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

A. 4131                             2

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  FORMU-
LARY, 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 3. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (ff) to read as follows:
  (FF)  EVERY  CONTRACT  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  CONTRACT  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 CORPORATION OR  ORGAN-
IZATION  CERTIFIED  PURSUANT  TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
LAW 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  CONTRACT  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 SUBSECTION, "SINGLE  SOURCE
DRUG" MEANS A BRANDNAME DRUG FOR WHICH THERE IS NO GENERIC EQUIVALENT.
  S  4.  This  act  shall take effect on the first of the calendar month
next succeeding the sixtieth day after  it  shall  have  become  a  law;
provided,  however,  that  this  act  shall  apply  only to policies and
contracts issued, renewed or amended on or after such effective date.