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.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A5502B
SPONSOR: Heastie (MS) 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:
* §1.- Subsection (i) of Section 3216 of the insurance law is amended by
adding a new paragraph (28) to require any policy which provides cover-
age 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' compen-
sation law regarding the purchase of prescription drugs and the use of
mail order pharmacy.
* §§2-3.- 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.
* §4.- 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 situ-
ation 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.
STATE OF NEW YORK
________________________________________________________________________
5502--B
2011-2012 Regular Sessions
IN ASSEMBLY
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 § 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 § 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 § 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 § 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.
