Bill S5851-2013

Relates to the purchase of fertility drugs through mail order pharmacies

Relates to the purchase of fertility drugs through mail order pharmacies.

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  • Jan 8, 2014: REFERRED TO INSURANCE
  • Jun 18, 2013: REFERRED TO RULES

Memo

BILL NUMBER:S5851

TITLE OF BILL: An act to amend the insurance law, in relation to the purchase of fertility drugs through mail order pharmacies

PURPOSE: To clarify the terms and conditions expected of non-mail order retail pharmacies in relation to reimbursement for fertility drugs.

SUMMARY OF PROVISIONS:

Section one amends section 3216 of the Insurance Law providing that the terms and conditions of an agreement between an insurer and a non-mail order retail pharmacy shall not be inconsistent with the terms and conditions of agreements with network participating mail order pharmacies in 2009. The provisions include exceptions for new products entering the market place; updated manufacturer guidelines; or as required by state and federal law.

Section two amends section 3221 of the Insurance Law providing that the terms and conditions of an agreement between an insurer and a non-mail order retail pharmacy shall not be inconsistent with the terms and conditions of agreements with network participating mail order pharmacies in 2009. The provisions include exceptions for new products entering the market place; updated manufacturer guidelines; or as required by state and federal law.

Section three amends 4303 of the Insurance Law providing that the terms and conditions of an agreement between an insurer and a non-mail order retail pharmacy shall not be inconsistent with the terms and conditions of agreements with network participating mail order pharmacies in 2009. The provisions include exceptions for new products entering the market place; updated manufacturer guidelines; or as required by state and federal law.

Section four, effective date.

EXISTING LAW:

Sections 3216, 3221 and 4303 of the insurance law currently requires insurance plans to reimburse local pharmacies for the provision of fertility drugs in the same manner they do mail order pharmacies, provided the local pharmacy agrees in advance to the same reimbursement amount and the same terms and conditions the insurer has established for a network participating mail order pharmacy.

JUSTIFICATION: This bill amends provisions enacted in 2011, that require insurance plans to reimburse local pharmacies for the provision of fertility drugs in the same manner they do mail order pharmacies, to clarify that the terms and conditions that must be met by the non-mail order retail pharmacy are the terms and conditions that were in place prior to the enactment of Chapter 598.

LEGISLATIVE HISTORY: New Bill

FISCAL IMPLICATIONS: New Bill

LOCAL FISCAL IMPLICATIONS: None

EFFECTIVE DATE: Immediately


Text

STATE OF NEW YORK ________________________________________________________________________ 5851 2013-2014 Regular Sessions IN SENATE June 18, 2013 ___________
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 fertility drugs through mail order pharmacies THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Paragraph 13-a of subsection (i) of section 3216 of the insurance law, as amended by chapter 10 of the laws of 2012, is amended 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 network participating mail order or other non-retail pharmacy shall provide the same coverage for prescription fertility drugs when such drugs are purchased from a network participating non-mail order retail pharmacy provided that the network participating non-mail order retail pharmacy agrees in advance through a contractual network agreement, to the same reimbursement amount, [as well as the same applicable terms and conditions,] that the insurer has established for a network participat- ing mail order or other non-retail pharmacy. PROVIDED, HOWEVER, THAT THE TERMS AND CONDITIONS OF SUCH AGREEMENT SHALL NOT BE INCONSISTENT WITH THE TERMS AND CONDITIONS OF AGREEMENTS MADE BY THE INSURER WITH NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY PROVIDERS FOR THE FIVE YEAR PERIOD PRIOR TO THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF TWO THOUSAND THIRTEEN WHICH AMENDED THIS PARAGRAPH. THIS PARAGRAPH SHALL NOT BE CONSTRUED AS PROHIBITING THE UPDATING OF POLICIES AND PROCEDURES (A) AS THEY RELATE TO NEW PRODUCTS ENTERING THE MARKET THAT ARE DISTRIBUTED BY THE MAIL ORDER, OTHER NON-RETAIL, AND NON-MAIL ORDER RETAIL PHARMACIES, (B) AS NECESSARY TO COMPLY WITH UPDATED MANUFACTURER GUIDELINES, OR UPDATED MEDICAL GUIDELINES, OR (C) AS REQUIRED BY STATE OR FEDERAL LAW. In such case, the policy shall not impose any fee, co-payment, co-insurance, deductible or other condition
on any insured who elects to purchase prescription fertility drugs through a network participating non-mail order retail pharmacy that it does not impose on any insured who purchases prescription fertility drugs through a network participating mail order or other non-retail pharmacy. S 2. Subparagraph (D) of paragraph 6 of subsection (k) of section 3221 of the insurance law, as amended by chapter 10 of the laws of 2012, is amended 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 network participating mail order or other non-retail pharmacy shall provide the same coverage for prescription fertility drugs when such drugs are purchased from a network participating non-mail order retail pharmacy provided that the network participating non-mail order retail pharmacy agrees in advance through a contractual network agreement, to the same reimbursement amount, [as well as the same applicable terms and conditions,] that the insurer has established for a network participat- ing mail order or other non-retail pharmacy. PROVIDED, HOWEVER, THAT THE TERMS AND CONDITIONS OF SUCH AGREEMENT SHALL NOT BE INCONSISTENT WITH THE TERMS AND CONDITIONS OF AGREEMENTS MADE BY THE INSURER WITH NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY PROVIDERS FOR THE FIVE YEAR PERIOD PRIOR TO THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF TWO THOUSAND THIRTEEN WHICH AMENDED THIS SUBPARAGRAPH. THIS PARAGRAPH SHALL NOT BE CONSTRUED AS PROHIBITING THE UPDATING OF POLICIES AND PROCEDURES (I) AS THEY RELATE TO NEW PRODUCTS ENTERING THE MARKET THAT ARE DISTRIBUTED BY THE MAIL ORDER, OTHER NON-RETAIL, AND NON-MAIL ORDER RETAIL PHARMACIES, (II) AS NECESSARY TO COMPLY WITH UPDATED MANUFACTURER GUIDELINES, OR UPDATED MEDICAL GUIDELINES, OR (III) AS REQUIRED BY STATE OR FEDERAL LAW. In such case, the policy shall not impose any fee, co-payment, co-insurance, deductible or other condition on any covered person who elects to purchase prescription fertility drugs through a network participating non-mail order retail pharmacy that it does not impose on any covered person who purchases prescription fertility drugs through a network participating mail order or other non-retail pharmacy; provided, however, that the provisions of this section shall not supersede the terms of a collective bargaining agree- ment or apply to a policy that is the result of a collective bargaining agreement between an employer and a recognized or certified employee organization. S 3. Paragraph 4 of subsection (s) of section 4303 of the insurance law, as amended by chapter 10 of the laws of 2012, is amended to read as follows: (4) Every contract 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 network participat- ing mail order or other non-retail pharmacy shall provide the same coverage for prescription fertility drugs when such drugs are purchased from a network participating non-mail order retail pharmacy provided that the network participating non-mail order retail pharmacy agrees in advance, through a contractual network agreement, to the same reimburse- ment amount, [as well as the same applicable terms and conditions,] that the corporation has established for the network participating mail order or other non-retail pharmacy. PROVIDED, HOWEVER, THAT THE TERMS AND CONDITIONS OF SUCH AGREEMENT SHALL NOT BE INCONSISTENT WITH THE TERMS AND CONDITIONS OF AGREEMENTS MADE BY THE INSURER WITH NETWORK PARTIC-
IPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY PROVIDERS FOR THE FIVE YEAR PERIOD PRIOR TO THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF TWO THOUSAND THIRTEEN WHICH AMENDED THIS PARAGRAPH. THIS PARAGRAPH SHALL NOT BE CONSTRUED AS PROHIBITING THE UPDATING OF POLICIES AND PROCEDURES (A) AS THEY RELATE TO NEW PRODUCTS ENTERING THE MARKET THAT ARE DISTRIB- UTED BY THE MAIL ORDER, OTHER NON-RETAIL, AND NON-MAIL ORDER RETAIL PHARMACIES, (B) AS NECESSARY TO COMPLY WITH UPDATED MANUFACTURER GUIDE- LINES, OR UPDATED MEDICAL GUIDELINES, OR (C) AS REQUIRED BY STATE OR FEDERAL LAW. In such case, the contract shall not impose any fee, co-payment, co-insurance, deductible or other condition on any covered person who does not elect to purchase prescription fertility drugs through a network participating mail order or other non-retail pharmacy; provided, however, that the provisions of this section shall not super- sede the terms of a collective bargaining agreement or apply to a contract that is the result of a collective bargaining agreement between an employer and a recognized or certified employee organization. S 4. This act shall take effect immediately.

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