Bill S5799-2011

Requires insurance coverage for prescription fertility drugs purchased at non-mail order pharmacies to be the same as for prescription fertility drugs purchased at mail order pharmacies

Requires insurance coverage for prescription fertility drugs purchased at non-mail order pharmacies to be the same as for prescription fertility drugs purchased at mail order pharmacies.

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  • Jun 21, 2011: SUBSTITUTED BY A7779
  • Jun 21, 2011: ORDERED TO THIRD READING CAL.1489
  • Jun 16, 2011: REFERRED TO RULES

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BILL NUMBER:S5799

TITLE OF BILL: An act to amend the insurance law, in relation to the purchase of prescription drugs

PURPOSE OR GENERAL IDEA OF BILL: The purpose of this bill is to ensure that fertility drugs may be purchased locally without additional financial burden to the insured person.

SUMMARY OF SPECIFIC PROVISIONS: This bill would amend the insurance law with respect to HMOs, and individual, group and not-for-profit insurance policies by requiring all policies that provide coverage for fertility drugs and require or permit a mail order pharmacy benefit to cover prescription fertility drugs purchased at a non-mail order pharmacy without any additional cost sharing to the covered individual.

JUSTIFICATION: In an effort to streamline the delivery of prescription drugs while maintaining the affordability of coverage, many health insurance policies require or incentivize the use of a mail order pharmacy. Nevertheless, the effectiveness of many fertility drugs relies on a strict treatment regimen that is often difficult or impossible to maintain when using a mail order pharmacy. Shipping and processing delays may impair these drugs' ability to produce the desired effect at a cost to both insureds and insurance companies themselves. This bill would ensure that individuals with prescription drug coverage have an equal opportunity to purchase fertility drugs from either a mail order or non-mail order pharmacy.

PRIOR LEGISLATIVE HISTORY: New Bill.

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: None.

EFFECTIVE DATE: Thirty days following enactment and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such effective date.


Text

STATE OF NEW YORK ________________________________________________________________________ 5799 2011-2012 Regular Sessions IN SENATE June 16, 2011 ___________
Introduced by Sen. SKELOS -- read twice and ordered printed, and when printed to be committed to the Committee on Rules 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: Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 13-a to read as follows: (13-A) EVERY POLICY THAT PROVIDES COVERAGE FOR PRESCRIPTION FERTILITY DRUGS AND REQUIRES OR PERMITS PRESCRIPTION DRUGS TO BE PURCHASED THROUGH A MAIL ORDER PHARMACY SHALL PROVIDE THE SAME COVERAGE FOR PRESCRIPTION FERTILITY DRUGS WHEN SUCH DRUGS ARE PURCHASED FROM A PHARMACY THAT IS NOT A MAIL ORDER PHARMACY. SUCH POLICY SHALL NOT IMPOSE ANY ADDITIONAL FEE, CO-PAYMENT, CO-INSURANCE, DEDUCTIBLE OR OTHER CONDITION ON ANY INSURED WHO DOES NOT ELECT TO PURCHASE PRESCRIPTION FERTILITY DRUGS THROUGH A MAIL ORDER PHARMACY. S 2. Paragraph 6 of subsection (k) of section 3221 of the insurance law is amended by adding a new subparagraph (D) to read as follows: (D) EVERY POLICY THAT PROVIDES COVERAGE FOR PRESCRIPTION FERTILITY DRUGS AND REQUIRES OR PERMITS PRESCRIPTION DRUGS TO BE PURCHASED THROUGH A MAIL ORDER PHARMACY SHALL PROVIDE THE SAME COVERAGE FOR PRESCRIPTION FERTILITY DRUGS WHEN SUCH DRUGS ARE PURCHASED FROM A PHARMACY THAT IS NOT A MAIL ORDER PHARMACY. SUCH POLICY SHALL NOT IMPOSE ANY ADDITIONAL FEE, CO-PAYMENT, CO-INSURANCE, DEDUCTIBLE OR OTHER CONDITION ON ANY COVERED PERSON WHO DOES NOT ELECT TO PURCHASE PRESCRIPTION FERTILITY DRUGS THROUGH A MAIL ORDER PHARMACY. S 3. Subsection (s) of section 4303 of the insurance law, as amended by section 2 of part K of chapter 82 of the laws of 2002, is amended by adding a new paragraph 4 to read as follows: (4) EVERY POLICY ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION, A HOSPITAL SERVICE CORPORATION OR A HEALTH SERVICES CORPORATION THAT
PROVIDES COVERAGE FOR PRESCRIPTION FERTILITY DRUGS AND REQUIRES OR PERMITS PRESCRIPTION DRUGS TO BE PURCHASED THROUGH A MAIL ORDER PHARMACY SHALL PROVIDE THE SAME COVERAGE FOR PRESCRIPTION FERTILITY DRUGS WHEN SUCH DRUGS ARE PURCHASED FROM A PHARMACY THAT IS NOT A MAIL ORDER PHAR- MACY. SUCH POLICY SHALL NOT IMPOSE ANY ADDITIONAL FEE, CO-PAYMENT, CO-INSURANCE, DEDUCTIBLE OR OTHER CONDITION ON ANY COVERED PERSON WHO DOES NOT ELECT TO PURCHASE PRESCRIPTION FERTILITY DRUGS THROUGH A MAIL ORDER PHARMACY. S 4. If any clause, subparagraph, subsection, section or other part of this act, or the application thereof be held to be invalid, such holding shall not affect, impair or invalidate the remainder of this act, or the application of such section or part of a section held inval- id. S 5. This act shall take effect on the thirtieth day after it shall have become a law and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such effective date.

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