S T A T E   O F   N E W   Y O R K
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                                  6130

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                             March 15, 2013
                               ___________

Introduced  by M. of A. RAMOS -- 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 30 to read as follows:
  (30) 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 19 to read as follows:
  (19) 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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03404-01-3
              

A. 6130                             2

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 (jj) to read as follows:
  (JJ)  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.