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A02317 Summary:

BILL NOA02317B
 
SAME ASSAME AS S05022-B
 
SPONSORPeoples-Stokes
 
COSPNSRHarris, Skoufis, Barrett, Niou, Ortiz, Sepulveda, Galef, Abinanti, Lavine, Colton, Jean-Pierre, Taylor, Byrne
 
MLTSPNSREnglebright, Hevesi, Ra
 
Add 4909, Ins L; add 4909, Pub Health L
 
Relates to prescription drug formulary changes during a contract year.
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A02317 Actions:

BILL NOA02317B
 
01/17/2017referred to insurance
05/16/2017reported
05/18/2017advanced to third reading cal.390
06/14/2017amended on third reading (t) 2317a
06/20/2017passed assembly
06/20/2017delivered to senate
06/20/2017REFERRED TO RULES
01/03/2018DIED IN SENATE
01/03/2018RETURNED TO ASSEMBLY
01/03/2018ordered to third reading cal.171
01/23/2018amended on third reading 2317b
02/06/2018passed assembly
02/06/2018delivered to senate
02/06/2018REFERRED TO INSURANCE
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A02317 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         2317--B
                                                                Cal. No. 171
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 17, 2017
                                       ___________
 
        Introduced  by  M. of A. PEOPLES-STOKES, HARRIS, SKOUFIS, BARRETT, NIOU,
          ORTIZ, SEPULVEDA, GALEF, ABINANTI, LAVINE -- Multi-Sponsored by --  M.
          of  A.  ENGLEBRIGHT, HEVESI -- read once and referred to the Committee
          on Insurance -- reported from committee, advanced to a third  reading,
          amended  and  ordered  reprinted,  retaining its place on the order of
          third reading -- ordered to  a  third  reading,  amended  and  ordered
          reprinted, retaining its place on the order of third reading
 
        AN ACT to amend the insurance law and the public health law, in relation
          to prescription drug formulary changes during a contract year
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. The insurance law is amended by adding a new  section  4909
     2  to read as follows:
     3    §  4909.  Prescription drug formulary changes. (a) Except as otherwise
     4  provided in subsection (c) of this section, a  health  care  plan  shall
     5  not:
     6    (i) remove a prescription drug from a formulary;
     7    (ii)  move  a  prescription  drug  to a tier with a larger deductible,
     8  copayment, or coinsurance if the formulary includes two or more tiers of
     9  benefits providing for different deductibles, copayments or  coinsurance
    10  applicable to the prescription drugs in each tier; or
    11    (iii)  add  utilization management restrictions to a prescription drug
    12  on a formulary, unless such changes occur at the time of  enrollment  or
    13  issuance of coverage.
    14    (b)  Prohibitions  provided  in  subsection  (a) of this section shall
    15  apply beginning on the date on which open enrollment begins for  a  plan
    16  year  and through the end of the plan year to which such open enrollment
    17  period applies.
    18    (c) (i) A health care plan with a formulary that includes two or  more
    19  tiers  of  benefits  providing  for different deductibles, copayments or
    20  coinsurance applicable to prescription drugs in each  tier  may  move  a
    21  prescription drug to a tier with a larger deductible, copayment or coin-
    22  surance  if an AB-rated generic equivalent for such prescription drug is
    23  added to the formulary at the same time.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05529-08-8

        A. 2317--B                          2
 
     1    (ii) A health care plan may remove a prescription drug from  a  formu-
     2  lary  if  the  federal Food and Drug Administration determines that such
     3  prescription drug should be  removed  from  the  market,  including  new
     4  utilization  management restrictions issued pursuant to federal Food and
     5  Drug Administration safety concerns.
     6    (d)  A  health  care plan shall provide notice to policyholders of the
     7  intent to remove a prescription drug from a formulary or  alter  deduct-
     8  ible,  copayment  or coinsurance requirements in the upcoming plan year,
     9  thirty days prior to the open enrollment period for the consecutive plan
    10  year. Such notice of impending formulary and  deductible,  copayment  or
    11  coinsurance  changes shall also be posted on the plan's online formulary
    12  and in any prescription drug finder system that the plan provides to the
    13  public.
    14    § 2. The public health law is amended by adding a new section 4909  to
    15  read as follows:
    16    §  4909.  Prescription  drug formulary changes. 1. Except as otherwise
    17  provided in subdivision three of this section, a health care plan  shall
    18  not:
    19    (a) remove a prescription drug from a formulary;
    20    (b)  move  a  prescription  drug  to  a tier with a larger deductible,
    21  copayment, or coinsurance if the formulary includes two or more tiers of
    22  benefits providing for different deductibles, copayments or  coinsurance
    23  applicable to the prescription drugs in each tier; or
    24    (c)  add utilization management restrictions to a prescription drug on
    25  a formulary, unless such changes occur at  the  time  of  enrollment  or
    26  issuance of coverage.
    27    2.  Prohibitions  provided  in  subdivision  one of this section shall
    28  apply beginning on the date on which open enrollment begins for  a  plan
    29  year  and through the end of the plan year to which such open enrollment
    30  period applies.
    31    3. (a) A health care plan with a formulary that includes two  or  more
    32  tiers  of  benefits  providing  for different deductibles, copayments or
    33  coinsurance applicable to prescription drugs in each  tier  may  move  a
    34  prescription drug to a tier with a larger deductible, copayment or coin-
    35  surance  if an AB-rated generic equivalent for such prescription drug is
    36  added to the formulary at the same time.
    37    (b) A health care plan may remove a prescription drug from a formulary
    38  if the  federal  Food  and  Drug  Administration  determines  that  such
    39  prescription  drug  should  be  removed  from  the market, including new
    40  utilization management restrictions issued pursuant to federal Food  and
    41  Drug Administration safety concerns.
    42    4.  A  health  care  plan shall provide notice to policyholders of the
    43  intent to remove a prescription drug from a formulary or  alter  deduct-
    44  ible,  copayment  or coinsurance requirements in the upcoming plan year,
    45  thirty days prior to the open enrollment period for the consecutive plan
    46  year. Such notice of impending formulary and  deductible,  copayment  or
    47  coinsurance  changes shall also be posted on the plan's online formulary
    48  and in any prescription drug finder system that the plan provides to the
    49  public.
    50    § 3. This act shall take effect on the sixtieth  day  after  it  shall
    51  have  become  a  law; provided, however, that effective immediately, the
    52  addition, amendment and/or repeal of any rule  or  regulation  necessary
    53  for  the implementation of this act on its effective date are authorized
    54  to be made and completed by the superintendent of financial services  on
    55  or before such date.
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