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S04111 Summary:

S04111 Actions:

S04111 Committee Votes:

S04111 Floor Votes:

S04111 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          4111
 
                               2021-2022 Regular Sessions
 
                    IN SENATE
 
                                    February 2, 2021
                                       ___________
 
        Introduced  by Sens. BRESLIN, ADDABBO, BENJAMIN, BIAGGI, BROOKS, COMRIE,
          GAUGHRAN,  GIANARIS,  GRIFFO,  HELMING,  HOYLMAN,  JORDAN,   KAMINSKY,
          KAPLAN,  KENNEDY,  KRUEGER, LANZA, MAY, MAYER, MYRIE, PARKER, RITCHIE,
          RIVERA, SALAZAR, SANDERS, SAVINO, SEPULVEDA, SERINO, SERRANO, SKOUFIS,
          THOMAS -- read twice and ordered  printed,  and  when  printed  to  be
          committed to the Committee on Insurance
 
        AN ACT to amend the insurance law and the public health law, in relation
          to prescription drug formulary changes during a contract year
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. The insurance law is amended by adding a new  section  4909
     2  to read as follows:
     3    §  4909.  Prescription drug formulary changes. (a) Except as otherwise
     4  provided in subsection (c) of this section, a  health  care  plan  shall
     5  not:
     6    (i) remove a prescription drug from a formulary;
     7    (ii)  move  a  prescription  drug  to a tier with a larger deductible,
     8  copayment, or coinsurance if the formulary includes two or more tiers of
     9  benefits providing for different deductibles, copayments or  coinsurance
    10  applicable to the prescription drugs in each tier; or
    11    (iii)  add  utilization management restrictions to a prescription drug
    12  on a formulary, unless such changes occur at the time of  enrollment  or
    13  issuance of coverage.
    14    (b)  Prohibitions  provided  in  subsection  (a) of this section shall
    15  apply beginning on the date on which open enrollment begins for  a  plan
    16  year  and through the end of the plan year to which such open enrollment
    17  period applies.
    18    (c) (i) A health care plan with a formulary that includes two or  more
    19  tiers  of  benefits  providing  for different deductibles, copayments or
    20  coinsurance applicable to prescription drugs in each  tier  may  move  a
    21  prescription drug to a tier with a larger deductible, copayment or coin-
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD08236-01-1
        S. 4111                             2
 
     1  surance  if an AB-rated generic equivalent or interchangeable biological
     2  product for such prescription drug is added to the formulary at the same
     3  time.
     4    (ii)  A  health care plan may remove a prescription drug from a formu-
     5  lary if the federal Food and Drug Administration  determines  that  such
     6  prescription  drug  should  be  removed  from  the market, including new
     7  utilization management restrictions issued pursuant to federal Food  and
     8  Drug Administration safety concerns.
     9    (iii)  A  health  care plan with a formulary that includes two or more
    10  tiers of benefits  providing  for  different  copayments  applicable  to
    11  prescription  drugs may move a prescription drug to a tier with a larger
    12  copayment during the plan year, provided the change is not applicable to
    13  an insured who is already receiving such prescription drug or  has  been
    14  diagnosed with or presented with a condition on or prior to the start of
    15  the  plan  year  which  is  treated  by  such  prescription drug or is a
    16  prescription drug that is or would be part of  the  insured's  treatment
    17  regimen for such condition.
    18    (d)  A  health  care plan shall provide notice to policyholders of the
    19  intent to remove a prescription drug from a formulary or  alter  deduct-
    20  ible,  copayment  or coinsurance requirements in the upcoming plan year,
    21  thirty days prior to the open enrollment period for the consecutive plan
    22  year. Such notice of impending formulary and  deductible,  copayment  or
    23  coinsurance  changes shall also be posted on the plan's online formulary
    24  and in any prescription drug finder system that the plan provides to the
    25  public.
    26    (e) The provisions of this section shall not supersede the terms of  a
    27  collective  bargaining  agreement, or the rights of labor representation
    28  groups to collectively bargain changes to the formularies.
    29    § 2. The public health law is amended by adding a new section 4909  to
    30  read as follows:
    31    §  4909.  Prescription  drug formulary changes. 1. Except as otherwise
    32  provided in subdivision three of this section, a health care plan  shall
    33  not:
    34    (a) remove a prescription drug from a formulary;
    35    (b)  move  a  prescription  drug  to  a tier with a larger deductible,
    36  copayment, or coinsurance if the formulary includes two or more tiers of
    37  benefits providing for different deductibles, copayments or  coinsurance
    38  applicable to the prescription drugs in each tier; or
    39    (c)  add utilization management restrictions to a prescription drug on
    40  a formulary, unless such changes occur at  the  time  of  enrollment  or
    41  issuance of coverage.
    42    2.  Prohibitions  provided  in  subdivision  one of this section shall
    43  apply beginning on the date on which open enrollment begins for  a  plan
    44  year  and through the end of the plan year to which such open enrollment
    45  period applies.
    46    3. (a) A health care plan with a formulary that includes two  or  more
    47  tiers  of  benefits  providing  for different deductibles, copayments or
    48  coinsurance applicable to prescription drugs in each  tier  may  move  a
    49  prescription drug to a tier with a larger deductible, copayment or coin-
    50  surance  if an AB-rated generic equivalent or interchangeable biological
    51  product for such prescription drug is added to the formulary at the same
    52  time.
    53    (b) A health care plan may remove a prescription drug from a formulary
    54  if the  federal  Food  and  Drug  Administration  determines  that  such
    55  prescription  drug  should  be  removed  from  the market, including new
        S. 4111                             3
 
     1  utilization management restrictions issued pursuant to federal Food  and
     2  Drug Administration safety concerns.
     3    (c)  A  health  care  plan  with a formulary that includes two or more
     4  tiers of benefits  providing  for  different  copayments  applicable  to
     5  prescription  drugs may move a prescription drug to a tier with a larger
     6  copayment during the plan year, provided the change is not applicable to
     7  an insured who is already receiving such prescription drug or  has  been
     8  diagnosed with or presented with a condition on or prior to the start of
     9  the  plan  year  which  is  treated  by  such  prescription drug or is a
    10  prescription drug that is or would be part of  the  insured's  treatment
    11  regimen for such condition.
    12    4.  A  health  care  plan shall provide notice to policyholders of the
    13  intent to remove a prescription drug from a formulary or  alter  deduct-
    14  ible,  copayment  or coinsurance requirements in the upcoming plan year,
    15  thirty days prior to the open enrollment period for the consecutive plan
    16  year.  Such notice of impending formulary and deductible,  copayment  or
    17  coinsurance  changes shall also be posted on the plan's online formulary
    18  and in any prescription drug finder system that the plan provides to the
    19  public.
    20    5. The provisions of this section shall not supersede the terms  of  a
    21  collective  bargaining  agreement, or the rights of labor representation
    22  groups to collectively bargain changes to the formularies.
    23    § 3. This act shall take effect on the sixtieth  day  after  it  shall
    24  have become a law. Effective immediately, the addition, amendment and/or
    25  repeal  of any rule or regulation necessary for the implantation of this
    26  act on its effective date are authorized to be made on  or  before  such
    27  effective date.