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S04463 Summary:

BILL NOS04463A
 
SAME ASNo Same As
 
SPONSORBRESLIN
 
COSPNSRADDABBO, MAY, METZGER
 
MLTSPNSR
 
Amd 3216, 3221 & 4303, Ins L
 
Relates to the purchase of prescription drugs by pharmacies; the same reimbursement amount shall be provided to all pharmacies.
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S04463 Actions:

BILL NOS04463A
 
03/12/2019REFERRED TO INSURANCE
05/29/2019REPORTED AND COMMITTED TO FINANCE
06/14/2019AMEND AND RECOMMIT TO FINANCE
06/14/2019PRINT NUMBER 4463A
06/17/2019COMMITTEE DISCHARGED AND COMMITTED TO RULES
06/17/2019ORDERED TO THIRD READING CAL.1425
06/17/2019PASSED SENATE
06/17/2019DELIVERED TO ASSEMBLY
06/17/2019referred to insurance
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S04463 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         4463--A
 
                               2019-2020 Regular Sessions
 
                    IN SENATE
 
                                     March 12, 2019
                                       ___________
 
        Introduced  by Sens. BRESLIN, ADDABBO -- read twice and ordered printed,
          and when printed to be committed to  the  Committee  on  Insurance  --
          reported  favorably from said committee and committed to the Committee
          on Finance -- committee discharged, bill amended, 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. 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    (i) "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    (ii) "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
    19  obtained at a network participating mail order or other non-retail phar-
    20  macy, at the insured's option, at a network participating non-mail order
    21  retail pharmacy provided that the network participating  non-mail  order
    22  retail pharmacy agrees [in advance, through a contractual network agree-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00271-02-9

        S. 4463--A                          2

     1  ment,] to the same reimbursement amount[, as well as the same applicable
     2  terms  and conditions,] that the insurer has established for the network
     3  participating mail order or other non-retail pharmacy. In such  a  case,
     4  the  policy  shall not impose a co-payment fee or other condition on any
     5  insured who elects to purchase prescription drugs from a network partic-
     6  ipating non-mail order retail pharmacy which  is  not  also  imposed  on
     7  insureds  electing  to  purchase drugs from a network participating mail
     8  order  or  other  non-retail  pharmacy;  provided,  however,  that   the
     9  provisions  of  this  subparagraph  shall  not  supersede the terms of a
    10  collective bargaining agreement or apply to a policy that is a result of
    11  a collective bargaining agreement between an employer and  a  recognized
    12  or certified employee organization.
    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    (i) "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    (ii) "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

        S. 4463--A                          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.
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