A00420 Summary:

BILL NO    A00420A

SAME AS    SAME AS S01494-A

SPONSOR    Paulin (MS)

COSPNSR    Gottfried, Englebright, Galef, Glick, Rosenthal, Skoufis, Lavine,
           Titone, Fahy

MLTSPNSR   Aubry, Brennan, Cahill, Clark, Cook, Crouch, Cymbrowitz, Dinowitz,
           Farrell, Gunther, Heastie, Hevesi, Hooper, Jacobs, Jaffee, Kellner,
           Lifton, Lupardo, Millman, Morelle, Perry, Pretlow, Thiele,
           Weisenberg, Wright

Amd SS6527, 6807, 6909 & 6951, add S6831, Ed L; amd SS3216, 3221 & 4304, Ins L;
amd S207, Pub Health L

Provides for the dispensing of emergency contraception under certain
circumstances and conditions.
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A00420 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A420A
 
SPONSOR: Paulin (MS)
  TITLE OF BILL: An act to amend the education law, the insurance law and the public health law, in relation to providing for dispensing emer- gency contraception under certain conditions   PURPOSE OR GENERAL IDEA OF BILL: This legislation will help to reduce the number of unintended pregnan- cies by increasing access to emergency contraception for women in New York State.   SUMMARY OF SPECIFIC PROVISIONS: Section one provides that this act shall be cited as the "unintended pregnancy prevention act." Section two describes legislative findings. Section three amends subdivision six of section 6527 of the education law and provides that a licensed physician may prescribe and order a non-patient specific regimen to a registered professional nurse for emergency contraception, to be administered to or dispense to be self- administered by the patient. Section three also provides that a licensed physician may prescribe and order a non-patient specific regimen to a licensed pharmacist, for dispensing emergency contraception, to be self- administered by the patient. Section four amends subdivision three of section 6807 of the education law by adding licensed midwife to the list of practitioners who may prescribe or order a non-patient specific regimen which allows a pharma- cist to dispense drugs and devices to a registered professional nurse who may possess and administer such drugs and devices. Current law only allows a licensed physician or certified nurse practitioner to prescribe and order a non-patient specific regimen. A new subdivision four is also added to section 6807 of the education law and provides that a licensed pharmacist may dispense a non-patient specific regimen of emergency contraception, to be self-administered by the patient, which was prescribed or ordered by a licensed physician, certified nurse practi- tioner, or licensed midwife. Section five amends the education law by adding a new section 6829: emergency contraception; non-patient specific prescription or order. Subdivision one defines the terms "emergency contraception" and "pres- criber." Subdivision two provides that section 6629 of the education law applies to the administering or dispensing of emergency contraception by a registered professional nurse or licensed pharmacist pursuant to a prescription or non-patient specific regimen made by prescribers as outlined in three sections of the education law. Subdivision three provides that the administering or dispensing of emergency contraception by a registered professional nurse or licensed pharmacist shall be done in accordance with professional standards of practice and in accordance with written procedures and protocols. Subdivision four outlines the contents of written material that must be provided to the patient. Such written material shall be developed or approved by the commissioner in consultation with the Department of Health (DOH) and the American College of Obstetricians and Gynecologists (ACOO). Section six amends paragraphs (a) and (b) of subdivision four of section 6909 of the education law. Paragraph (a) provides that emergency contra- ception is added to the list for which a certified nurse practitioner may already prescribe and order a non-patient specific regimen to a registered professional nurse. Paragraph (b) provides that, in addition to a registered professional nurse, a certified nurse practitioner may also prescribe or order a non-patient specific regimen to a licensed pharmacist, for dispensing emergency contraception. Section seven amends subdivision five of section 6909 of the education law by adding a licensed midwife to those practitioners who may already prescribe and order a non-patient specific regimen to a registered professional nurse. Section eight amends section 6951 of the education law by adding a new subdivision four which provides that a licensed midwife may prescribe and order a non-patient specific regimen to: a registered professional nurse for emergency contraception to be administered to or dispensed to be self-administered by the patient and; a licensed pharmacist for dispensing emergency contraception, to be self-administered by the patient. Sections nine, ten, and eleven amend three sections of the insurance law to mandate that under these articles any insurance policy that covers emergency contraception shall also cover emergency contraception when provided by a non-patient-specific prescription. Section twelve adds a new paragraph (g) to subdivision one of section 207 of the public health law to broaden the education and outreach program to include information on emergency contraception and its safe- ty, efficacy, appropriate use and availability. Section thirteen provides that this act shall take effect on the 180'h day after it shall have become law, provided that the commissioner of education is authorized to promulgate any and all rules and regulations and take any other measures necessary to implement this act.   JUSTIFICATION: EC is Safe: In February of 1997, the Food and Drug Administration (FDA) announced that certain combinations of estrogen and progestin were safe and effective for use as postcoital emergency contraception. Adminis- tered in pill form, EC is a higher dosage of standard birth control pills that serve to prevent pregnancy after unprotected intercourse, including when birth control fails or in cases of sexual assault. EC can reduce the risk of pregnancy from 75% to 89% if the first dose is taken within 72 hours of unprotected intercourse. BC is almost seven times more effective if taken within the first 24 hours of unprotected inter- course. EC will not cause an abortion; it is not the same as RU-486 (also known as Mifepristone or the medical abortion pill). In 1999, the FDA prescription use Plan B (which is Levonorgestrel, a form of progest- erone) is, currently, the only brand of emergency contraception packaged for that use. In 2007, Plan B was approved by the FDA for over the coun- ter sale if a person is seventeen years or older. However, young women in New York State currently face barriers to accessing EC, as current law requires that a traditionally licensed source, such as a physician, prescribe EC. This bill would allow New York State pharmacists and registered professional nurses to dispense EC from a non-patient specif- ic order, written by either a licensed physician, certified nurse prac- titioner or licensed midwife, bypassing the frequent difficulties encountered in obtaining medical appointments at offices with limited hours, long waits, or inconvenient locations. By accessing EC in this manner, young women will have the opportunity to ask questions and have them answered by a healthcare professional who will also provide a fact sheet and a verbal explanation about EC. Currently, a pharmacist may refuse to dispense any medication if he or she reasonably feels that it would endanger someone. This same discretion would apply to EC. EC Will Significantly Lower the Number of Abortions: In New York State, there were 120,349 induced abortions in 2002, of which 9,155 were performed on girls ages seventeen and under, according to the New York State Department of Health (NYSDOI-I). Medical experts, including the American College of Obstetricians and Gynecologists (ACOG), believe that increased access to EC will reduce the number of abortions in New York by at least one half. Increased access to EC will not only reduce the number of abortions young women have, but reduce the cost and health risks associated with pregnancy, childbirth and abortion. A commonsense, risk-benefit analysis indicates that increased access to EC will enable young women to pursue a better, healthier future by preventing an unin- tended pregnancy in a safe and timely fashion. EC Will Positively Impact the Lives of Young Women: Victims of sexual assault are most often younger women and adolescents. According to Tjaden and Thoennes, researchers from the National Institute of Justice, "Rape is primarily a crime against youth." A study conducted by National Violence Against Women reported 5495 of rape victims were between the ages of 12 and 17. Similarly, the National Women's Study found that 62% of sexual assault victims were under seventeen years of age. Every two years, Youth Risk Behavior Survey (YRBS) conducts a study of high school students in grades nine through twelve throughout the entire country. In 1997 and in 1999, a question was added to the Massachusetts survey regarding teen violence. One in five girls reported being sexually or physically abused by a dating partner and of those females, one in ten was sexually abused. The statistics support the fact that there is a tremendous need for prevention of unintended pregnancies in very young women. A misconception about EC is that by giving women, especially young women, access to EC the rate of sexually transmitted infections (STIs) will increase and it will lead to more risky sexual behavior. However, a study providing EC to 2,117 young women a ges 15 to 24, reported in the January 5, 2005 issue of the Journal of the American Medical Association (JAMA), concludes that giving young women access to BC does not negate the ability of women to act responsibly. The study confirmed that EC does not increase promiscuity or unprotected sex among women, nor does it cause women to abandon their regular birth control methods. Moreover, other methods of birth control such as condoms and spermicides may already be purchased over the counter in pharmacies, grocery stores, or convenience stores. EC Will Be Covered by Insurance: This legislation provides that if an insurance policy covers contraception when it is provided pursuant to a prescription, that same policy shall cover emergency contraception. Education and Outreach Programs are Effective: In 1998, Washington State began to conduct public relations and promotional activities to increase public awareness of emergency contraception and of the national emergen- cy contraception hotline (1-888-NOT-2-LATE). Calls from Washington State to the hotline increased tenfold, an average of 1,160 per month, after the campaign was launched, indicating that outreach programs are effec- tive. This legislation adds emergency contraception to the list of health related issues for which the Commissioner of Health shall conduct education and outreach programs. Making the public aware of the safety, efficacy, appropriate use, and availability of EC is important to the health and safety of women in New York. Conclusion: BC is designed to be just that: emergency contraception, to be used when other methods of contraception fail or in cases of rape, incest, or human error. Many pregnancies, births and abortions are far more dangerous to a woman's health, especially a young woman's health, than EC. By allowing women the chance to prevent an unintended pregnan- cy, the abortion rate will drop, healthcare costs will decrease and young women will not have to start their adult lives with the difficult decision of whether to have a baby (often as a single mother), have an abortion, or give a baby up for adoption. By allowing young women access to EC, they will have the opportunity to have a healthier and more promising future.   PRIOR LEGISLATIVE HISTORY: A.85, 2011 and 2012 advanced to assembly calendar 436. Same as S.892, referred to rules. A.627A, 2010 advanced to assembly rules calendar 125. Same as S.1410A. referred to higher education. A.627, 2009 advanced to assembly calendar 351. A.5569A, 2007 and 2008 passed assembly. Same as S.3579A, 2007 and 2008 referred to higher education. Similar bills introduced between 2002 and 2006 are listed here: A.9906, 2006 passed assembly. Same as S.6686, 2006 referred to higher education. A.116, 2005 passed assembly. Same as S.3661, 2005 passed senate. Vetoed, memo 47. A.888, 2003 and 2004 passed assembly. Same as S.3339, 2003 and 2004 referred to higher education. A.9653A, 2002 referred to health.   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: This act shall take effect 180 days after it becomes law provided the commissioner of education is authorized to promulgate any and all rules, regulations and measures necessary for implementation on or before such date.
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A00420 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         420--A
 
                               2013-2014 Regular Sessions
 
                   IN ASSEMBLY
 
                                       (Prefiled)
 
                                     January 9, 2013
                                       ___________
 
        Introduced  by  M.  of  A. PAULIN, GOTTFRIED, ENGLEBRIGHT, GALEF, GLICK,
          ROSENTHAL, BOYLAND, SKOUFIS, LAVINE, TITONE, FAHY  --  Multi-Sponsored
          by  -- M. of A.  AUBRY, BRENNAN, CAHILL, CLARK, COOK, CROUCH, CYMBROW-
          ITZ, DINOWITZ, FARRELL,  GUNTHER,  HEASTIE,  HEVESI,  HOOPER,  JACOBS,

          JAFFEE,  KELLNER,  LIFTON,  LUPARDO, MILLMAN, MORELLE, PERRY, PRETLOW,
          THIELE, WEISENBERG, WRIGHT -- read once and referred to the  Committee
          on Health -- recommitted to the Committee on Health in accordance with
          Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered
          reprinted as amended and recommitted to said committee
 
        AN  ACT  to  amend  the  education law, the insurance law and the public
          health law, in relation to providing for dispensing emergency  contra-
          ception under certain conditions
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Short title. This act shall be known and may  be  cited  as
     2  the "unintended pregnancy prevention act".
     3    §  2.  Legislative  findings. The United States Food and Drug Adminis-

     4  tration (FDA) has declared emergency contraceptive pills to be safe  and
     5  effective in preventing pregnancy when used within 72 hours after unpro-
     6  tected  intercourse. The American College of Obstetricians and Gynecolo-
     7  gists and the American College of Nurse-Midwives  state  that  emergency
     8  contraception  (EC)  is  so  safe, and using it quickly is so important,
     9  that it should be available over the counter,  without  a  prescription.
    10  They also emphasize the need for unimpeded access to EC for all women of
    11  reproductive  age.  However,  although  there  are no medical reasons to
    12  limit provision of EC, the FDA only approved non-prescription access for
    13  women 18 years and older. Additionally, the FDA imposed requirements for
    14  proving the patient's  identity  with  government-issued  identification
    15  documents.  The  need  remains,  however, to provide access to women who

    16  have difficulty obtaining the required identification documents  and  to
    17  women under the age of 17 years. Minors in New York State have long been
    18  legally entitled to full access, without parental consent, to all repro-
    19  ductive  health care and services, including EC. Providing direct access
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00945-03-4

        A. 420--A                           2
 
     1  to EC for younger women will also make it more  likely  that  they  will
     2  receive  appropriate  and  timely  professional  attention,  support and
     3  assistance.
     4    The legislature deems it necessary to create a structure for simplify-

     5  ing  access  to  EC for these women, while respecting and preserving the
     6  prescribing scopes of practice of physicians, nurse  practitioners,  and
     7  midwives,  the treating and case-finding scope of practice of registered
     8  professional nurses, and the dispensing scope  of  practice  of  pharma-
     9  cists.  This act does not alter the scopes of such professions, nor does
    10  this legislation interfere with non-prescription access to EC  where  it
    11  is otherwise lawful.
    12    The  legislature  also  finds  that  this  legislation is necessary to
    13  ensure that women do not lose insurance coverage for EC  solely  because
    14  it has become available without a prescription. Losing coverage would be
    15  a  major  obstacle to access, which would undermine the important health
    16  objectives of the FDA and the legislature.
    17    § 3. Subdivision 6 of section 6527 of the education law, as  added  by

    18  chapter  573  of the laws of 1999, paragraph (c) as added by chapter 221
    19  of the laws of 2002 and paragraph (d) as added by  chapter  429  of  the
    20  laws of 2005, is amended to read as follows:
    21    6. A licensed physician may prescribe and order a non-patient specific
    22  regimen  [to  a  registered professional nurse], pursuant to regulations
    23  promulgated by the commissioner, and consistent with the  public  health
    24  law, [for] to:
    25    (a) a registered professional nurse for:
    26    (i) administering immunizations[.];
    27    [(b)] (ii) the emergency treatment of anaphylaxis[.];
    28    [(c)] (iii) administering purified protein derivative (PPD) tests[.];

    29    [(d)]  (iv) administering tests to determine the presence of the human
    30  immunodeficiency virus[.];
    31    (v) emergency contraception, to be administered to or dispensed to  be
    32  self-administered  by  the  patient,  under  section sixty-eight hundred
    33  thirty-one of this title; or
    34    (b) a licensed pharmacist, for dispensing emergency contraception,  to
    35  be  self-administered  by the patient, under section sixty-eight hundred
    36  thirty-one of this title.
    37    § 4. Subdivision 3 of section 6807 of the education law, as  added  by
    38  chapter  573  of the laws of 1999, is amended and a new subdivision 4 is
    39  added to read as follows:
    40    3. A pharmacist may dispense drugs and devices to a registered profes-

    41  sional nurse, and a registered professional nurse may possess and admin-
    42  ister, drugs and devices, pursuant to  a  non-patient  specific  regimen
    43  prescribed  or  ordered  by  a  licensed physician, licensed midwife, or
    44  certified nurse practitioner, pursuant to regulations promulgated by the
    45  commissioner and the public health law.
    46    4. A licensed pharmacist may dispense a non-patient  specific  regimen
    47  of  emergency  contraception,  to  be  self-administered by the patient,
    48  prescribed or ordered by a licensed physician, certified  nurse  practi-
    49  tioner,  or  licensed midwife, under section sixty-eight hundred thirty-
    50  one of this article.
    51    § 5. The education law is amended by adding a new section 6831 to read
    52  as follows:

    53    § 6831. Emergency contraception; non-patient specific prescription  or
    54  order.  1.  As  used in this section, the following terms shall have the
    55  following meanings, unless the context requires otherwise:

        A. 420--A                           3
 
     1    (a) "Emergency contraception" means one or more prescription  or  non-
     2  prescription  drugs,  used separately or in combination, in a dosage and
     3  manner for preventing pregnancy when used after intercourse, found  safe
     4  and  effective  for that use by the United States food and drug adminis-
     5  tration, and dispensed or administered for that purpose.
     6    (b)  "Prescriber"  means a licensed physician, certified nurse practi-
     7  tioner or licensed midwife.

     8    2. This section applies to the administering or dispensing of emergen-
     9  cy contraception by a registered professional nurse or licensed  pharma-
    10  cist  pursuant  to  a  prescription  or order for a non-patient specific
    11  regimen made by a prescriber under section  sixty-five  hundred  twenty-
    12  seven,  sixty-nine  hundred nine or sixty-nine hundred fifty-one of this
    13  title. This section does not apply to administering or dispensing  emer-
    14  gency  contraception  when  lawfully done without such a prescription or
    15  order.
    16    3. The administering or dispensing of  emergency  contraception  by  a
    17  registered  professional  nurse  or licensed pharmacist shall be done in
    18  accordance with professional standards of  practice  and  in  accordance

    19  with  written  procedures  and  protocols  agreed  to  by the registered
    20  professional nurse or licensed pharmacist and the prescriber or a hospi-
    21  tal (licensed under article twenty-eight of the public health law)  that
    22  provides gynecological or family planning services.
    23    4.  (a) When emergency contraception is administered or dispensed, the
    24  registered professional nurse or licensed pharmacist  shall  provide  to
    25  the  patient  written material that includes: (i) the clinical consider-
    26  ations and recommendations for use of the  drug;  (ii)  the  appropriate
    27  method  for  using  the  drug;  (iii)  information  on the importance of
    28  follow-up health care; (iv) information on the health  risks  and  other

    29  dangers  of unprotected intercourse; and (v) referral information relat-
    30  ing to health care and services relating to sexual  abuse  and  domestic
    31  violence.
    32    (b)  Such  written  material  shall  be  developed  or approved by the
    33  commissioner in consultation with the department of health and the Amer-
    34  ican college of obstetricians and gynecologists.
    35    § 6. Subdivision 4 of section 6909 of the education law, as  added  by
    36  chapter  573 of the laws of 1999, paragraph (a) as amended and paragraph
    37  (c) as added by chapter 221 of the laws of 2002  and  paragraph  (d)  as
    38  added by chapter 429 of the laws of 2005, is amended to read as follows:
    39    4.  A  certified  nurse practitioner may prescribe and order a non-pa-
    40  tient specific regimen [to a registered professional nurse], pursuant to

    41  regulations promulgated by the commissioner, consistent with subdivision
    42  three of section [six thousand nine]  sixty-nine  hundred  two  of  this
    43  article, and consistent with the public health law, [for] to:
    44    (a) a registered professional nurse for:
    45    (i) administering immunizations[.];
    46    [(b)] (ii) the emergency treatment of anaphylaxis[.];
    47    [(c)] (iii) administering purified protein derivative (PPD) tests[.];
    48    [(d)]  (iv) administering tests to determine the presence of the human
    49  immunodeficiency virus[.];
    50    (v) emergency contraception, to be administered to or dispensed to  be

    51  self-administered  by  the  patient,  under  section sixty-eight hundred
    52  thirty-one of this title; or
    53    (b) a licensed pharmacist, for dispensing emergency contraception,  to
    54  be  self-administered  by the patient, under section sixty-eight hundred
    55  thirty-one of this title.

        A. 420--A                           4
 
     1    § 7. Subdivision 5 of section 6909 of the education law, as  added  by
     2  chapter 573 of the laws of 1999, is amended to read as follows:
     3    5.  A registered professional nurse may execute a non-patient specific
     4  regimen prescribed or ordered by a licensed physician, licensed midwife,
     5  or certified nurse practitioner, pursuant to regulations promulgated  by
     6  the commissioner.
     7    §  8.  Section  6951  of  the education law is amended by adding a new

     8  subdivision 4 to read as follows:
     9    4. A licensed midwife may prescribe and order a  non-patient  specific
    10  regimen  pursuant  to  regulations  of the commissioner, consistent with
    11  this section and the public health law, to:
    12    (a) a registered professional nurse for emergency contraception, to be
    13  administered to or dispensed to be  self-administered  by  the  patient,
    14  under section sixty-eight hundred thirty-one of this title; or
    15    (b)  a licensed pharmacist, for dispensing emergency contraception, to
    16  be self-administered by the patient, under section  sixty-eight  hundred
    17  thirty-one of this title.
    18    §  9.  Section  3216  of  the insurance law is amended by adding a new
    19  subsection (n) to read as follows:

    20    (n) Any policy under  this  article  that  covers  contraception  when
    21  provided  pursuant to a prescription shall cover emergency contraception
    22  as defined in paragraph (a) of subdivision one  of  section  sixty-eight
    23  hundred  thirty-one  of  the education law, when provided pursuant to an
    24  ordinary prescription or order under section sixty-eight  hundred  thir-
    25  ty-one  of  the  education  law  and  when  lawfully provided other than
    26  through a prescription or order.
    27    § 10. Section 3221 of the insurance law is amended  by  adding  a  new
    28  subsection (t) to read as follows:
    29    (t)  Any  policy  under  this  article  that covers contraception when
    30  provided pursuant to a prescription, shall cover emergency contraception

    31  as defined in paragraph (a) of subdivision one  of  section  sixty-eight
    32  hundred  thirty-one  of  the education law, when provided pursuant to an
    33  ordinary prescription or order under section sixty-eight  hundred  thir-
    34  ty-one  of  the  education  law  and  when  lawfully provided other than
    35  through a prescription or order.
    36    § 11. Section 4304 of the insurance law is amended  by  adding  a  new
    37  subsection (n) to read as follows:
    38    (n)  Any  policy  under  this  article  that covers contraception when
    39  provided pursuant to a prescription, shall cover emergency contraception
    40  as defined in paragraph (a) of subdivision one  of  section  sixty-eight
    41  hundred  thirty-one  of  the education law, when provided pursuant to an

    42  ordinary prescription or order under section sixty-eight  hundred  thir-
    43  ty-one  of  the  education  law  and  when  lawfully provided other than
    44  through a prescription or order.
    45    § 12. Subdivision 1 of section 207 of the public health law is amended
    46  by adding a new paragraph (j) to read as follows:
    47    (j) Emergency contraception, including information about  its  safety,
    48  efficacy, appropriate use and availability.
    49    §  13.  This  act  shall  take effect on the one hundred eightieth day
    50  after it shall have become a law; and sections nine, ten and  eleven  of
    51  this  act  shall  apply to policies and contracts issued, renewed, modi-
    52  fied, altered or amended on  or after such effective date.  The  commis-
    53  sioner  of  education  is authorized to promulgate any and all rules and

    54  regulations and take any other measures necessary to implement this  act
    55  on its effective date on or before such effective date.
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