NY State Senate Bill 2011-S7180

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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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 01, 2012	referred to insurance

2011-S7180 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2013-2014: S670
2015-2016: S695
2017-2018: S1893

2011-S7180 (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".

2011-S7180 (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S7180

TITLE OF BILL:
An act
to amend the insurance law, in relation to coverage for
single source drugs

PURPOSE OR GENERAL IDEA OF THE BILL:
The purpose of this legislation
is to require continued coverage of a prescription drug if a patient
was on such drug prior to a policy change.

SUMMARY OF PROVISIONS:
Section 1 of the bill amends the adds a new paragraph 29 to subsection
(l) of § 3216 of the insurance law to require continued coverage of a
prescription drug if such drug was previously covered under an
individual's insurance plan and no generic equivalent is available.

Section 2 of the bill adds a new paragraph 18 to subsection (k) of
§ 3221 of the insurance law requiring each group policy to continue
coverage of a prescription drug during a grievance or an appeal when
a policy removes a prescription from the formulary while patient was
taking such drug as part of a prescribed therapy.

Section 3 of the bill adds a new subsection bb to § 4303 of the
insurance law requiring contracts issued by a health service

corporation or a medical expense indemnity corporation to continue
coverage of a prescription drug during a grievance or an appeal when
a policy removes a prescription from the formulary while the patient
was taking such drug as part of a prescribed therapy.

Section 4 sets forth an effective date of the first day of the
calendar month next succeeding the sixtieth day after it shall have
become a law but shall apply only to policies and contracts issued,
renewed or amended on or after the effective date of this act.

JUSTIFICATION:
This legislation was modeled after a 1998 law in California. This bill
would require an insurance plan to continue their coverage of
prescription medication for patients currently taking the medication
when no generic equivalent is available.

When a patient is on a prescribed therapy it is very important for the
patient to maintain that therapy to the end. When a drug is dropped
from a plan, the consequences can be dire and/or costly for the
patients that are in various stages of therapy with that drug. If the
patient were to maintain the prescribed therapy, the out of pocket
cost to the patient could be so exorbitant that the patient would
eventually stop taking the prescription prior to the completion of
the therapy.

In another circumstance, the patient may be forced to change to a
similar brand name drug - that is covered under the plan- in the
midst of the prescribed therapy. That new drug may not be as suitable
or may cause adverse reactions. The new drug may not react well with


other medication that the patient is taking. Also, the new drug may
not achieve the desired effect that the other drug accomplished.

The physician should have the final say in which prescription a
patient takes. Although one drug may seem to have the same effect as
another, it may not be as compatible with other medications a patient
is taking or, one drug may be more effective under certain
conditions. In any event, health care cannot be directed by the
bottom dollar in every instance. When a patient's well being is
affected, policy must be changed for the betterment of the patient.

LEGISLATIVE HISTORY:
Senate:   New Bill
Assembly: A.9448 of 1999/2000, A.1912 of 2001/2002
A.4191 of 2009/2010

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect on the first day of the calendar month next
succeeding the sixtieth day after it shall have become a law but
shall apply only to policies and contracts issued, renewed or amended
on or after the effective date of this act.

2011-S7180 (ACTIVE) - Bill Text download pdf

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

                                  7180

                            I N  S E N A T E

                               May 1, 2012
                               ___________

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 29 to read as follows:
  (29) 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 18 to read as follows:
  (18) 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
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

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

                                                           LBD08466-02-2

S. 7180                             2

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 (ii) to read as follows:
  (II) 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.

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Senate Bill S7180

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

2011-S7180 (ACTIVE) - Details

2011-S7180 (ACTIVE) - Summary

2011-S7180 (ACTIVE) - Sponsor Memo

2011-S7180 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S7180

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Sponsored By

Tony Avella

Archive: Last Bill Status - In Senate Committee Insurance Committee

2011-S7180 (ACTIVE) - Details

2011-S7180 (ACTIVE) - Summary

2011-S7180 (ACTIVE) - Sponsor Memo

2011-S7180 (ACTIVE) - Bill Text download pdf

Comments