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A02317 Summary:

BILL NOA02317C
 
SAME ASSAME AS S05022-C
 
SPONSORPeoples-Stokes
 
COSPNSRSkoufis, Barrett, Niou, Ortiz, Sepulveda, Galef, Abinanti, Lavine, Colton, Jean-Pierre, Taylor, Byrne, Weprin, Seawright, Barron, Mosley, Lupardo
 
MLTSPNSREnglebright, Hevesi, Ra, Thiele
 
Add §4909, Ins L; add §4909, Pub Health L
 
Prohibits a health care plan from making prescription drug formulary changes during a contract year.
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A02317 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A2317C
 
SPONSOR: Peoples-Stokes
  TITLE OF BILL: An act to amend the insurance law and the public health law, in relation to prescription drug formulary changes during a contract year   PURPOSE OR GENERAL IDEA OF BILL: To clarify that health insurance consumers covered by plans that are required to offer essential health benefits under the affordable care act are protected from adverse effects of mid-year formulary changes, and properly notified of formulary changes.   SUMMARY OF PROVISIONS: Section 1 adds a new section 4909 to the Insurance Law to state that a health care plan which provides essential health benefits under the federal affordable care act may not remove a prescription drug from a formulary during the enrollment year. If the plan's drug formulary has two or more tiers of drug benefits with different deductibles, copay- ments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the enrollment year. The plan may also not add new or additional formulary restrictions during the enrollment year. A health care plan may move a prescription drug to a tier with a larger copayment, coinsurance and different deductible if an AB-rated generic equivalent drug or interchangeable biological product is added to the formulary at the same time. In addition, provide notice to policyholders of the intent to remove a prescription drugs from a formulary or alter deductible, copayment or coinsurance requirements in the upcoming plan year, thirty days prior to the open enrollment period for the consec- utive plan year. Section 2 adds a new section 4909 to the public health law to also state that a health care plan which provides essential health benefits under the federal affordable care act may not remove a prescription drug from a formulary during the enrollment year. If the plan's drug formulary has two or more tiers of drug benefits with different deductibles, copay- ments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the enrollment year. The plan may also not add new or additional formulary restrictions during the enrollment year. A health care plan may move a prescription drug to a tier with a larger copayment, coinsurance and different deductible if an AB-rated generic equivalent drug or interchangeable biological product is added to the formulary at the same time. In addition, provide notice to policyholders of the intent to remove a prescription drugs from a formulary or alter deductible, copayment or coinsurance requirements in the upcoming plan year, thirty days prior to the open enrollment period for the consec- utive plan year. Section 3 provides that this act would take effect on the 60th day after enactment, provided that effective immediately the superintendent of insurance may make regulations and take other actions necessary to implement the act.   DIFFERENCE BETWEEN ORIGINAL AND AMENDED VERSION (IF APPLICABLE): The amended version adds "interchangeable biological product" to the new provisions of the insurance law and public health law.   JUSTIFICATION: This bill ensures that enrollees who select a health exchange plan based on their individual prescription drug needs have assurance that the health plan will maintain continuity in coverage for those prescription drugs during the course of the enrollment year, and be provided adequate notice of the intent to remove a prescription on the upcoming plan year. Enrollees choose health exchange plans based on the formulary status of a necessary therapy. A change in prescription drug availability could result in serious medical problems for the enrollee. Also, these unex- pected formulary changes can be extremely financially burdensome and have negative health outcomes.   PRIOR LEGISLATIVE HISTORY: A.7707A of 2015/2016   FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: None.   EFFECTIVE DATE: This act shall take effect on the sixtieth day after it shall have become a law; provided, however, that effective immediately, the addi- tion, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorized to be made and completed by the superintendent of financial services on or before such date.
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