Senate Bill S695A

2015-2016 Legislative Session

Relates to coverage for single source drugs

download bill text pdf

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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Bill Amendments

co-Sponsors

2015-S695 - Details

Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:
2011-2012: S7180
2013-2014: S670
2017-2018: S1893

2015-S695 - Summary

Provides that every insurance policy which provides coverage for prescription drugs shall insure that there is continuous coverage of a single source drug that is part of a prescribed therapy until such prescribed therapy is no longer medically necessary for the enrollee of such policy; defines "single source drug".

2015-S695 - Sponsor Memo

2015-S695 - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                   695

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 7, 2015
                               ___________

Introduced  by  Sen.  AVELLA -- 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  coverage  for  single
  source 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 32 to read as follows:
  (32) EVERY INDIVIDUAL OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIV-
ERY  IN THIS STATE PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH THE
USE OF A DRUG FORMULARY SHALL INCLUDE A PROVISION WHICH, IN THE EVENT OF
A CHANGE TO SUCH FORMULARY, ALLOWS A COVERED  PERSON  WHO  IS  TAKING  A
SINGLE  SOURCE DRUG COVERED UNDER SUCH POLICY THAT IS NO LONGER INCLUDED
IN OR PREFERRED UNDER SUCH FORMULARY AND HAS FILED  A  GRIEVANCE  OR  AN
APPEAL  OF  THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER OR A STATE
OR FEDERAL AGENCY OR DESIGNEE OF  SUCH  AGENCY,  TO  CONTINUE  RECEIVING
COVERAGE  FOR  SUCH  DRUG  UNDER  THE SAME TERMS AND CONDITIONS AS WOULD
APPLY UNDER THE POLICY WERE SUCH DRUG STILL  INCLUDED  IN  OR  PREFERRED
UNDER THE FORMULARY, UNTIL A FINAL DECISION IS RENDERED ON THE APPEAL OR
GRIEVANCE. FOR THE PURPOSE OF THIS PARAGRAPH, "SINGLE SOURCE DRUG" MEANS
A BRANDNAME DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
  S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 20 to read as follows:
  (20) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN
THIS  STATE PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH THE USE OF
A DRUG FORMULARY SHALL INCLUDE A PROVISION WHICH,  IN  THE  EVENT  OF  A
CHANGE TO SUCH FORMULARY, ALLOWS A COVERED PERSON WHO IS TAKING A SINGLE
SOURCE  DRUG  COVERED UNDER SUCH POLICY THAT IS NO LONGER INCLUDED IN OR
PREFERRED UNDER SUCH FORMULARY AND HAS FILED A GRIEVANCE OR AN APPEAL OF
THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER OR A STATE OR  FEDERAL

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

co-Sponsors

2015-S695A (ACTIVE) - Details

Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:
2011-2012: S7180
2013-2014: S670
2017-2018: S1893

2015-S695A (ACTIVE) - Summary

Provides that every insurance policy which provides coverage for prescription drugs shall insure that there is continuous coverage of a single source drug that is part of a prescribed therapy until such prescribed therapy is no longer medically necessary for the enrollee of such policy; defines "single source drug".

2015-S695A (ACTIVE) - Sponsor Memo

2015-S695A (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 695--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 7, 2015
                               ___________

Introduced  by  Sens. AVELLA, LATIMER -- read twice and ordered printed,
  and when printed to be committed to  the  Committee  on  Insurance  --
  recommitted  to  the  Committee on Insurance in accordance with Senate
  Rule  6,  sec.  8  --  committee  discharged,  bill  amended,  ordered
  reprinted as amended and recommitted to said committee

AN  ACT  to  amend the insurance law, in relation to coverage for single
  source 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 33 to read as follows:
  (33) EVERY INDIVIDUAL OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIV-
ERY IN THIS STATE PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH  THE
USE OF A DRUG FORMULARY SHALL INCLUDE A PROVISION WHICH, IN THE EVENT OF
A  CHANGE  TO  SUCH  FORMULARY,  ALLOWS A COVERED PERSON WHO IS TAKING A
SINGLE SOURCE DRUG COVERED UNDER SUCH POLICY THAT IS NO LONGER  INCLUDED
IN  OR  PREFERRED  UNDER  SUCH FORMULARY AND HAS FILED A GRIEVANCE OR AN
APPEAL OF THE DENIAL OF ACCESS TO THE DRUG WITH THE INSURER OR  A  STATE
OR  FEDERAL  AGENCY  OR  DESIGNEE  OF SUCH AGENCY, TO CONTINUE RECEIVING
COVERAGE FOR SUCH DRUG UNDER THE SAME  TERMS  AND  CONDITIONS  AS  WOULD
APPLY  UNDER  THE  POLICY  WERE SUCH DRUG STILL INCLUDED IN OR PREFERRED
UNDER THE FORMULARY, UNTIL A FINAL DECISION IS RENDERED ON THE APPEAL OR
GRIEVANCE. FOR THE PURPOSE OF THIS PARAGRAPH, "SINGLE SOURCE DRUG" MEANS
A BRANDNAME DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
  S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 21 to read as follows:
  (21) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN
THIS STATE PROVIDING COVERAGE FOR PRESCRIPTION DRUGS THROUGH THE USE  OF
A  DRUG  FORMULARY  SHALL  INCLUDE  A PROVISION WHICH, IN THE EVENT OF A
CHANGE TO SUCH FORMULARY, ALLOWS A COVERED PERSON WHO IS TAKING A SINGLE

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

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