Bill S6126-2011

Relates to the purchase of prescription drugs

Enacts chapter amendment to Chapter 598 of 2011 relating to the purchase of prescription drugs through a network participating non-mail order retail pharmacy.

Details

Actions

  • Feb 6, 2012: SUBSTITUTED BY A8900
  • Jan 9, 2012: ORDERED TO THIRD READING CAL.18
  • Jan 9, 2012: REPORTED AND COMMITTED TO RULES
  • Jan 4, 2012: REFERRED TO INSURANCE

Votes

VOTE: COMMITTEE VOTE: - Rules - Jan 9, 2012
Ayes (22): Skelos, Alesi, Farley, Hannon, Johnson, Larkin, LaValle, Libous, Marcellino, Maziarz, Nozzolio, Saland, Seward, Sampson, Breslin, Dilan, Hassell-Thompson, Krueger, Montgomery, Perkins, Smith, Stewart-Cousins
Ayes W/R (1): Parker
Nays (1): Duane

Memo

BILL NUMBER:S6126

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

PURPOSE: The purpose of this bill is to make clarifying changes to Chapter 598 of the Laws of 2011 to ensure proper implementation of the intent of the law.

SUMMARY OF PROVISIONS: This bill would clarify the provisions of Chapter 598 of the Laws of 2011 to require that insurance policies that provide coverage for prescription fertility drugs purchased through a network participating mail order or non-retail specialty pharmacy shall provide the same coverage when such drugs are purchased from a network participating non-mail order retail pharmacy. The bill would further require that prior to such coverage by the insurer, the network participating non-mail order retail pharmacy must accept the reimbursement rate and other contractual terms and conditions as the insurer has established for network participating mail order or non-retail specialty pharmacies.

The bill would also make conforming changes within sections 3216, 3221 and 4303 of the Insurance Law that are necessary for the implementation of these provisions as well as other minor technical modifications to ensure consistency with existing law.

JUSTIFICATION: The Legislature's intent in enacting Chapter 598 of the Laws of 2011 was to ensure that consumers with insurance policies that provide coverage for prescription fertility drugs are afforded a choice in the manner in which they make their prescription drug purchases. This bill would make clearer, the provisions of Chapter 598 and facilitate its implementation by the affected parties.

LEGISLATIVE HISTORY: This is a new bill.

FISCAL IMPLICATIONS: None.

LOCAL FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This act shall take effect on the same date and in the same manner as Chapter 598 of the Laws of 2011.


Text

STATE OF NEW YORK ________________________________________________________________________ 6126 IN SENATE (PREFILED) January 4, 2012 ___________
Introduced by Sen. SKELOS -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance 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. Paragraph 13-a of subsection (i) of section 3216 of the insurance law, as added by Chapter 598 of the laws of 2011, 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 [that is not a mail order 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 ESTAB- LISHED FOR A NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHAR- MACY. [Such] IN SUCH CASE, THE policy shall not impose any [additional] fee, co-payment, co-insurance, deductible or other condition on any insured who [does not elect] ELECTS to purchase prescription fertility drugs through a [mail order] 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 added by Chapter 598 of the laws of 2011, 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 [that is not a mail order 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 ESTAB- LISHED FOR A NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHAR- MACY. [Such] IN SUCH CASE, THE policy shall not impose any [additional] fee, co-payment, co-insurance, deductible or other condition on any covered person who [does not elect] ELECTS to purchase prescription fertility drugs through a [mail order] 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 AGREEMENT 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 added by Chapter 598 of the laws of 2011, is amended to read as follows: (4) Every [policy] CONTRACT issued by a medical expense indemnity corporation, a hospital service corporation or a health services corpo- ration 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 [that is not a mail order pharmacy] PROVIDED THAT THE NETWORK PARTIC- IPATING 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 CORPORATION HAS ESTABLISHED FOR THE NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY. [Such policy] IN SUCH CASE, THE CONTRACT shall not impose any [additional] fee, co-payment, co-insurance, deductible or other condi- tion 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 SUPERSEDE THE TERMS OF A COLLECTIVE BARGAINING AGREE- MENT OR APPLY TO A CONTRACT THAT IS THE RESULT OF A COLLECTIVE BARGAIN- ING AGREEMENT BETWEEN AN EMPLOYER AND A RECOGNIZED OR CERTIFIED EMPLOYEE ORGANIZATION. S 4. This act shall take effect on the same date and in the same manner as section 5 of chapter 598 of the laws of 2011, takes effect.

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