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A08900 Summary:

BILL NO    A08900 

SAME AS    SAME AS S06126

SPONSOR    Silver

COSPNSR    Cymbrowitz, Weinstein

MLTSPNSR   

Amd SS3216, 3221 & 4303, Ins L

Enacts chapter amendment to Chapter 598 of 2011 relating to the purchase of
prescription drugs through a network participating non-mail order retail
pharmacy.
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A08900 Text:

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

                                         8900

                                 I N  A S S E M B L Y

                                      (PREFILED)

                                    January 4, 2012
                                      ___________

       Introduced by M. of A. SILVER -- read once and referred to the Committee
         on Insurance

       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.  Paragraph  13-a  of subsection (i) of section 3216 of the
    2  insurance law, as added by Chapter 598 of the laws of 2011,  is  amended
    3  to read as follows:
    4    (13-a)  Every policy that provides coverage for prescription fertility
    5  drugs and requires or permits prescription drugs to be purchased through
    6  a NETWORK PARTICIPATING mail order OR OTHER  NON-RETAIL  pharmacy  shall
    7  provide  the  same  coverage  for prescription fertility drugs when such
    8  drugs are purchased from a NETWORK PARTICIPATING NON-MAIL  ORDER  RETAIL
    9  pharmacy  [that  is not a mail order pharmacy] PROVIDED THAT THE NETWORK
   10  PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY AGREES IN ADVANCE THROUGH A
   11  CONTRACTUAL NETWORK AGREEMENT, TO THE SAME REIMBURSEMENT AMOUNT, AS WELL
   12  AS THE SAME APPLICABLE TERMS AND CONDITIONS, THAT THE INSURER HAS ESTAB-
   13  LISHED FOR A NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL  PHAR-
   14  MACY.  [Such] IN SUCH CASE, THE policy shall not impose any [additional]
   15  fee,  co-payment,  co-insurance,  deductible  or  other condition on any
   16  insured who [does not elect] ELECTS to purchase  prescription  fertility
   17  drugs through a [mail order] NETWORK PARTICIPATING NON-MAIL ORDER RETAIL
   18  pharmacy   THAT  IT  DOES  NOT  IMPOSE  ON  ANY  INSURED  WHO  PURCHASES
   19  PRESCRIPTION FERTILITY DRUGS THROUGH A NETWORK PARTICIPATING MAIL  ORDER
   20  OR OTHER NON-RETAIL PHARMACY.
   21    S 2. Subparagraph (D) of paragraph 6 of subsection (k) of section 3221
   22  of  the  insurance  law, as added by Chapter 598 of the laws of 2011, is
   23  amended to read as follows:
   24    (D) Every policy that provides  coverage  for  prescription  fertility
   25  drugs and requires or permits prescription drugs to be purchased through
   26  a  NETWORK  PARTICIPATING  mail order OR OTHER NON-RETAIL pharmacy shall
   27  provide the same coverage for prescription  fertility  drugs  when  such

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD10740-06-2
       A. 8900                             2

    1  drugs  are  purchased from a NETWORK PARTICIPATING NON-MAIL ORDER RETAIL
    2  pharmacy [that is not a mail order pharmacy] PROVIDED THAT  THE  NETWORK
    3  PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY AGREES IN ADVANCE THROUGH A
    4  CONTRACTUAL NETWORK AGREEMENT, TO THE SAME REIMBURSEMENT AMOUNT, AS WELL
    5  AS THE SAME APPLICABLE TERMS AND CONDITIONS, THAT THE INSURER HAS ESTAB-
    6  LISHED  FOR A NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHAR-
    7  MACY.  [Such] IN SUCH CASE, THE policy shall not impose any [additional]
    8  fee, co-payment, co-insurance, deductible  or  other  condition  on  any
    9  covered  person  who  [does  not  elect] ELECTS to purchase prescription
   10  fertility drugs through a [mail order]  NETWORK  PARTICIPATING  NON-MAIL
   11  ORDER  RETAIL pharmacy THAT IT DOES NOT IMPOSE ON ANY COVERED PERSON WHO
   12  PURCHASES PRESCRIPTION FERTILITY DRUGS THROUGH A  NETWORK  PARTICIPATING
   13  MAIL  ORDER  OR  OTHER  NON-RETAIL PHARMACY; PROVIDED, HOWEVER, THAT THE
   14  PROVISIONS OF THIS SECTION SHALL NOT SUPERSEDE THE TERMS OF A COLLECTIVE
   15  BARGAINING AGREEMENT OR APPLY TO A  POLICY  THAT  IS  THE  RESULT  OF  A
   16  COLLECTIVE  BARGAINING AGREEMENT BETWEEN AN EMPLOYER AND A RECOGNIZED OR
   17  CERTIFIED EMPLOYEE ORGANIZATION.
   18    S 3. Paragraph 4 of subsection (s) of section 4303  of  the  insurance
   19  law,  as added by Chapter 598 of the laws of 2011, is amended to read as
   20  follows:
   21    (4) Every [policy] CONTRACT issued  by  a  medical  expense  indemnity
   22  corporation,  a hospital service corporation or a health services corpo-
   23  ration that provides  coverage  for  prescription  fertility  drugs  and
   24  requires or permits prescription drugs to be purchased through a NETWORK
   25  PARTICIPATING  mail order OR OTHER NON-RETAIL pharmacy shall provide the
   26  same coverage for prescription  fertility  drugs  when  such  drugs  are
   27  purchased  from  a  NETWORK PARTICIPATING NON-MAIL ORDER RETAIL pharmacy
   28  [that is not a mail order pharmacy] PROVIDED THAT  THE  NETWORK  PARTIC-
   29  IPATING  NON-MAIL  ORDER  RETAIL  PHARMACY  AGREES IN ADVANCE, THROUGH A
   30  CONTRACTUAL NETWORK AGREEMENT, TO THE SAME REIMBURSEMENT AMOUNT, AS WELL
   31  AS THE SAME APPLICABLE TERMS AND CONDITIONS, THAT  THE  CORPORATION  HAS
   32  ESTABLISHED FOR THE NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL
   33  PHARMACY.  [Such policy] IN SUCH CASE, THE CONTRACT shall not impose any
   34  [additional]  fee,  co-payment, co-insurance, deductible or other condi-
   35  tion on any covered person who does not elect to  purchase  prescription
   36  fertility  drugs  through  a  NETWORK  PARTICIPATING mail order OR OTHER
   37  NON-RETAIL pharmacy; PROVIDED, HOWEVER,  THAT  THE  PROVISIONS  OF  THIS
   38  SECTION  SHALL NOT SUPERSEDE THE TERMS OF A COLLECTIVE BARGAINING AGREE-
   39  MENT OR APPLY TO A CONTRACT THAT IS THE RESULT OF A COLLECTIVE  BARGAIN-
   40  ING AGREEMENT BETWEEN AN EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE
   41  ORGANIZATION.
   42    S  4.  This  act  shall  take  effect on the same date and in the same
   43  manner as section 5 of chapter 598 of the laws of 2011, takes effect.
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