Bill Text: NY S09120 | 2017-2018 | General Assembly | Introduced
Bill Title: Relates to insurance coverage for FDA-approved contraceptive drugs, devices and products and contraceptive education, counseling and follow up services.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2018-06-20 - REFERRED TO RULES [S09120 Detail]
Download: New_York-2017-S09120-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 9120 IN SENATE June 20, 2018 ___________ Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Rules AN ACT to amend the insurance law, in relation to requiring health insurance policies to include coverage of all FDA-approved contracep- tive drugs, devices, and products, contraceptive education and coun- seling, and related follow up services and prohibiting a health insur- ance policy from imposing any cost-sharing requirements or other restrictions or delays with respect to this coverage The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 16 of subsection (l) of section 3221 of the 2 insurance law, as added by chapter 554 of the laws of 2002, is amended 3 to read as follows: 4 (16) (A) Every group or blanket policy which provides coverage for 5 prescription drugs shall [include coverage for the cost of contraceptive6drugs or devices approved by the federal food and drug administration or7generic equivalents approved as substitutes by such food and drug admin-8istration under the prescription of a health care provider legally9authorized to prescribe under title eight of the education law. The10coverage required by this section shall be included in policies and11certificates only through the addition of a rider.12(A)] provide coverage for all of the following services and contracep- 13 tive methods: 14 (1) All FDA-approved contraceptive drugs, devices, and other products 15 provided for in comprehensive guidelines supported by the Health 16 Resources and Services Administration (HRSA), as prescribed by a physi- 17 cian or other licensed health care provider legally authorized to 18 prescribe under title eight of the education law. The following applies 19 to this coverage: 20 (a) where the FDA has approved one or more forms of contraception 21 within a method of contraception identified by the FDA, a group or blan- 22 ket policy is not required to include all such forms in its formulary, 23 so long as at least one is included and covered without cost-sharing; EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD06579-19-8S. 9120 2 1 (b) if the treating physician or other licensed health care provider 2 legally authorized to prescribe under title eight of the education law 3 recommends a particular service or FDA-approved item based on a determi- 4 nation of medical necessity with respect to that individual, a group or 5 blanket policy must cover that service or item without cost-sharing; 6 (c) this coverage must allow for the dispensing of an initial three- 7 month supply. For subsequent dispensing of the same contraceptive 8 prescribed by the physician or other licensed health care provider 9 legally authorized to prescribe under title eight of the education law 10 and covered under the same policy or renewal thereof, an insurer shall 11 allow coverage for the dispensing of the entire prescribed supply, up to 12 twelve months, at the same time; 13 (2) Patient education and counseling on contraception without cost- 14 sharing; and 15 (3) Follow-up services related to the drugs, devices, products, and 16 procedures covered under this paragraph, including, but not limited to, 17 management of side effects, counseling for continued adherence, and 18 device insertion and removal without cost-sharing. 19 (B) Nothing in this paragraph shall be construed to prevent reasonable 20 medical management or utilization review of drugs, devices, products or 21 services provided herein. 22 (C) Notwithstanding any other provision of this subsection, a reli- 23 gious employer may request a contract without coverage for federal food 24 and drug administration approved contraceptive methods that are contrary 25 to the religious employer's religious tenets. If so requested, such 26 contract shall be provided without coverage for contraceptive methods. 27 This paragraph shall not be construed to deny an enrollee coverage of, 28 and timely access to, contraceptive methods. 29 (1) For purposes of this subsection, a "religious employer" is an 30 entity for which each of the following is true: 31 (a) The inculcation of religious values is the purpose of the entity. 32 (b) The entity primarily employs persons who share the religious 33 tenets of the entity. 34 (c) The entity serves primarily persons who share the religious tenets 35 of the entity. 36 (d) The entity is a nonprofit organization as described in Section 37 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended. 38 (2) Every religious employer that invokes the exemption provided under 39 this paragraph shall provide written notice to prospective enrollees 40 prior to enrollment with the plan, listing the contraceptive health care 41 services the employer refuses to cover for religious reasons. 42 [(B) (i)] (D) (1) Where a group policyholder makes an election not to 43 purchase coverage for contraceptive drugs or devices in accordance with 44 subparagraph [(A)] (C) of this paragraph each certificateholder covered 45 under the policy issued to that group policyholder shall have the right 46 to directly purchase the rider required by this paragraph from the 47 insurer which issued the group policy at the prevailing small group 48 community rate for such rider whether or not the employee is part of a 49 small group. 50 [(ii)] (2) Where a group policyholder makes an election not to 51 purchase coverage for contraceptive drugs or devices in accordance with 52 subparagraph [(A)] (C) of this paragraph, the insurer that provides such 53 coverage shall provide written notice to certificateholders upon enroll- 54 ment with the insurer of their right to directly purchase a rider for 55 coverage for the cost of contraceptive drugs or devices. The noticeS. 9120 3 1 shall also advise the certificateholders of the additional premium for 2 such coverage. 3 [(C)] (E) Nothing in this paragraph shall be construed as authorizing 4 a group or blanket policy which provides coverage for prescription drugs 5 to exclude coverage for prescription drugs prescribed for reasons other 6 than contraceptive purposes. 7 [(D) Such coverage may be subject to reasonable annual deductibles and8coinsurance as may be deemed appropriate by the superintendent and as9are consistent with those established for other drugs or devices covered10under the policy.] 11 § 2. Subsection (cc) of section 4303 of the insurance law, as added by 12 chapter 554 of the laws of 2002, is amended to read as follows: 13 (cc) (1) Every contract which provides coverage for prescription drugs 14 shall [include coverage for the cost of contraceptive drugs or devices15approved by the federal food and drug administration or generic equiv-16alents approved as substitutes by such food and drug administration17under the prescription of a health care provider legally authorized to18prescribe under title eight of the education law. The coverage required19by this section shall be included in contracts and certificates only20through the addition of a rider.21(1)] provide coverage for all of the following services and contracep- 22 tive methods: 23 (A) All FDA-approved contraceptive drugs, devices, and other products 24 provided for in comprehensive guidelines supported by the Health 25 Resources and Services Administration (HRSA), as prescribed by a physi- 26 cian or other licensed health care provider legally authorized to 27 prescribe under title eight of the education law. The following applies 28 to this coverage: 29 (i) where the FDA has approved one or more forms of contraception 30 within a method of contraception identified by the FDA, a contract is 31 not required to include all such forms in its formulary, so long as at 32 least one is included and covered without cost-sharing; 33 (ii) if the treating physician or other licensed health care provider 34 legally authorized to prescribe under title eight of the education law 35 recommends a particular service or FDA-approved item based on a determi- 36 nation of medical necessity with respect to that individual, a contract 37 must cover that service or item without cost-sharing; 38 (iii) this coverage must allow for the dispensing of an initial three- 39 month supply. For subsequent dispensing of the same contraceptive 40 prescribed by the physician or other licensed health care provider 41 legally authorized to prescribe under title eight of the education law 42 and covered under the same policy or renewal thereof, an insurer shall 43 allow coverage for the dispensing of the entire prescribed supply, up to 44 twelve months, at the same time; 45 (B) Patient education and counseling on contraception without cost- 46 sharing; and 47 (C) Follow-up services related to the drugs, devices, products, and 48 procedures covered under this subsection, including, but not limited to, 49 management of side effects, counseling for continued adherence, and 50 device insertion and removal without cost-sharing. 51 (2) Nothing in this paragraph shall be construed to prevent reasonable 52 medical management or utilization review of drugs, devices, products or 53 services provided herein. 54 (3) Notwithstanding any other provision of this subsection, a reli- 55 gious employer may request a contract without coverage for federal food 56 and drug administration approved contraceptive methods that are contraryS. 9120 4 1 to the religious employer's religious tenets. If so requested, such 2 contract shall be provided without coverage for contraceptive methods. 3 This paragraph shall not be construed to deny an enrollee coverage of, 4 and timely access to, contraceptive methods. 5 (A) For purposes of this subsection, a "religious employer" is an 6 entity for which each of the following is true: 7 (i) The inculcation of religious values is the purpose of the entity. 8 (ii) The entity primarily employs persons who share the religious 9 tenets of the entity. 10 (iii) The entity serves primarily persons who share the religious 11 tenets of the entity. 12 (iv) The entity is a nonprofit organization as described in Section 13 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended. 14 (B) Every religious employer that invokes the exemption provided under 15 this paragraph shall provide written notice to prospective enrollees 16 prior to enrollment with the plan, listing the contraceptive health care 17 services the employer refuses to cover for religious reasons. 18 [(2)](4) (A) Where a group contractholder makes an election not to 19 purchase coverage for contraceptive drugs or devices in accordance with 20 paragraph [one] three of this subsection, each enrollee covered under 21 the contract issued to that group contractholder shall have the right to 22 directly purchase the rider required by this subsection from the insurer 23 or health maintenance organization which issued the group contract at 24 the prevailing small group community rate for such rider whether or not 25 the employee is part of a small group. 26 (B) Where a group contractholder makes an election not to purchase 27 coverage for contraceptive drugs or devices in accordance with paragraph 28 [one] three of this subsection, the insurer or health maintenance organ- 29 ization that provides such coverage shall provide written notice to 30 enrollees upon enrollment with the insurer or health maintenance organ- 31 ization of their right to directly purchase a rider for coverage for the 32 cost of contraceptive drugs or devices. The notice shall also advise the 33 enrollees of the additional premium for such coverage. 34 [(3)](5) Nothing in this subsection shall be construed as authorizing 35 a contract which provides coverage for prescription drugs to exclude 36 coverage for prescription drugs prescribed for reasons other than 37 contraceptive purposes. 38 [(4) Such coverage may be subject to reasonable annual deductibles and39coinsurance as may be deemed appropriate by the superintendent and as40are consistent with those established for other drugs or devices covered41under the policy.] 42 § 3. Clauses (iii) and (iv) of subparagraph (E) of paragraph 17 of 43 subsection (i) of section 3216 of the insurance law, as amended by chap- 44 ter 219 of the laws of 2011, are amended and a new clause (v) is added 45 to read as follows: 46 (iii) with respect to children, including infants and adolescents, 47 evidence-informed preventive care and screenings provided for in compre- 48 hensive guidelines supported by the health resources and services admin- 49 istration; [and] 50 (iv) with respect to women, such additional preventive care and 51 screenings not described in item (i) of this subparagraph and as 52 provided for in comprehensive guidelines supported by the health 53 resources and services administration[.]; and 54 (v) all FDA-approved contraceptive drugs, devices, and other products 55 provided for in comprehensive guidelines supported by the Health 56 Resources and Services Administration (HRSA), as prescribed by a physi-S. 9120 5 1 cian or other licensed health care provider legally authorized to 2 prescribe under title eight of the education law; patient education and 3 counseling on contraception; and follow-up services related to the 4 drugs, devices, products, and procedures covered under this clause, 5 including, but not limited to, management of side effects, counseling 6 for continued adherence, and device insertion and removal. However, 7 where the FDA has approved one or more forms of contraception within a 8 method of contraception identified by the FDA, versions of a contracep- 9 tive drug, device, or product, a contract is not required to include all 10 such methods in its formulary, so long as at least one is included and 11 covered without cost-sharing. Provided, however, if the treating physi- 12 cian or other licensed health care provider legally authorized to 13 prescribe under title eight of the education law recommends a particular 14 service or FDA-approved item based on the determination of medical 15 necessity with respect to that individual, a contract must cover that 16 service or item without cost-sharing. This coverage must allow for the 17 dispensing of an initial three-month supply. For subsequent dispensing 18 of the same contraceptive prescribed by the physician or other licensed 19 health care provider legally authorized to prescribe under title eight 20 of the education law and covered under the same policy or renewal there- 21 of, an insurer shall allow coverage for the dispensing of the entire 22 prescribed supply, up to twelve months, at the same time. Nothing in 23 this subparagraph shall be construed to prevent reasonable medical 24 management or utilization review of drugs, devices, products or services 25 provided herein. 26 § 4. This act shall take effect January 1, 2019, and shall apply to 27 contracts and policies issued, renewed, modified or amended on or after 28 such date.
