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.
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.
