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A06194 Summary:

A06194 Actions:

A06194 Committee Votes:

A06194 Floor Votes:

A06194 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          6194
 
                               2015-2016 Regular Sessions
 
                   IN ASSEMBLY
 
                                     March 16, 2015
                                       ___________
 
        Introduced  by  M.  of  A.  JOYNER, ABINANTI, AUBRY, BARRETT, BENEDETTO,
          BLAKE, BRINDISI, BUCHWALD, CLARK, COLTON, CRESPO, CUSICK,  CYMBROWITZ,
          DINOWITZ,  GALEF,  GJONAJ, GOTTFRIED, GUNTHER, HEVESI, JAFFEE, KEARNS,
          LAVINE, McDONALD, MOSLEY, MOYA, ORTIZ, OTIS,  PAULIN,  PEOPLES-STOKES,
          PERRY,  PICHARDO,  RODRIGUEZ, ROSENTHAL, SEPULVEDA, SIMANOWITZ, SIMON,
          SIMOTAS, SKOUFIS, THIELE, TITONE, WEPRIN, ZEBROWSKI -- Multi-Sponsored
          by -- M. of A.  ARROYO,  BRAUNSTEIN,  COOK,  FARRELL,  GLICK,  HOOPER,
          LENTOL,  LUPARDO,  MAYER, O'DONNELL, ROZIC, SCHIMEL, WEINSTEIN -- 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 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.
    17    (B) Any policy that provides coverage  for  prescription  drugs  shall
    18  permit  each  insured  to  fill  any  covered  prescription  that may be
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01495-01-5
        A. 6194                             2
 
     1  obtained at a network participating mail order or other non-retail phar-
     2  macy, at the insured's option, at a network participating non-mail order
     3  retail pharmacy provided that the network participating  non-mail  order
     4  retail pharmacy agrees [in advance, through a contractual network agree-
     5  ment,] to the same reimbursement amount[, as well as the same applicable
     6  terms  and conditions,] that the insurer has established for the network
     7  participating mail order or other non-retail pharmacy. In such  a  case,
     8  the  policy  shall not impose a co-payment fee or other condition on any
     9  insured who elects to purchase prescription drugs from a network partic-
    10  ipating non-mail order retail pharmacy which  is  not  also  imposed  on
    11  insureds  electing  to  purchase drugs from a network participating mail
    12  order or other non-retail pharmacy.
    13    § 2. Paragraph 18 of subsection (l) of section 3221 of  the  insurance
    14  law, as amended by chapter 11 of the laws of 2012, is amended to read as
    15  follows:
    16    (18) (A) Definitions. For the purpose of this paragraph:
    17    (1) "Same reimbursement amount" shall mean that any coverage described
    18  under  subparagraph  (B) of this paragraph shall provide the same bench-
    19  mark index, including the same average wholesale price,  maximum  allow-
    20  able  cost and national prescription drug codes to reimburse all pharma-
    21  cies participating in the insurance  network  regardless  of  whether  a
    22  pharmacy is a mail order pharmacy or a non-mail order pharmacy.
    23    (2)  "Mail  order pharmacy" means a pharmacy whose primary business is
    24  to  receive  prescriptions  by  mail,  telefax  or  through   electronic
    25  submissions  and  to  dispense medication to patients through the use of
    26  the United States mail or other common or contract carrier services  and
    27  provides any consultation with patients electronically rather than face-
    28  to-face.
    29    (B)  Any  insurer  delivering  a  group or blanket policy or issuing a
    30  group or blanket policy for delivery in this state that provides  cover-
    31  age for prescription drugs shall permit each insured to fill any covered
    32  prescription  that may be obtained at a network participating mail order
    33  or other non-retail pharmacy, at the  insured's  option,  at  a  network
    34  participating  non-mail  order retail pharmacy provided that the network
    35  participating non-mail order retail pharmacy agrees [in advance, through
    36  a contractual network agreement,] to the same reimbursement amount[,  as
    37  well  as the same applicable terms and conditions,] that the insurer has
    38  established for the network participating mail order or other non-retail
    39  pharmacy. In such a case, the policy shall not impose a  co-payment  fee
    40  or  other  condition  on any insured who elects to purchase drugs from a
    41  network participating non-mail order retail pharmacy which is  not  also
    42  imposed  on  insureds  electing to purchase drugs from a network partic-
    43  ipating mail order or other non-retail pharmacy; provided, however, that
    44  the provisions of this section  shall  not  supersede  the  terms  of  a
    45  collective  bargaining agreement or apply to a policy that is the result
    46  of a collective bargaining agreement between an employer  and  a  recog-
    47  nized or certified employee organization.
    48    §  3. Subsection (kk) of section 4303 of the insurance law, as amended
    49  by chapter 11 of the laws of 2012 and as relettered  by  section  55  of
    50  part D of chapter 56 of the laws of 2013, is amended to read as follows:
    51    (kk) (1) Definitions. For the purpose of this subsection:
    52    (A) "Same reimbursement amount" shall mean that any coverage described
    53  under  paragraph two of this subsection shall provide the same benchmark
    54  index, including the same average  wholesale  price,  maximum  allowable
    55  cost  and  national  prescription drug codes to reimburse all pharmacies
        A. 6194                             3
 
     1  participating in the health benefit plan regardless of whether a pharma-
     2  cy is a mail order pharmacy or a non-mail order pharmacy.
     3    (B)  "Mail  order pharmacy" means a pharmacy whose primary business is
     4  to  receive  prescriptions  by  mail,  telefax  or  through   electronic
     5  submissions  and  to  dispense medication to patients through the use of
     6  the United States mail or other common or contract carrier services  and
     7  provides any consultation with patients electronically rather than face-
     8  to-face.
     9    (2)  Any contract issued by a medical expense indemnity corporation, a
    10  hospital service corporation  or  a  health  services  corporation  that
    11  provides  coverage  for  prescription  drugs  shall  permit each covered
    12  person to fill any covered  prescription  that  may  be  obtained  at  a
    13  network  participating  mail  order or other non-retail pharmacy, at the
    14  covered person's option,  at  a  network  participating  non-mail  order
    15  retail  pharmacy  provided that the network participating non-mail order
    16  retail pharmacy agrees [in advance, through a contractual network agree-
    17  ment,] to the same reimbursement amount[, as well as the same applicable
    18  terms and conditions,] that the  corporation  has  established  for  the
    19  network  participating mail order or other non-retail pharmacy.  In such
    20  a case, the contract shall not impose a copayment fee or other condition
    21  on any covered person who  elects  to  purchase  drugs  from  a  network
    22  participating  non-mail  order retail pharmacy which is not also imposed
    23  on covered persons electing to purchase drugs from a network participat-
    24  ing mail order or other non-retail pharmacy; provided, however, that the
    25  provisions of this section shall not supersede the terms of a collective
    26  bargaining agreement or apply to a contract that  is  the  result  of  a
    27  collective  bargaining agreement between an employer and a recognized or
    28  certified employee organization.
    29    § 4. This act shall take effect immediately.