S03995 Summary:
| BILL NO | S03995B |
| SAME AS | SAME AS A05723-B |
| SPONSOR | MAZIARZ |
| COSPNSR | ADDABBO, AVELLA, BOYLE, CARLUCCI, ESPAILLAT, GIPSON, GOLDEN, GRISANTI, HOYLMAN, KRUEGER, LANZA, LARKIN, LATIMER, LIBOUS, MARTINS, NOZZOLIO, PARKER, PERALTA, RANZENHOFER, RITCHIE, RIVERA, SAMPSON, SAVINO, SMITH, SQUADRON, STAVISKY, VALESKY, ZELDIN |
| MLTSPNSR | |
| Amd SS3216, 3221 & 4303, Ins L | |
| Relates to the purchase of prescription drugs. | |
S03995 Memo:
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S03995 Text:
Go to topSTATE OF NEW YORK ________________________________________________________________________ 3995--B 2013-2014 Regular Sessions IN SENATE March 4, 2013 ___________ Introduced by Sens. MAZIARZ, ADDABBO, AVELLA, BOYLE, CARLUCCI, ESPAIL- LAT, GIPSON, GOLDEN, GRISANTI, HOYLMAN, LANZA, LARKIN, LATIMER, MARTINS, PARKER, PERALTA, RANZENHOFER, RITCHIE, SAMPSON, SMITH, STAVI- SKY, VALESKY, ZELDIN -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- recommitted to the Committee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said commit- tee 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 28 of subsection (i) of section 3216 of the 2 insurance law, as amended by chapter 11 of the laws of 2012, is amended 3 to read as follows: 4 (28) (A) Definitions. For the purpose of this paragraph: 5 (1) "Same reimbursement amount" shall mean that any coverage described 6 under subparagraph (B) of this paragraph shall provide the same bench- 7 mark index, including the same average wholesale price, maximum allow- 8 able cost and national prescription drug codes to reimburse all pharma- 9 cies participating in the insurance network regardless of whether a 10 pharmacy is a mail order pharmacy or a non-mail order pharmacy. 11 (2) "Mail order pharmacy" means a pharmacy whose primary business is 12 to receive prescriptions by mail, telefax or through electronic 13 submissions and to dispense medication to patients through the use of 14 the United States mail or other common or contract carrier services and 15 provides any consultation with patients electronically rather than face- 16 to-face. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD09462-07-4S. 3995--B 2 1 (B) Any policy that provides coverage for prescription drugs shall 2 permit each insured to fill any covered prescription that may be 3 obtained at a network participating mail order or other non-retail phar- 4 macy, at the insured's option, at a network participating non-mail order 5 retail pharmacy provided that the network participating non-mail order 6 retail pharmacy agrees [in advance, through a contractual network agree-7ment,] to the same reimbursement amount[, as well as the same applicable8terms and conditions,] that the insurer has established for the network 9 participating mail order or other non-retail pharmacy. In such a case, 10 the policy shall not impose a co-payment fee or other condition on any 11 insured who elects to purchase prescription drugs from a network partic- 12 ipating non-mail order retail pharmacy which is not also imposed on 13 insureds electing to purchase drugs from a network participating mail 14 order or other non-retail pharmacy. 15 § 2. Paragraph 18 of subsection (l) of section 3221 of the insurance 16 law, as amended by chapter 11 of the laws of 2012, is amended to read as 17 follows: 18 (18) (A) Definitions. For the purpose of this paragraph: 19 (1) "Same reimbursement amount" shall mean that any coverage described 20 under subparagraph (B) of this paragraph shall provide the same bench- 21 mark index, including the same average wholesale price, maximum allow- 22 able cost and national prescription drug codes to reimburse all pharma- 23 cies participating in the insurance network regardless of whether a 24 pharmacy is a mail order pharmacy or a non-mail order pharmacy. 25 (2) "Mail order pharmacy" means a pharmacy whose primary business is 26 to receive prescriptions by mail, telefax or through electronic 27 submissions and to dispense medication to patients through the use of 28 the United States mail or other common or contract carrier services and 29 provides any consultation with patients electronically rather than face- 30 to-face. 31 (B) Any insurer delivering a group or blanket policy or issuing a 32 group or blanket policy for delivery in this state that provides cover- 33 age for prescription drugs shall permit each insured to fill any covered 34 prescription that may be obtained at a network participating mail order 35 or other non-retail pharmacy, at the insured's option, at a network 36 participating non-mail order retail pharmacy provided that the network 37 participating non-mail order retail pharmacy agrees [in advance, through38a contractual network agreement,] to the same reimbursement amount[, as39well as the same applicable terms and conditions,] that the insurer has 40 established for the network participating mail order or other non-retail 41 pharmacy. In such a case, the policy shall not impose a co-payment fee 42 or other condition on any insured who elects to purchase drugs from a 43 network participating non-mail order retail pharmacy which is not also 44 imposed on insureds electing to purchase drugs from a network partic- 45 ipating mail order or other non-retail pharmacy; provided, however, that 46 the provisions of this section shall not supersede the terms of a 47 collective bargaining agreement or apply to a policy that is the result 48 of a collective bargaining agreement between an employer and a recog- 49 nized or certified employee organization. 50 § 3. Subsection (kk) of section 4303 of the insurance law, as amended 51 by chapter 11 of the laws of 2012 and as relettered by section 55 of 52 part D of chapter 56 of the laws of 2013, is amended to read as follows: 53 (kk) (1) Definitions. For the purpose of this subsection: 54 (A) "Same reimbursement amount" shall mean that any coverage described 55 under paragraph two of this subsection shall provide the same benchmark 56 index, including the same average wholesale price, maximum allowableS. 3995--B 3 1 cost and national prescription drug codes to reimburse all pharmacies 2 participating in the health benefit plan regardless of whether a pharma- 3 cy is a mail order pharmacy or a non-mail order pharmacy. 4 (B) "Mail order pharmacy" means a pharmacy whose primary business is 5 to receive prescriptions by mail, telefax or through electronic 6 submissions and to dispense medication to patients through the use of 7 the United States mail or other common or contract carrier services and 8 provides any consultation with patients electronically rather than face- 9 to-face. 10 (2) Any contract issued by a medical expense indemnity corporation, a 11 hospital service corporation or a health services corporation that 12 provides coverage for prescription drugs shall permit each covered 13 person to fill any covered prescription that may be obtained at a 14 network participating mail order or other non-retail pharmacy, at the 15 covered person's option, at a network participating non-mail order 16 retail pharmacy provided that the network participating non-mail order 17 retail pharmacy agrees [in advance, through a contractual network agree-18ment,] to the same reimbursement amount[, as well as the same applicable19terms and conditions,] that the corporation has established for the 20 network participating mail order or other non-retail pharmacy. In such 21 a case, the contract shall not impose a copayment fee or other condition 22 on any covered person who elects to purchase drugs from a network 23 participating non-mail order retail pharmacy which is not also imposed 24 on covered persons electing to purchase drugs from a network participat- 25 ing mail order or other non-retail pharmacy; provided, however, that the 26 provisions of this section shall not supersede the terms of a collective 27 bargaining agreement or apply to a contract that is the result of a 28 collective bargaining agreement between an employer and a recognized or 29 certified employee organization. 30 § 4. This act shall take effect immediately.