Assembly Bill A4131

2009-2010 Legislative Session

Relates to coverage for single source drugs

download bill text pdf

Sponsored By

Archive: Last Bill Status - In Assembly 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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2009-A4131 (ACTIVE) - Details

Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:
2011-2012: A4724
2013-2014: A6130
2015-2016: A4477
2017-2018: A5273
2019-2020: A4899
2021-2022: A5032
2023-2024: A4494

2009-A4131 (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".

2009-A4131 (ACTIVE) - Bill Text download pdf

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

                                  4131

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 30, 2009
                               ___________

Introduced  by M. of A. RAMOS -- Multi-Sponsored by -- M. of A. BENEDET-
  TO, COOK, DIAZ, FIELDS, GREENE, LAVINE, McENENY,  PHEFFER,  WEISENBERG
  -- read once and referred 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 26 to read as follows:
  (26) 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 15 to read as follows:
  (15) 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.
                                                           LBD07608-01-9
              

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