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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 Actions:

BILL NOA02317C
 
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
04/17/2018recalled from senate
04/17/2018RETURNED TO ASSEMBLY
04/17/2018vote reconsidered - restored to third reading
04/17/2018amended on third reading 2317c
04/30/2018repassed assembly
04/30/2018returned to senate
04/30/2018RECOMMITTED TO INSURANCE
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A02317 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         2317--C
                                                                Cal. No. 171
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 17, 2017
                                       ___________
 
        Introduced  by  M.  of A. PEOPLES-STOKES, SKOUFIS, BARRETT, NIOU, ORTIZ,
          SEPULVEDA,  GALEF,  ABINANTI,  LAVINE,  COLTON,  JEAN-PIERRE,  TAYLOR,
          BYRNE,  WEPRIN  -- Multi-Sponsored by -- M. of A. ENGLEBRIGHT, HEVESI,
          RA -- 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 -- passed by Assembly and
          delivered to the Senate, recalled from the Senate, vote  reconsidered,
          bill  amended,  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
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05529-11-8

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

        A. 2317--C                          3
 
     1  coinsurance  changes shall also be posted on the plan's online formulary
     2  and in any prescription drug finder system that the plan provides to the
     3  public.
     4    §  3.  This  act  shall take effect on the sixtieth day after it shall
     5  have become a law; provided, however, that  effective  immediately,  the
     6  addition,  amendment  and/or  repeal of any rule or regulation necessary
     7  for the implementation of this act on its effective date are  authorized
     8  to  be made and completed by the superintendent of financial services on
     9  or before such date.
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