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A05502 Summary:

BILL NO    A05502B

SAME AS    SAME AS S03510-B

SPONSOR    Heastie (MS)

COSPNSR    Gottfried, Colton, Rosenthal, Miller M, Cymbrowitz, Moya, O'Donnell,
           Thiele, Galef, Castro, DenDekker, Benedetto, Gunther, Schroeder,
           Maisel, Spano, Schimel, Lopez V, Weisenberg, Lavine, Weprin,
           Englebright, Sweeney, Paulin, Dinowitz, Meng, Rodriguez, Hoyt,
           Gabryszak, Titone, Jaffee, Linares, Simotas, Clark, Boyland, Gibson,
           Millman

MLTSPNSR   Abbate, Abinanti, Boyle, Burling, Calhoun, Castelli, Ceretto, Conte,
           Corwin, Crespo, Crouch, Curran, Duprey, Giglio, Graf, Hayes, Jacobs,
           Katz, Latimer, Lifton, Lopez P, Losquadro, Malliotakis, Miller J,
           Montesano, Murray, Palmesano, Peoples-Stokes, Perry, Ra, Raia, Rivera
           P, Roberts, Saladino, Sayward, Smardz, Tobacco

Amd SS3216, 3221 & 4303, Ins L

Prohibits health insurers from requiring the insured purchase prescribed drugs
from a mail order pharmacy or pay a co-payment fee when such purchases are not
made from a mail order pharmacy if a similar fee is not charged for drugs from
a mail order pharmacy.
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A05502 Actions:

BILL NO    A05502B

02/22/2011 referred to insurance
04/25/2011 amend and recommit to insurance
04/25/2011 print number 5502a
05/17/2011 amend and recommit to insurance
05/17/2011 print number 5502b
05/24/2011 reported 
05/26/2011 advanced to third reading cal.462
06/15/2011 passed assembly
06/15/2011 delivered to senate
06/15/2011 REFERRED TO RULES
06/20/2011 SUBSTITUTED FOR S3510B
06/20/2011 3RD READING CAL.1383
06/20/2011 PASSED SENATE
06/20/2011 RETURNED TO ASSEMBLY
11/30/2011 delivered to governor
12/12/2011 signed chap.597
12/12/2011 approval memo.14
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A05502 Votes:

A05502B06/15/2011 143/2
AbbateYCastellYGalefYKatzYMcKevitYRabbittYStevensY
AbinantYCastroYGanttYKavanagYMcLaughNORaiaYSweeneyY
AmedoreYCerettoYGibsonYKellnerYMengYRamosYTediscoY
ArroyoYClarkYGiglioYKirwanERMill D NOReilichYTenneyY
AubryYColtonYGlickYKolbYMill JMYReillyYThieleY
BarclayYConteYGoodellYLancmanYMill MGYRive J YTitoneY
BarronYCookYGottfriYLatimerYMillmanYRive N YTitusY
BenedetYCorwinYGrafYLavineYMolinarYRive PMYTobaccoY
BingYCrespoYGuntherYLentolYMontesaYRobertsYWeinsteY
BlankenYCrouchYHannaYLiftonYMorelleYRobinsoYWeisenbY
BoylandYCurranYHawleyYLinaresYMoyaYRodriguYWeprinY
BoyleYCusickYHayesYLope PDYMurrayYRosenthYWrightY
BraunstYCymbrowYHeastieYLope VJYNolanYRussellYZebrowsY
BrennanYDenDekkYHevesiYLosquadYOaksYSaladinYMr SpkrY
BronsonYDinowitYHikindYLupardoYO'DonneYSaywardY
Brook KYDupreyYHooperYMageeYOrtizYScarborY
BurlingYEnglebrYHoytYMagnareYPalmesaYSchimelY
ButlerYFarrellYJacobsYMaiselYPaulinYSchimmiY
CahillYFinchYJaffeeYMalliotYPeoplesYSchroedY
CalhounYFitzpatYJeffrieYMarkeyYPerryYSimotasY
CamaraYFriendYJohnsYMcDonouYPretlowYSmardzY
CanestrYGabryszYJordanYMcEnenyYRaYSpanoY

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A05502 Memo:

BILL NUMBER:A5502B

TITLE OF BILL:  An act to amend the insurance law, in relation to the
purchase of prescription drugs

PURPOSE OR GENERAL IDEA OF BILL: Prohibits health insurance policies
from mandating their insured to purchase prescribed drugs from a mail
order pharmacy.

SUMMARY OF SPECIFIC PROVISIONS:

* S1.- Subsection (i) of Section 3216 of the insurance law is amended
by adding a new paragraph (28) to require any policy which provides
coverage for prescription drugs shall allow participants to fill any
mail order covered prescription, at his or her option, at any mail
order pharmacy or network participating non-mail order retail pharmacy
if the network participating non-mail order retail pharmacy offers to
accept a price that is comparable to that of the mail order pharmacy.
This section goes on to bar the imposition of a co-payment if the
insured would not have been charged one at the mail order pharmacy.
Also this section states that these changes shall not supersede the
terms of a collective bargaining agreement entered into between an
employer and a certified employee organization.  Additionally, this
shall not alter any provisions in sections thirteen and thirteen-a of
the workers' compensation law regarding the purchase of prescription
drugs and the use of mail order pharmacy.

* SS2-3.- A new paragraph (18) is also added to subsection (1) of
Section 3221 of such law and a new Subsection (hh) is likewise added
to section 4303 to impose such a prohibition on all policies of health
insurance in the state including those issued by health services or
medical expense indemnity corporations issuing group contracts.

* S4.- This section adds a severance clause to the legislation.

JUSTIFICATION: This legislation will provide freedom of choice to
consumers who have coverage for prescribed drugs as part of their
health insurance. When a policy mandates purchase from a specific mail
order pharmacy the consumer is forced to purchase an interim supply of
the prescribed drug from his or her neighborhood pharmacist who is
familiar with his or her medical history. The risk to the consumer in
this situation is obvious.

Furthermore, the neighborhood pharmacy in these situations is forced
to bear the burden of educating the patient as to the use and
potential effects of the prescribed drug. The inability of the
consumer to purchase the full prescription from the neighborhood
pharmacy imposes this burden inequitably, thereby providing the mail
order house with an economic advantage that the local provider cannot
over come.

Finally, many consumers, especially senior citizens, rely on their
local pharmacist for the service that they provide with respect to
monitoring the regimen of drugs that they take. A mandate of purchase
by mail denies them of this important service and confidence.

PRIOR LEGISLATIVE HISTORY:


2010 - A.1267A
2008 - A.2808/Insurance; S.8775/Rules
2007 - A.2808/Insurance; S.8775/Rules
2006 - A.6934/Insurance
2005 - A.6934/Insurance

FISCAL IMPLICATIONS: None

EFFECTIVE DATE: This act shall take effect on the thirtieth day after
it shall have become law and shall apply to all policies and contracts
issued, renewed, modified, altered or amended on or after such
effective date.
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A05502 Text:

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                        5502--B

                              2011-2012 Regular Sessions

                                 I N  A S S E M B L Y

                                   February 22, 2011
                                      ___________

       Introduced by M. of A. HEASTIE, GOTTFRIED, COLTON, ROSENTHAL, M. MILLER,
         CYMBROWITZ,  MOYA,  O'DONNELL, THIELE, GALEF, CASTRO, DenDEKKER, BENE-
         DETTO, GUNTHER, SCHROEDER, MAISEL, SPANO, SCHIMEL,  V. LOPEZ,  WEISEN-
         BERG,  LAVINE,  WEPRIN,  ENGLEBRIGHT, SWEENEY, PAULIN, DINOWITZ, MENG,
         RODRIGUEZ, HOYT, GABRYSZAK, TITONE -- Multi-Sponsored by -- M.  of  A.
         ABBATE,  ABINANTI,  BOYLE, BURLING, CASTELLI, CERETTO, CORWIN, CRESPO,
         CROUCH, DUPREY, GIGLIO, GRAF, HAYES, JACOBS, KATZ, LATIMER,  P. LOPEZ,
         LOSQUADRO,   MALLIOTAKIS,  J. MILLER,  MONTESANO,  MURRAY,  PALMESANO,
         PEOPLES-STOKES,  RA,  RAIA,  P. RIVERA,  ROBERTS,  SALADINO,  SAYWARD,
         SMARDZ  --  read  once  and  referred to the Committee on Insurance --
         committee discharged, bill amended, ordered reprinted as  amended  and
         recommitted  to  said  committee -- again reported from said committee
         with amendments, ordered reprinted as amended and recommitted to  said
         committee

       AN  ACT  to  amend  the  insurance  law,  in relation to the purchase of
         prescription drugs

         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:

    1    Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
    2  amended by adding a new paragraph 28 to read as follows:
    3    (28) ANY POLICY WHICH PROVIDES COVERAGE FOR PRESCRIPTION  DRUGS  SHALL
    4  PERMIT  EACH PARTICIPANT TO FILL ANY MAIL ORDER COVERED PRESCRIPTION, AT
    5  HIS OR HER OPTION, AT ANY MAIL ORDER PHARMACY OR  NETWORK  PARTICIPATING
    6  NON-MAIL  ORDER  RETAIL  PHARMACY  IF THE NETWORK PARTICIPATING NON-MAIL
    7  ORDER RETAIL PHARMACY OFFERS TO ACCEPT A PRICE  THAT  IS  COMPARABLE  TO
    8  THAT  OF THE MAIL ORDER PHARMACY. ANY POLICY WHICH PROVIDES COVERAGE FOR
    9  PRESCRIPTION DRUGS SHALL NOT IMPOSE A CO-PAYMENT FEE OR OTHER  CONDITION
   10  ON ANY INSURED WHO ELECTS TO PURCHASE DRUGS FROM A NETWORK PARTICIPATING
   11  NON-MAIL  ORDER  RETAIL  PHARMACY  WHICH IS NOT ALSO IMPOSED ON INSUREDS
   12  ELECTING TO PURCHASE  DRUGS  FROM  A  DESIGNATED  MAIL  ORDER  PHARMACY;
   13  PROVIDED,  HOWEVER, THAT THE PROVISIONS OF THIS SECTION SHALL NOT SUPER-

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD09145-06-1
       A. 5502--B                          2

    1  SEDE THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT OR APPLY TO A POLICY
    2  THAT IS THE RESULT OF  A  COLLECTIVE  BARGAINING  AGREEMENT  BETWEEN  AN
    3  EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGANIZATION.
    4    S 2. Subsection (1) of section 3221 of the insurance law is amended by
    5  adding a new paragraph 18 to read as follows:
    6    (18)  ANY  INSURER  DELIVERING  A GROUP OR BLANKET POLICY OR ISSUING A
    7  GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE WHICH PROVIDES COVER-
    8  AGE FOR PRESCRIPTION DRUGS SHALL PERMIT EACH  PARTICIPANT  TO  FILL  ANY
    9  MAIL ORDER COVERED PRESCRIPTION, AT HIS OR HER OPTION, AT ANY MAIL ORDER
   10  PHARMACY  OR NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY IF THE
   11  NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY OFFERS TO ACCEPT  A
   12  PRICE  THAT IS COMPARABLE TO THAT OF THE MAIL ORDER PHARMACY. ANY POLICY
   13  WHICH PROVIDES COVERAGE  FOR  PRESCRIPTION  DRUGS  SHALL  NOT  IMPOSE  A
   14  CO-PAYMENT  FEE OR OTHER CONDITION ON ANY INSURED WHO ELECTS TO PURCHASE
   15  DRUGS FROM A NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY  WHICH
   16  IS NOT ALSO IMPOSED ON INSUREDS ELECTING TO PURCHASE DRUGS FROM A DESIG-
   17  NATED  MAIL  ORDER  PHARMACY;  PROVIDED, HOWEVER, THAT THE PROVISIONS OF
   18  THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF  A  COLLECTIVE  BARGAINING
   19  AGREEMENT  OR  APPLY  TO  A  POLICY  THAT  IS THE RESULT OF A COLLECTIVE
   20  BARGAINING AGREEMENT BETWEEN AN EMPLOYER AND A RECOGNIZED  OR  CERTIFIED
   21  EMPLOYEE ORGANIZATION.
   22    S  3.  Section  4303  of  the insurance law is amended by adding a new
   23  subsection (hh) to read as follows:
   24    (HH) ANY POLICY ISSUED BY A MEDICAL EXPENSE INDEMNITY  CORPORATION,  A
   25  HOSPITAL  SERVICE  CORPORATION  OR  A  HEALTH SERVICES CORPORATION WHICH
   26  PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL PERMIT  EACH  PARTICIPANT
   27  TO  FILL  ANY  MAIL ORDER COVERED PRESCRIPTION, AT HIS OR HER OPTION, AT
   28  ANY MAIL ORDER PHARMACY OR NETWORK PARTICIPATING NON-MAIL  ORDER  RETAIL
   29  PHARMACY  IF  THE  NETWORK  PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY
   30  OFFERS TO ACCEPT A PRICE THAT IS COMPARABLE TO THAT OF  THE  MAIL  ORDER
   31  PHARMACY.  ANY  POLICY  WHICH  PROVIDES  COVERAGE FOR PRESCRIPTION DRUGS
   32  SHALL NOT IMPOSE A COPAYMENT FEE OR OTHER CONDITION ON ANY  INSURED  WHO
   33  ELECTS  TO  PURCHASE  DRUGS  FROM A NETWORK PARTICIPATING NON-MAIL ORDER
   34  RETAIL PHARMACY WHICH IS  NOT  ALSO  IMPOSED  ON  INSUREDS  ELECTING  TO
   35  PURCHASE DRUGS FROM A DESIGNATED MAIL ORDER PHARMACY; PROVIDED, HOWEVER,
   36  THAT  THE  PROVISIONS OF THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF A
   37  COLLECTIVE BARGAINING AGREEMENT OR APPLY TO A POLICY THAT IS THE  RESULT
   38  OF  A  COLLECTIVE  BARGAINING AGREEMENT BETWEEN AN EMPLOYER AND A RECOG-
   39  NIZED OR CERTIFIED EMPLOYEE ORGANIZATION.
   40    S 4.  If any clause, subparagraph, subsection, section or  other  part
   41  of  this  act,  or the   application thereof be held to be invalid, such
   42  holding shall not affect, impair or invalidate  the  remainder  of  this
   43  act, or the application of such section or part of a section held inval-
   44  id.
   45    S  5.  This  act shall take effect on the thirtieth day after it shall
   46  have become a law and shall apply to all policies and contracts  issued,
   47  renewed, modified, altered or amended on or after such effective date.
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