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A05371 Summary:

COSPNSRJaffee, Ortiz, Rivera, Gunther, Peoples-Stokes, Galef, O'Donnell
MLTSPNSRLupardo, Markey
Amd SS3216, 3221 & 4303, Ins L
Requires prescription coverage for the treatment of shingles.
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A05371 Memo:

submitted in accordance with Assembly Rule III, Sec 1(f)
SPONSOR: Lifton (MS)
  TITLE OF BILL: An act to amend the insurance law, in relation to prescription coverage for shingles   PURPOSE OR GENERAL IDEA OF BILL: This bill would ensure that the prescription drug for the treatment of shingles be covered by every insurance policy, including hospitals and health services that provide coverage for prescription drugs.   SUMMARY OF SPECIFIC PROVISIONS: § 1 would amend subsection (i) of section 3216 of the insurance law; § 2 would amend subsection (1) of section 3221 of the insurance law; § 3 would amend section 4303 of the insurance law: these amendments shall provide prescription coverage for Zostavax under every policy and contract issued by a hospital or health services corporation, which provides coverage for prescription drugs.   JUSTIFICATION: Shingles (herpes zoster), is a viral infection of the nerve root, which causes severe pain and a blistering-rash that spreads on one side of the body, most often found in older adults due to weakened immunity that comes with advancing age. Shingles is caused by the varicella-zoster virus - the same virus that causes chickenpox - that remains in a dormant state after someone has had chickenpox, but which can reacti- vate, multiply and damage sensory nerve cells. This very painful disease can lead to serious and long-lasting complications, such as postherpetic neuralgia (PHN), that can last anywhere from 30 days to months or even years. The pain is usually severe enough for a doctor to prescribe painkillers and can degrade the quality of life. There are approximately 50 million Americans over age 60 - 95% of whom had chickenpox as chil- dren - making them vulnerable to shingles. It is estimated that 1 million people develop shingles in the United States each year. Zostavax, the first vaccine to protect adults against shingles, has been shown to reduce the incidence of shingles by fifty-one per cent and the severity and complications of shingles were dramatically reduced in those who got the disease. It has also been shown to reduce the inci- dence of postherpetic neuralgia (PHN) by two-thirds. The safety and efficacy of Zostavax for older adults has been proven, according to a study published in THE NEW ENGLAND JOURNAL OF MEDICINE, June 2005. Zostavax was approved by the Federal Food and Drug Administration in May 2006, and in October 2006, the Center of Disease Control's (CDC) Advi- sory Committee on Immunization Practices (ACIP) voted to recommend that Zostavax be given to all adults age 60 and over, including those who have had a previous episode of shingles. The Secretary of the United States Department of Veterans' Affairs, R. James Nicholson, recently announced the immediate availability of the vaccine to veterans at Veterans' Affairs medical facilities who are recommended for the treat- ment. As people live longer and the proportion of older people in our popu- lation increases, it is highly likely that the prevalence of shingles will increase. It is estimated that fifty-percent of those who live to age 85 will get the disease. Lack of insurance coverage could impede lower-income people from getting the vaccine. This bill will provide much-needed coverage for prescription drugs for the treatment of shin- gles, under the prescription of a health care provider or by a hospital or a health services corporation which provides coverage for prescription drugs.   PRIOR LEGISLATIVE HISTORY: 2007-2008: A9469; referred to insurance 2009-2010: A4082; referred to insurance 2011-2012: A3901; referred to insurance 2013-2014: A887; referred to insurance   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: This act shall take effect on the sixtieth day after it shall have become a law.
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