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A00347 Summary:

A00347 Actions:

A00347 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
 submitted in accordance with Assembly Rule III, Sec 1(f)



 
BILL NUMBER: A347
 
SPONSOR: Joyner (MS)

 
TITLE OF BILL:
 
An act to amend the insurance law, in relation to coverage of
prescriptions obtained by mail order or at a non-retail pharmacy
 
 
PURPOSE:
 
Ensure patient access to retail pharmacies upon the prescriber's deter-
mination that mail order delivery would not be appropriate
 
 
SUMMARY OF PROVISIONS:
 
Sections one, two and three amend Insurance Law §§ 3216, 3221 and 4303
respectively to provide that a prescriber, after consultation with the
patient's insurer, may determine that mail order delivery of
prescription medication is not appropriate given the patient's resi-
dence, medical condition, storage requirements of the drug, availability
of the insured to receive the prescription or the patient's ability to
understand guidance and support over the telephone. Provided the retail
pharmacy agrees to the same reimbursement amount and is able to fill the
prescription, the prescriber's determination shall be final.
 
Section four provides that the act take effect immediately.
 
 
JUSTIFICATION:
 
While recognizing the value of mail order pharmacies and the convenience
they provide for many, not all patients have the same needs. For many
patients, especially those with complex medical conditions, access to
local pharmacies for their medications can be essential for their health
and wellbeing. Patients may have residences lacking secure deliver
locations, be on specific treatment regimens that may be disrupted if
the medications are not promptly received, take medications that need
special handling, or need the in person counseling of a pharmacist.
There are many different reasons why an individual may benefit from
access to a retail pharmacy rather than a mail order pharmacy. That
decision should be made between the patient and his or her prescriber.
The Legislature has already acknowledged the need to ensure patient
access to pharmacy options.  This legislation will expand upon the 2011
provisions to ensure a prescriber, considering all factors relevant to
the patient, can determine when mail order is not appropriate. The bill
also ensures that cost is not affected, by requiring the retail pharmacy
to agree to the same reimbursement amount.
 
 
LEGISLATIVE HISTORY:
 
2016 - Print Number 10290a, Amend and Recommit to Insurance
 
 
FISCAL IMPLICATIONS:
 
None.
 
 
EFFECTIVE DATE:
Immediately.

A00347 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                           347
 
                               2019-2020 Regular Sessions
 
                   IN ASSEMBLY
 
                                       (Prefiled)
 
                                     January 9, 2019
                                       ___________
 
        Introduced by M. of A. JOYNER, COLTON, ORTIZ, COOK, GLICK, D'URSO, GOTT-
          FRIED  --  Multi-Sponsored  by -- M. of A. THIELE, WRIGHT -- read once
          and referred to the Committee on Insurance
 
        AN  ACT  to  amend  the  insurance  law,  in  relation  to  coverage  of
          prescriptions obtained by mail order or at a non-retail pharmacy
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. The opening paragraph of paragraph 28 of subsection (i)  of
     2  section  3216  of the insurance law, as added by chapter 589 of the laws
     3  of 2011, is designated subparagraph (A) and a new  subparagraph  (B)  is
     4  added to read as follows:
     5    (B)  Notwithstanding any other provision of this paragraph, if a pres-
     6  criber, after consulting with the insurer regarding the  appropriateness
     7  of  mail order delivery given: (i) the residence or delivery location of
     8  the insured; (ii) the medical condition of the insured; (iii) the  stor-
     9  age  requirements  of  the drug; (iv) the availability of the insured to
    10  receive the prescription; or (v) the  insured's  ability  to  comprehend
    11  pharmaceutical  guidance and support over the telephone, determines that
    12  a drug as prescribed on an individual basis is most appropriately filled
    13  at a retail location, provided that an in-network retail pharmacy of the
    14  patient's choosing agrees to the same reimbursement amount and  is  able
    15  to fill the prescription, the prescriber's determination shall be final.
    16    §  2.  The  opening  paragraph  of  paragraph  18 of subsection (l) of
    17  section 3221 of the insurance law is designated subparagraph (A)  and  a
    18  new subparagraph (B) is added to read as follows:
    19    (B)  Notwithstanding any other provision of this paragraph, if a pres-
    20  criber, after consulting with the insurer regarding the  appropriateness
    21  of  mail order delivery given: (i) the residence or delivery location of
    22  the insured; (ii) the medical condition of the insured; (iii) the  stor-
    23  age  requirements  of  the drug; (iv) the availability of the insured to
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00064-02-9
        A. 347                              2
 
     1  receive the prescription; or (v) the  insured's  ability  to  comprehend
     2  pharmaceutical  guidance and support over the telephone, determines that
     3  a drug as prescribed on an individual basis is most appropriately filled
     4  at a retail location, provided that an in-network retail pharmacy of the
     5  patient's  choosing  agrees to the same reimbursement amount and is able
     6  to fill the prescription, the prescriber's determination shall be final.
     7    § 3. The opening paragraph of subsection (kk) of section 4303  of  the
     8  insurance  law  is designated paragraph 1 and a new paragraph 2 is added
     9  to read as follows:
    10    (2) Notwithstanding any other provision of this subsection, if a pres-
    11  criber, after consulting with the insurer regarding the  appropriateness
    12  of  mail order delivery given: (A) the residence or delivery location of
    13  the covered person; (B) the medical condition of the covered person; (C)
    14  the storage requirements of  the  drug;  (D)  the  availability  of  the
    15  covered  person to receive the prescription; or (E) the covered person's
    16  ability to comprehend pharmaceutical guidance and support over the tele-
    17  phone, determines that a drug as prescribed on an  individual  basis  is
    18  most appropriately filled at a retail location, provided that an in-net-
    19  work  retail  pharmacy  of  the  patient's  choosing  agrees to the same
    20  reimbursement  amount  and  is  able  to  fill  the  prescription,   the
    21  prescriber's determination shall be final.
    22    § 4. This act shall take effect immediately.