Bill S1434-2011

Prohibits incentive arrangements for inducing a health care provider to change prescriptions

Prohibits incentive arrangements for inducing a health care provider to change prescriptions.

Details

Actions

  • Jan 4, 2012: REFERRED TO INSURANCE
  • Jan 7, 2011: REFERRED TO INSURANCE

Memo

BILL NUMBER:S1434

TITLE OF BILL: An act to amend the insurance law and the public health law, in relation to prohibiting accident and health insurers from offering incentives to health care providers to prescribe a specific drug or medical product

PURPOSE: To prohibit insurers from offering incentives to health care providers for issuing or changing prescriptions.

SUMMARY OF PROVISIONS: Section 1 - Amends section 3217-b of the Insurance Law to add new subsection (j), which prohibits an insurer from providing payment or incentive to a health care provider to issue or change a prescription for a specific drug or medical product.

Section 2 - Amends section 4325 of the Insurance Law to add new subsection (k), which prohibits an insurer from providing payment or incentive to a health care provider to issue or change a prescription for specific drug or medical product.

Section 3 - Amends section 4406-c of the Public Health Law to add a new subdivision 5-e, which prohibits a healthcare plan from providing payment or incentive to a health care provider to issue or change a prescription for a specific drug or medical product.

Section 4- Effective date is ninety days after becoming a law.

JUSTIFICATION: It has been reported that some insurance companies are providing financial incentives to doctors for switching patients' prescriptions to less expensive drugs. Some health plans have offered as much as $100 each time a physician switches a patient's prescription from a brand name to a generic. An upstate New York health plan began a pilot project with several medical groups in 2006 as part of a campaign to boost generic drug use. In this pilot, physicians who increased their ratio of generic drug prescriptions to brand-name drugs by five percentage points, would receive a slightly higher reimbursement for their patient office visits.

While lowering health care costs is an essential and necessary task if we are to meet the goal of ensuring that every New Yorker has affordable quality health care, insurance companies should not offer incentives to influence medical decisions. Monetary rewards for health care providers who switch patients' prescriptions from a costlier drug to a less expensive one should not be an acceptable practice. This legislation would prevent companies in New York from providing "kickbacks" to participating practitioners for changing prescriptions. Although many generics work as well as their counterpart brand-name products, ethical medical practice requires that a prescribers' independent clinical judgment not be compromised. A patient's diagnosis, symptoms, risk of complications, medical profile and prior clinical history should be taken into account prior

to changing or prescribing a prescription. The decision to prescribe a particular medication should be made without concern for financial gain.

LEGISLATIVE HISTORY: 2009-2010: S.3037- Referred to Insurance 2008: S.7516 - Referred to Insurance

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: Ninety days after becoming a law.


Text

STATE OF NEW YORK ________________________________________________________________________ 1434 2011-2012 Regular Sessions IN SENATE January 7, 2011 ___________
Introduced by Sen. SALAND -- 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 prohibiting accident and health insurers from offering incentives to health care providers to prescribe a specific drug or medical prod- uct THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 3217-b of the insurance law is amended by adding a new subsection (j) to read as follows: (J) NO INSURER SUBJECT TO THE PROVISIONS OF THIS ARTICLE SHALL, BY CONTRACT, WRITTEN POLICY OR PROCEDURE OR ANY OTHER AGREEMENT, PROVIDE PAYMENT OR ANY OTHER INCENTIVE TO A HEALTH CARE PROVIDER TO ISSUE OR CHANGE A PRESCRIPTION FOR A SPECIFIC DRUG OR MEDICAL PRODUCT. VIOLATIONS OF THIS SUBSECTION SHALL BE PUNISHABLE AS PROVIDED IN SECTION ONE HUNDRED NINE OF THIS CHAPTER. S 2. Section 4325 of the insurance law is amended by adding a new subsection (k) to read as follows: (K) NO INSURER SUBJECT TO THE PROVISIONS OF THIS ARTICLE SHALL, BY CONTRACT, WRITTEN POLICY OR PROCEDURE OR ANY OTHER AGREEMENT, PROVIDE PAYMENT OR ANY OTHER INCENTIVE TO A HEALTH CARE PROVIDER TO ISSUE OR CHANGE A PRESCRIPTION FOR A SPECIFIC DRUG OR MEDICAL PRODUCT. VIOLATIONS OF THIS SUBSECTION SHALL BE PUNISHABLE AS PROVIDED IN SECTION ONE HUNDRED NINE OF THIS CHAPTER. S 3. Section 4406-c of the public health law is amended by adding a new subdivision 5-e to read as follows: 5-E. NO HEALTH CARE PLAN SUBJECT TO THE PROVISIONS OF THIS ARTICLE SHALL, BY CONTRACT, WRITTEN POLICY OR PROCEDURE OR ANY OTHER AGREEMENT, PROVIDE PAYMENT OR ANY OTHER INCENTIVE TO A HEALTH CARE PROVIDER TO ISSUE OR CHANGE A PRESCRIPTION FOR A SPECIFIC DRUG OR MEDICAL PRODUCT. S 4. This act shall take effect on the ninetieth day after it shall have become a law.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Discuss!

blog comments powered by Disqus