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S05000 Summary:

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S05000 Floor Votes:

S05000 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         5000--B
            Cal. No. 418
 
                               2009-2010 Regular Sessions
 
                    IN SENATE
 
                                     April 27, 2009
                                       ___________
 
        Introduced  by Sens. DUANE, DILAN, ESPADA, KRUEGER, MONTGOMERY, PERKINS,
          THOMPSON, VALESKY -- read twice and ordered printed, and when  printed
          to  be  committed  to  the  Committee  on Health -- recommitted to the
          Committee on Health in accordance  with  Senate  Rule  6,  sec.  8  --

          committee  discharged,  bill amended, ordered reprinted as amended and
          recommitted to said committee -- reported favorably from said  commit-
          tee and committed to the Committee on Codes -- reported favorably from
          said committee, ordered to first and second report, ordered to a third
          reading,  amended  and  ordered  reprinted, retaining its place in the
          order of third reading
 
        AN ACT to amend the public health law and the insurance law, in relation
          to cost-sharing, deductible or co-insurance for tier  IV  prescription
          drugs; and to amend the executive law, in relation to unlawful discri-
          minatory practice in relation to tier IV prescription drugs
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Legislative findings.  The  cost-sharing,  deductibles  and

     2  co-insurance obligations for certain drugs are becoming cost prohibitive
     3  for  persons  trying  to  overcome  serious  and  often life-threatening
     4  diseases and conditions such as cancer, multiple  sclerosis,  rheumatoid
     5  arthritis, hepatitis C, hemophilia and psoriasis.  These drugs are typi-
     6  cally  new,  produced  in  lesser  quantities  than other drugs, and not
     7  available as less expensive brand name or  generic  prescription  drugs.
     8  Some health insurance plans and policies in other states as well as some
     9  self-insured  plans  in  New  York have established unique categories or
    10  specialty tiers for these drugs, sometimes referred to  as  Tier  IV  or
    11  Tier  V.  Patients under these plans are required to pay a percentage of
    12  the cost of these high-priced drugs, rather than the traditional co-pay-
    13  ment amounts for  generic,  preferred  brand,  and  non-preferred  brand

    14  prescription drugs, often covered by Tier I, Tier II, and Tier III plans
    15  and  policies,  respectively.  As a result, patients covered under plans
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11409-05-0
        S. 5000--B                          2
 
     1  with specialty tiers must pay  thousands  of  dollars  in  out-of-pocket
     2  costs for drugs critical for their treatment.
     3    It  is  in  the  public  interest to help patients to afford necessary
     4  prescription drugs by prohibiting cost-sharing, deductibles and co-insu-
     5  rance obligations by patients that  exceed  payments  for  non-preferred
     6  brand prescription drugs or the equivalent thereof. It is not the intent

     7  of  this  legislation  to  preclude  plans or policies from categorizing
     8  drugs used in the treatment of  these  common  diseases  as  brand  name
     9  prescription drugs or generic prescription drug equivalents.
    10    The  extraordinary  disparity in cost-sharing, deductible and co-insu-
    11  rance burdens imposed on patients whose life and health depend on  these
    12  drugs  constitutes serious and unjustified discrimination based on their
    13  disease or disability.
    14    This legislation is  intended  to  provide  patients  more  affordable
    15  access  to  prescription  drugs essential for their treatment of cancer,
    16  multiple  sclerosis,  rheumatoid  arthritis,  hepatitis  C,  hemophilia,
    17  psoriasis, and other diseases.
    18    §  2.  Section  4406-c of the public health law is amended by adding a
    19  new subdivision 7 to read as follows:

    20    7. No health maintenance  organization  which  provides  coverage  for
    21  prescription  drugs  and for which cost-sharing, deductibles or co-insu-
    22  rance obligations are determined by category of prescription drugs shall
    23  impose cost-sharing, deductibles or  co-insurance  obligations  for  any
    24  prescription drug that exceeds the dollar amount of cost-sharing, deduc-
    25  tibles  or co-insurance obligations for non-preferred brand drugs or its
    26  equivalent (or brand drugs if there is no non-preferred brand drug cate-
    27  gory).
    28    § 3. Subsection (i) of section 3216 of the insurance law is amended by
    29  adding a new paragraph 27 to read as follows:
    30    (27) No policy delivered or issued for delivery in  this  state  which

    31  provides  coverage  for  prescription  drugs and for which cost-sharing,
    32  deductibles or co-insurance obligations are determined  by  category  of
    33  prescription  drugs  shall  impose cost-sharing, deductibles or co-insu-
    34  rance obligations for any prescription  drug  that  exceeds  the  dollar
    35  amount  of  cost-sharing,  deductibles  or  co-insurance obligations for
    36  non-preferred brand drugs or its equivalent (or brand drugs if there  is
    37  no non-preferred brand drug category).
    38    § 4. Subsection (a) of section 3221 of the insurance law is amended by
    39  adding a new paragraph 16 to read as follows:
    40    (16)  No  policy  delivered or issued for delivery in this state which
    41  provides coverage for prescription drugs  and  for  which  cost-sharing,

    42  deductibles  or  co-insurance  obligations are determined by category of
    43  prescription drugs shall impose cost-sharing,  deductibles  or  co-insu-
    44  rance  obligations  for  any  prescription  drug that exceeds the dollar
    45  amount of cost-sharing,  deductibles  or  co-insurance  obligations  for
    46  non-preferred  brand drugs or its equivalent (or brand drugs if there is
    47  no non-preferred brand drug category).
    48    § 5. Section 4303 of the insurance law is  amended  by  adding  a  new
    49  subsection (gg) to read as follows:
    50    (gg)  No  medical  expense  indemnity  corporation, a hospital service
    51  corporation or a health service corporation which provides coverage  for
    52  prescription  drugs  and for which cost-sharing, deductibles or co-insu-

    53  rance obligations are determined by category of prescription drugs shall
    54  impose cost-sharing, deductibles or  co-insurance  obligations  for  any
    55  prescription drug that exceeds the dollar amount of cost-sharing, deduc-
    56  tibles  or co-insurance obligations for non-preferred brand drugs or its
        S. 5000--B                          3
 
     1  equivalent (or brand drugs if there is no non-preferred brand drug cate-
     2  gory).
     3    §  6.    Subdivision 20 of section 296 of the executive law, as renum-
     4  bered by chapter 204 of the laws of 1996, is renumbered  subdivision  21
     5  and a new subdivision 20 is added to read as follows:
     6    20.  It shall be an unlawful discriminatory practice for any employer,

     7  labor organization, insurer, health maintenance  organization  or  other
     8  entity to limit health care coverage such that cost-sharing, deductibles
     9  or co-insurance obligations for any prescription drug exceeds the dollar
    10  amount  of cost-sharing, deductibles or co-insurance obligations for any
    11  other prescription drug provided under such health care coverage in  the
    12  category  of non-preferred brand drugs or its equivalent (or brand drugs
    13  if there is no non-preferred brand  drug  category);  provided  however,
    14  this  subdivision  shall  not apply to any self-insured employee welfare
    15  benefit plan, as defined in the employee retirement income security  act
    16  of 1974, as amended.
    17    § 7. Severability. If any provision of this act, or any application of

    18  any provision of this act, is held to be invalid, or ruled by any feder-
    19  al  agency to violate or be inconsistent with any applicable federal law
    20  or regulation, that shall not affect the validity  or  effectiveness  of
    21  any  other  provision  of  this  act, or of any other application of any
    22  provision of this act.
    23    § 8. This act shall take effect on the thirtieth day  after  it  shall
    24  have become a law.