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

                                  8900

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 4, 2012
                               ___________

Introduced by M. of A. SILVER -- read once and referred 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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                      [ ] is old law to be omitted.
                                                           LBD10740-06-2

A. 8900                             2

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.