105 | 2019-2020 | General Assembly | Introduced

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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) 2020-03-23 - REFERRED TO INSURANCE [S08105 Detail]

Download: New_York-2019-S08105-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          8105

                    IN SENATE

                                     March 23, 2020
                                       ___________

        Introduced  by  Sen.  PARKER -- 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 36 to read as follows:
     3    (36) 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    § 2. Subsection (k) of section 3221 of the insurance law is amended by
    17  adding a new paragraph 22 to read as follows:
    18    (22) 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.
                                                                   LBD07563-03-0
        S. 8105                             2

     1  the purpose of this paragraph, "single source drug"  means  a  brandname
     2  drug for which there is no generic equivalent.
     3    §  3.  Section  4303  of  the insurance law is amended by adding a new
     4  subsection (ss) to read as follows:
     5    (ss) 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    § 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.